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ACCS Training – An overview


ACCS (Acute Common Care Stem) is the programme that forms the first two years of training for Emergency Medicine. 

It can also be undertaken by those wishing to enter Acute Medicine, Anaesthesia or Intensive Care Medicine: these specialties differ slightly, however, in that there is also an alternative, specialty-specific training programme.  ACCS represents a single point of entry for Emergency Medicine trainees.  The information below is generic, however there may be some deanery-specific variations and each deanery has an ACCS lead who can be contacted for further advice.

There is an ACCS website - see

Training programme

Each ACCS trainee has placements in the following:

-     Core Trainee Year 1 (CT1)

      6 months of Emergency Medicine, 6 months of Acute Medicine

-     Core Trainee Year 2 (CT2)

      1 year of Anaesthesia and Intensive Care Medicine

Trainees are required to complete a portfolio to record completion of competencies, including:

-      Work-based assessments (see below)

-      Clinical log book

-      Record of educational activities

-      Record of management activities

-      Record of audit and clinical governance activities

-      Record of continuing professional development activities

-      Record of supervisor meetings

-      Record of personal development plan


An electronic portfolio has been created for Royal College of Emergency Medicine ACCS trainees and trainees are required to become members of the College before they register for an ePortfolio.  This is similar to the portfolio used by Foundation trainees.  A paper record is also required to supplement this.

Work-based assessments

The following assessment tools are used for the ACCS programme:

Mini clinical evaluation exercise (mini-CEX) involves direct observation of a trainee’s clinical skills during an every-day clinical encounter.

Case-based discussion (CbD) is a formal discussion reflecting on a case seen by a trainee, usually centred around the notes.  The aim is to bring out the key messages of the case and the trainee’s understanding.  A CbD can be done for case presentations given by trainees as well.

Directly observed procedural skills (DOPS) are used to evaluate the trainee’s ability to complete specific procedures.

Multi-source feedback (MSF) is a 360-degree assessment where anonymous colleagues rate a trainee in different skill areas, including communication skills, professional attitudes and behaviours.

Acute care assessment tool (ACAT) is used in medical specialties to grade trainees on their clinical assessment, record-keeping and handover, usually during an acute take. 

The table below summarises the minimum requirements in terms of work-based assessments for ACCS trainees.  Individual deaneries may have specific additional requirements.  There is also a list of 20 presentations and 4 resuscitation cases in the Acute Medicine curriculum (see ACCS website) that must be covered by the work-based assessments or the logbook. 





Acute Medicine

Emergency Medicine


Intensive Care Medicine

















6 (ideally 12)





At least one per year, preferably one per rotation


Where next?

Following successful completion of ACCS training, trainees progress to ST3 (specialist training year 3).  The ST3 year consists of 6 months of Paediatric Emergency Medicine and 6 months of general EM (often focussing on Musculoskeletal competencies).  Trainees are then required to apply for continued specialist training.  ST4-6 years are spent furthering clinical, academic and managerial abilities in emergency medicine.  There is some scope for placements outside the ED for those with a subspecialist interest and this needs to be discussed with trainers and the deanery as early as possible.

Trainees who wish to sub-specialise in Paediatric EM, Intensive Care, Acute Medicine, Pre-Hospital Care, Sports Medicine or Wilderness Medicine are advised to make arrangements as early as possible.  There is a separate section on the EMTA website with further advice regarding subspecialty training. 


Exams and other training requirements

This is a brief summary, as all of the details regarding examinations are on the main CEM website. 

The MCEM (Membership of the Royal College of Emergency Medicine) examination is required for entry into ST4 training.  There are 3 parts, A (a multi-choice, theory-based paper), B (a written, short-answer question paper) and C  (a structured clinical examination).  Completion of part A is required for entry into ST3.

The FCEM (Fellowship of the Royal College of Emergency Medicine) examination is required for CCT.

In addition, trainees must have successfully completed ALS (Advanced Life Support), APLS (Advanced Paediatric Life Support) and ATLS (Advanced Trauma Life Support) before entry into ST4.