Training Pathways

Careers in Emergency Medicine offer excitement, variety, challenge and reward. Doctors and practitioners working in Emergency Medicine use their clinical skills and experience to recognise and treat the full spectrum of emergencies in patients of all ages. Take a look at our resources below to support your career pathway decision. We also have a range of upcoming study days and events you can attend or watch our On-Demand video events if you want to get instant insights such as how to manage the transition from trainee to consultant. Doctors and practitioners working in Emergency Medicine use their clinical skills and experience to recognise and treat the full spectrum of emergencies in patients of all ages. Being the first clinician to see a patient who is seriously ill or injured, gathering information and thinking on your feet is what working in Emergency Medicine is all about. You will use your core clinical skills to rapidly assess patients, work out what’s going on, and make quick decisions about what to do. You will learn through training and experience how to deal with anything that comes your way. In the midst of a stressful or uncertain situation, you will remain calm whilst providing emergency treatment, reassurance and pain relief. You will see patients at their sickest and they will improve in front of you as a result of your care. You will be part of a team of doctors, specialist nurses, practitioners and support staff focused on providing emergency care. Senior clinicians will work alongside you, providing training and support as you assess and manage patients together. Working in the Emergency Department, at the centre of the acute hospital, Emergency Physicians work closely with other specialties to coordinate the initial phase of the patient’s journey. You will also be in regular contact with the emergency services, and you will work with allied health professionals and social care to provide a holistic approach to your patients’ needs. The Emergency Department is open 24 hours a day, 365 days a year. It is where the public know to come if they need medical help. Every day you will interact with many different patients, relatives, carers, and other members of the public. You never know what might come through the door. You will deal with everything from major trauma to social and psychiatric emergencies. One minute you might be reducing a dislocated shoulder, the next assessing a sick child. The breadth of clinical practice in Emergency Medicine means there is plenty of variety and the opportunity to specialise or focus on the aspects that you find most interesting. Perhaps you have already decided that this exciting, varied and dynamic specialty is for you! Or maybe you are interested in finding out more. Whether you are fully committed or still undecided, there is plenty of information here to help make up your mind. The Recruitment and Careers Committee is proud to launch the RCEM Careers Strategy. This is a focused and forward-looking plan to better support doctors and practitioners at every stage of their emergency medicine journey. To make our approach clearer and more impactful, we’ve structured the strategy around distinct stakeholder groups, reflecting the different routes and career stages including: Medical Students, Foundation Doctors, Core and Higher Trainees, EMSAS Doctors, Consultants, and Advanced Clinical Practitioners. By recognising the unique needs, motivations and challenges of each group, this strategy sets out tailored messaging and targeted communication opportunities. It highlights the key moments along the career pathway where timely support and engagement can make the greatest difference, ensuring we connect with the right people, in the right way, at the right time. The Emergency Department is a great place to get experience, finely tune your clinical skills, and learn how to recognise the critically unwell patient. It’s never too early to explore Emergency Medicine as a career. Spend as much time as possible in the Emergency Department, gaining experience in this environment. Many medical schools offer optional Emergency Medicine special study modules based in the department, which will give you an even better opportunity to see what it’s like. The College run annual Careers events, either face to face or virtually, aimed at providing a real insight into life as an Emergency Physician. You will hear first hand accounts from doctors and practitioners at various different points in their careers. If you are looking for the inside story, plenty of information, and all of your questions answered then you’ve come to the right place! As a student you can become an Associate Member of the College. This gives you access to the latest information and advice on training, and a wealth of educational resources such as e-learning modules and up to date guidelines, together with reduced price entry to College conferences and events. Student Membership is £20 per year. Become a member Many universities have student societies of Emergency Medicine, or societies focused on one of the main areas of our practice, such as Trauma. This is a great way to find out more about Emergency Medicine knowledge and skills and to speak to other people considering it as a career. Why not find out what is available locally? RCEM Careers welcomes applications from Student Societies wishing to be affiliated with the College. Societies have to be officially registered with their university or medical school, and application for affiliation need to be supported by a local RCEM Fellow. Where no such relationship exists, RCEM would approach regional Chairs to ask for a volunteer Fellow to make contact. There are many benefits to being affiliated including support and links with RCEM and local Emergency Medicine faculty. Affiliated Societies can also apply for sponsorship for events that foster interest and learning in Emergency Medicine at your University. Please see our Affiliation Guidance for further information. Applications for both Affiliation and Sponsorship can be submitted to careers@rcem.ac.uk. There are plenty of ways to get more experience. An elective in an Emergency Department at home or abroad would help to broaden your experience and demonstrate your commitment to the specialty. It’s useful to see how practice changes in different settings with their own unique challenges and there is always something new to learn. Build on your emergency medicine knowledge by making the most of online resources. A great way to do this is to base your learning around cases you have seen. Much of what you learn will be useful in day to day practice. Consider volunteering on a local first aid or life support course – this is a great way to get experience in resuscitation skills and the care of the seriously ill or injured patient. As you prepare for Foundation Training, make sure you apply for a rotation that includes four months spent in an Emergency Department in your F2 year, and use your taster week in F1 if you can. Let your supervisor know early on that you are considering Emergency Medicine as a career and they can help to make sure you make the most of your time. Emergency Departments provide plenty of opportunity for short audit or quality improvement projects for those who are enthusiastic, another great way to get involved and begin to build your portfolio. Your local Emergency Department could be a good place to start – let them know you are interested and see if there are any other opportunities to be involved. Find out more about training on this page. Training in Emergency Medicine puts you at the frontline of medical care and enables you to develop the knowledge and skills you need to manage the breadth of acute presentations. During your training you will gain valuable experience working with a number of multidisciplinary teams in Emergency Medicine and other acute specialties. You will develop a wide range of clinical skills and competencies that you can put into action when needed. You will work alongside senior clinicians who will train you “on the job” and you will attend local teaching and regional training days. As you progress further through training you will be supported to develop leadership and managerial skills, such as coordinating patient care across the department and supervising more junior colleagues. You will be encouraged to develop sub-specialty interests such as Paediatric Emergency Medicine, and given the opportunity to take time out of program to gain additional experience that will complement your training. This could involve anything from academic research, developing your skills as a clinical educator, or practising Humanitarian Medicine abroad. Finally you will need to pass the fellowship exam (FRCEM) before the end of specialty training, when you will be awarded a CCT (Certificate of Completion of Training), which means you will be eligible to apply for a Consultant post in the UK. Many doctors’ first experience of working in Emergency Medicine is a four month post during foundation training. This provides a good opportunity to get a feel for working in an Emergency Department, and start learning how to assess patients and make decisions with close supervision. From here, the standard training pathway involves the Acute Care Common Stem (ACCS) (ST1-ST3), followed by Higher Specialist Training (ST4-ST6), taking a minimum of 6 years. This can easily be extended by out of programme time, sub-specialty training, or if you wish to work part time. Applicants can opt for “run-through training” which avoids the need for re-application after the first three years, subject to satisfactory progress. An alternative route into training is provided by the DRE-EM (Defined Route of Entry into Emergency Medicine) programme. This is designed for doctors who have already gained additional experience in Emergency Medicine or other specialties, with entry at ST3 level. These training pathways are described in more detail below. Of course, a career in Emergency Medicine is flexible, and many doctors follow a career path that includes time spent out of training or one that follows a different route altogether. The EM Careers Pathways Map provides an overview of career paths and the links between them: Most trainees will start with the ACCS core training programme. During the first two years, trainees rotate through six month posts in Emergency Medicine, Acute Medicine, Intensive Care Medicine, and Anaesthetics. This broad experience in acute specialties equips you with the confidence and skills to manage the full spectrum of acutely ill and injured patients. The third year is focused on gaining further experience in Emergency Medicine, and spending six months training in Paediatric Emergency Medicine, in preparation for Higher Specialist Training. As you progress through training you will build an e-portfolio of your learning and achievements, supported by your educational and clinical supervisors. Your e-portfolio enables you to demonstrate increasing levels of competency and will be reviewed regularly to ensure you are on track with your training. Prior to entering higher training at ST4 level you also have to successfully complete the FRCEM Intermediate exams, which are based on the competencies you have been working towards during the ACCS programme. Applying for Specialty TrainingPerson Specification for ACCS ApplicationCurrent recruitment timeline As a senior trainee, you will spend your time working in the Emergency Department, consolidating and finely tuning your clinical skills. You will put them to good use, delivering care to the most seriously unwell or injured patients as resuscitation or trauma team leader. You will feel confident to approach any clinical scenario. You will learn how to safely supervise more junior members of the team, and work with the consultant to coordinate care on the shop-floor and provide senior review. At other times you will be the most senior doctor in the department with on-call consultant support. At other times you will be the most senior doctor in the department with on-call consultant support. You will learn more about leading and managing the emergency care system, with dedicated leadership training and a management portfolio that you will build up through supported experience. You will work towards completing your final FRCEM exams, which bring together all of the knowledge, skills, competencies and expertise you have learnt during training, and are used to putting into action in your daily practice. The DRE-EM programme provides an alternative pathway into specialty training for those with prior experience of EM and other acute specialties, or those who have completed basic surgical training. It also provides a method of switching from other ACCS programmes. DRE-EM takes into account this prior experience and provides an opportunity to enter training at ST3 level. The programme is tailored to individual training needs, with a variable amount of time spent at ST3, enabling the trainee to gain any missing competencies or experience prior to entering Higher Specialist Training at ST4. More information about DRE-EM and eligibility criteria can be found in the Exams & Training section of the College website. DRE-EM EligibilityPerson Specification for DRE-EM ApplicationCurrent recruitment information The broad base of Emergency Medicine means that there is huge scope to develop a specialist interest in almost anything you can think of. Well recognised sub specialties and niche personal interests happily co-exist. There are two recognised sub-specialties, Paediatric EM and Pre-Hospital EM, and trainees can also dual-accredit in Intensive Care Medicine. These sub-specialty options lead to recognised accreditation with the GMC. Trainees competitively apply for these posts during Higher Specialist Training. The Portfolio Pathway offers a supportive and flexible alternative route to joining the Specialist Register for Emergency Medicine. It’s designed to help applicants showcase the knowledge, skills, and experience (KSEs) needed for practice in Emergency Medicine, using both the Emergency Medicine (EM) Curriculum and the Specialty Specific Guidance (SSG) as helpful guides throughout the process. When preparing an application, it’s important that the evidence you provide clearly links to the competencies set out in these documents—and that it reflects your recent practice. As a general rule, evidence from the last six years of whole time equivalent (WTE) experience—which doesn’t need to be consecutive—is ideal, as it demonstrates that your skills have been kept current. Overall, the Portfolio Pathway offers a more personalised and accommodating way to demonstrate your capability, while still ensuring you meet the standards required for specialist registration. Read more: Certificate of Eligibility for Specialist Registration (CESR) and Combined Programme (CESR-CP) The workforce of Emergency Departments in the UK is often augmented by overseas recruitment of International Medical Graduates (IMGs). Many of these doctors will taking up their first post in the NHS and will benefit from the variety and experience Emergency Medicine has to offer in a supported environment. Some may be more senior and will be transferring their specialist qualifications to the UK. It is important to ensure that all of these colleagues are welcomed as part of the EM family. A proportion of these doctors will choose to continue a career in Emergency Medicine, either via completion of a CREST form and entry into specialist training, or via the specialty doctor route. More senior IMGs may benefit from support with the CESR process. The College should provide information and support to these individuals and their supervisors. Resources from EDs with experience in running successful IMG programmes could be shared. Find out more: Supporting Overseas Doctors (IMGs) on RCEMLearning Emergency Medicine is a young, forward thinking and progressive specialty. Equity, Diversity and Inclusion (EDI) is a core value of the College, which is actively focused on promoting diversity and addressing discrimination and inequality through its EDI Committee and its Women in Emergency Medicine Special Interest Group. One of the greatest strengths of the EM workforce is its diversity and the way which this reflects the wider population. The nature of specialty is that we work with the full spectrum of society, and a diverse workforce enriches our specialty with broader knowledge and understanding of our patients, and enhances the service we are able to provide. The opportunity to work alongside a diverse group of people who each bring something different to the team is an attractive feature of a career in our specialty. It is important that RCEM Careers considers how best to provide information and support to colleagues from all backgrounds, in particular those who might need additional support and advice with the application process. Diverse representation in our communications and careers materials is an important part of ensuring everyone is welcomed and included. Promoting the range of flexible career options on offer attracts a wide range of individuals who may be looking for a bespoke for a variety of reasons. Those with specific health needs or with a disability may need reasonable adjustments to their work environment or working patterns, but can be supported to work to the full scope of their potential by their EM colleagues. Find out more: Equity, Diversity and Inclusion in RCEM RCEMLearning induction programme: These modules cover essential topics and provide a structured approach to learning, ensuring that trainees receive a comprehensive understanding of both adult and paediatric emergency medicine. This online resource will enrich the training programme and enhance the learning experience for trainees. Learn More About a Career In Emergency Medicine Creative Careers in Emergency Medicine Part 1 – Career LongevityCreative Careers in Emergency Medicine Part 2 – Slowing Down to Think“You are brave!” Starting a life-long career in emergency medicine Address Royal College of Emergency Medicine, Octavia House, 54 Ayres Street, London, SE1 1EU. Equity & Diversity Comments, Compliments, Complaints General Data Protection Regulations and our Privacy Policy RCEMLearning Get help or ask a question