Training Pathways

About the role

Emergency Medicine offers excitement, variety, challenge, and reward. Doctors and practitioners in this field use their clinical skills and experience to recognize and treat the full spectrum of emergencies in patients of all ages. As the first clinician to see seriously ill or injured patients, you will gather information, think on your feet, and make rapid decisions about patient care.

You will use core clinical skills to assess patients quickly, determine their condition, and decide on immediate treatment. Through training and experience, you will learn to handle any emergency that comes your way, remaining calm under pressure while providing treatment, reassurance, and pain relief. You will witness patients improve as a direct result of your care.

Emergency Medicine involves working as part of a multidisciplinary team, including doctors, specialist nurses, practitioners, and support staff. Senior clinicians will provide training and support as you assess and manage patients together. The Emergency Department operates 24/7, serving as the central hub for acute care in the hospital, where you will collaborate closely with other specialties to coordinate the initial phase of a patient’s journey.

You will interact with emergency services, allied health professionals, and social care to provide a holistic approach to patient needs. The role offers immense variety—from major trauma to social and psychiatric emergencies—ensuring no two days are the same. You might reduce a dislocated shoulder one minute and assess a sick child the next. The breadth of clinical practice allows you to specialize or focus on areas that interest you most.

Career Pathways and Support

The Royal College of Emergency Medicine (RCEM) has launched a Careers Strategy to support doctors and practitioners at every stage of their emergency medicine journey. The strategy is structured around distinct stakeholder groups, including:

• Medical Students
• Foundation Doctors
• Core and Higher Trainees
• EMSAS Doctors
• Consultants
• Advanced Clinical Practitioners

This tailored approach ensures targeted messaging and support at key moments in the career pathway, connecting with individuals at the right time and in the right way.

Opportunities for Medical Students

The Emergency Department is an excellent place to gain experience, refine clinical skills, and learn to recognize critically unwell patients. Medical students are encouraged to spend time in the Emergency Department, and many medical schools offer optional Emergency Medicine special study modules. The College hosts annual careers events, both in-person and virtual, providing insights into life as an Emergency Physician through firsthand accounts from doctors at various career stages.

Students can become Associate Members of the College for £20 per year, gaining access to training advice, educational resources (e.g., e-learning modules, guidelines), and reduced-price entry to College conferences and events. Many universities also have student societies focused on Emergency Medicine or related fields, offering opportunities to network and learn. RCEM welcomes applications from student societies for affiliation, which includes benefits such as support from local Emergency Medicine faculty and sponsorship for events.

Additional ways to gain experience include:

• Completing an elective in an Emergency Department (domestic or international) to broaden experience and demonstrate commitment.
• Volunteering on local first aid or life support courses to develop resuscitation skills.
• Applying for a foundation training rotation that includes four months in an Emergency Department during the F2 year.
• Using taster weeks in F1 to explore the specialty.
• Engaging in short audit or quality improvement projects in the Emergency Department to build your portfolio.

Training in Emergency Medicine

Training in Emergency Medicine places you at the frontline of medical care, equipping you with the knowledge and skills to manage a wide range of acute presentations. During training, you will work with multidisciplinary teams in Emergency Medicine and other acute specialties, developing clinical skills and competencies for real-world application.

You will train alongside senior clinicians, attend local teaching sessions, and participate in regional training days. As you progress, you will develop leadership and managerial skills, such as coordinating patient care and supervising junior colleagues. Opportunities to pursue sub-specialty interests (e.g., Paediatric Emergency Medicine) or take time out of the program for academic research, clinical education, or humanitarian work are also available.

To complete specialty training, you must pass the Fellowship exam (FRCEM) and obtain a Certificate of Completion of Training (CCT), qualifying you to apply for Consultant posts in the UK.

Training Pathways

Most trainees begin with a four-month post in Emergency Medicine during foundation training, providing an introduction to assessing patients and making decisions under supervision. The standard training pathway includes:

• Acute Care Common Stem (ACCS) (ST1-ST3): A three-year program with rotations in Emergency Medicine, Acute Medicine, Intensive Care Medicine, and Anaesthetics. The third year focuses on Emergency Medicine and includes six months of Paediatric Emergency Medicine training.
• Higher Specialist Training (ST4-ST6): A minimum of three years to consolidate clinical skills, lead resuscitation or trauma teams, supervise junior colleagues, and coordinate care.

Trainees can opt for "run-through training," which avoids re-application after the first three years if progress is satisfactory. An alternative route is the DRE-EM (Defined Route of Entry into Emergency Medicine) program, designed for doctors with prior experience in Emergency Medicine or other specialties, entering at ST3 level.

Training is flexible, and many doctors take time out of the program or follow alternative career paths. The EM Careers Pathways Map provides an overview of these routes.

Throughout training, you will build an e-portfolio to document learning and achievements, supported by educational and clinical supervisors. Regular reviews ensure you remain on track. Before entering higher training at ST4, you must complete the FRCEM Intermediate exams, which assess competencies gained during the ACCS program.