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Emergency Medicine Training In The UK: What It Is & How To Apply

Find out all about the UK’s Emergency Medicine training pathway, and what you can do to ace the MSRA along the way.

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UK Emergency Medicine Training

Is Emergency Medicine specialty training for you?

Do you have a desire for rapid thinking? Are you prepared to handle any illness that knocks on your door? Do you have a general affinity for procedures? Then the UK’s Emergency Medicine training pathway may well be your area of interest in specialisation.

What is Emergency Medicine?
As per the International Federation of Emergency Medicine “Emergency Medicine is a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development.

The Royal College of Emergency Medicine (RCEM) is a professional body of emergency physicians in the United Kingdom that sets UK emergency medicine training requirements, manages the emergency medicine licensing procedure for the award of Fellowship and Membership of the College, and recommends trainees for CCT in Emergency Medicine.

UK Emergency Medicine Training

Structure of UK Emergency Medicine training

The first two years of ACCS (Acute common care specialties) compromises 6 months each of Emergency medicine, Acute Medicine, Intensive care Medicine and Anesthesia. The third year is focused on Pediatric Emergency Medicine and Minor injuries/Musculoskeletal injuries. 

The final three years of higher specialty training (HST) are based in Emergency Medicine.

UK Emergency Medicine Training

Eligibility and Person Specification

There are essential and desirable criteria to apply for EM training (ST1) 

Essential criteria are as follows:
– Applicants must have MBBS or equivalent medical qualification.
– Applicants must be eligible for full registration with, and hold a current license to practice from, the GMC at intended start date.
– Have evidence of achievement of foundation competences (either through completion of UK foundation year program or through evidence of signed the latest CREST form).
Read more: The CREST Form – Everything You Need To Know.
– Applicants must be eligible to work in the UK.

The full list of essential and desirable criteria for ACUTE CARE COMMON STEM (ACCS) EMERGENCY MEDICINE – CT1/ST1 can be found by clicking here.

Emergency Medicine Training UK Recruitment

EM trainees are recruited through a national coordinated process. The National Recruitment Office for Acute Care Common Stem (ACCS) Emergency Medicine ST1/CT1 is Health Education England – London and Kent, Surrey and Sussex (London and KSS).

Usually there are two rounds of recruitment each year depending on the vacancy after the first round. The adverts for EM training usually appear in November.

The ORIEL website is used to manage all applications. Once the application is open the number of vacancies is available on the website.

The ORIEL website is used to manage all applications. Once the application is open the number of vacancies is available on the website.

Emergency medicine training MSRA

The MSRA is a computer-based assessment that is given in collaboration with Work Psychology Group and Pearson VUE and is based on clinical situations.

It has been created to evaluate some of the six fundamental abilities listed in the Person Specification. 

To schedule an interview, log into your Oriel account. Slots are available on a first come, first served basis, and must be reserved by the deadline specified in the invitation to interview.

The online interview lasts for the full 30 minutes. There will be a 20-minute face-to-face interview via Microsoft Teams with two panel members, and the remaining 10 minutes will be spent by the panel cross-referencing your submitted application to complete scoring. You will be asked questions relating to your application and commitment to specialty during the clinician interview.

The MSRA will be weighted 40% and the interview score 60% of the total score.

To pass your emergency medicine MSRA success is a must. Read more about how best to equip yourself for the MSRA via our MSRA preparation article here. 

We also run several MSRA courses — with our MSRA Ultimate Package being the most comprehensive one to help you achieve exam success.

Emergency Medicine Training UK

Coupled vs Uncoupled training

Successful applicants will have another chance to decide whether to take an uncoupled or run-through training route after accepting an offer.

Run-through training (ST1) allows for continuous progression; candidates begin in specialty training year 1 (ST1) and automatically advance to ST2, ST3, ST4, ST5, and ST6 if all curriculum criteria are met. With uncoupled training, trainees must reapply for HST (ST4) after ST3.

Emergency Medicine Training UK

Other routes of entry

Applicants can also apply for EM training at ST3/ ST4 provided the person’s specifications are met. More information about the ST3/ DRE-EM Entry can be found here.

Emergency Medicine Training UK

Exams in Training

The MRCEM and FRCEM are the two recognized EM exams. There are three components of MRCEM: MRCEM primary, MRCEM SBA, and MRCEM OSCE. Before moving on to ST4, trainees are expected to finish all three components of MRCEM.

FRCEM is divided into two components: FRCEM Final SBA and FRCEM OSCE. Before applying for this exam, trainees must have at least 12 months of HST experience.

Emergency Medicine Training UK


Trainees in emergency medicine have the option to dual or sub-specialise in some specialties. The three recognized specialties are:

1. Pre-Hospital Emergency medicine (PHEM)
2. Paediatric Emergency Medicine (PEM)
3. Intensive care Medicine (ICM)

EM trainees can submit applications for PHEM training during their ST4 year. Only a few one-year pure PHEM posts (1 year) are available nationally, and the bulk of PHEM positions involve blended training over a two-year period that includes a mix of EM/PHEM shifts (for a total of one year of EM and one year of PHEM). 

Trainees are required to pass two exams as part of the PHEM training – Diploma in Immediate Medical Care (DIMC) and Fellowship in Immediate Medical care (FIMC).

A subspecialty combining both paediatrics and emergency medicine, paediatric emergency medicine. EM trainees in the UK, trainees have the option to apply for and, if selected, train in PEM. There are no separate exams for PEM.

The Faculty of Intensive Care Medicine (FICM) has established intermediate and advanced level accreditation in intensive care medicine (ICM) for EM trainees. The training process is competitive, and the training may be extended by 2.5 to 3 years. Trainees are required to pass three parts of the Final FFICM exams.

Emergency Medicine Training UK

Competition Ratios

In the UK, EM training is extremely competitive. Below is a snapshot of the competition ratios during the previous years.

Emergency Medicine Training UK

Tips and Tricks

Start in a non-training job. Spend the initial months being familiar with the NHS and the system.
– Arrange a meeting with your supervisor earlier.
– Download the latest CREST form and Person specifications for the specialty. Talk about them with your supervisor, and then plan how to achieve them.
– Participate in QI/audits and present in local/ national conferences.
– Conduct some teaching sessions. 
– Enhance your portfolio to the person specifications.
– Do some mock interviews with fellow registrars and consultants.

Emergency Medicine Training UK


Emergency Medicine Training UK

Looking to improve your MSRA Emergency Medicine training score?

Then Arora Medical can help. 

Our most popular and comprehensive MSRA Ultimate Package contains an all round and complete preparation plan for boosting your MSRA score. It contains multiple resources in one discounted bundle – 2x online video courses, Live MSRA crammer course, SJT and clinical mock exams, 2x audiobooks and 3x digital flashcard sets (clinical, pharmacology and SJT).

For individual MSRA resources (e.g. mocks, online courses etc.) check out all of our MSRA courses here.

To register for our next free MSRA webinar click here: Next Free Webinar.

For our Free MSRA Countdown Programmes click here: Free MSRA Downloads.

Emergency Medicine Training in the UK: What it is and How to Apply

On a final note

We look forward to supporting you through your successful application process – in particular for the MSRA.

And remember, nothing is impossible. Work smartly. Plan, practice, and succeed. Wish you good luck, from Dr Anoop!

Good luck and #CanPassWillPass

Author Bio — Dr Aman Arora

Hello and welcome to Arora Medical Education! I am a Portfolio GP with a 24/7/365 passion for helping you fly through your medical exams and maximise your career. You can find out more about me here.

I’ve been fortunate to teach over 50,000 doctors globally through a combination of face-to-face, online, audio and social teaching, helping them pass exams such as MRCGP AKT and RCAMSRA and PLAB. You can find out more about my previous roles and qualifications here.

Feel free to contact me with any thoughts, questions or ideas to help you reach your potential. I look forward to meeting you soon!

Author Bio — Dr Pooja Arora

Dr Pooja Arora is a GP with a background in Medical Politics, where she passionately focuses on improving the opportunities and working conditions for junior doctors. She is proud to hold FRCGP (Fellow of Royal College of General Practitioners).

You can find out more about Pooja’s previous roles and qualifications here.

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