Application and scoring
How does ACCS Emergency Medicine ST1 selection work?
The current person specification governs 2027 eligibility and selection criteria. The applying page reviewed on 8 October removes the Core Training option: current applicants enter run-through ST1. The pathway includes longlisting, a fresh MSRA sitting, capacity-based shortlisting, online interview, scaled combination, ranking, preferences and offers.
Check the 2027 person specification, Foundation competence route, registration and any reapplication support forms.
Submit one truthful Oriel application during national Round 1 and request reasonable adjustments by the stated route where needed.
Sit a fresh MSRA for 2027; scores from previous sittings are not accepted.
If interview capacity is exceeded, expect the current-cycle published shortlisting rule to determine who progresses.
Prepare the confirmed 2027 portfolio and combined clinical/ethical stations, each lasting up to 10 minutes.
If appointable, final rank and preferences determine which post can be offered; rank every programme you would genuinely accept.
MSRA
Confirmed 2027: total MSRA score supports shortlisting to approximately 882 interview places if demand exceeds capacity and contributes 40% after scaling.
Interview
Confirmed 2027: two online stations of up to 10 minutes and 60% final weighting. Detailed scoring anchors and internal clinical/ethical sequencing remain unpublished.
2027 criteria
Official: clinical judgement, prioritisation, acute illness, safety, teamwork, leadership, communication, research, QI and evidence-informed practice.
Portfolio and evidence
What should go into an ACCS EM portfolio answer?
There is no published ST1 self-assessment grid. Build a compact example bank for the person specification and make every claim easy to test with a follow-up question.
Informed commitment
Show that you understand undifferentiated work, short patient contact, crowding, shift patterns, ACCS placements and the examination pathway.
What to do: Use specific exposure and reflection; avoid generic claims about adrenaline, variety or procedures.
Clinical judgement and prioritisation
Choose examples where you recognised risk, acted within competence, used help and reassessed as the situation changed.
What to do: Make the information available at each decision point and your escalation threshold explicit.
Teamwork, leadership and communication
Use examples that show coordination across professions and clear risk communication rather than a title or an unowned team success.
What to do: State your task, exact action, outcome, feedback and what changed afterwards.
QI, teaching and research
These are desirable experiences, while understanding their principles is part of the core criteria. Completion and ownership matter more than prestige.
What to do: Prepare one truthful example for each area you claim and label unfinished work accurately.
Interview process
What is the latest published ACCS EM interview format?
For 2027, NHS England confirms two online stations lasting up to 10 minutes each: portfolio and clinical/ethical. The interview page states that commitment to specialty and communication are assessed alongside person-specification criteria.
- Portfolio
- Up to 10 min · confirmed 2027
- Clinical / ethical
- Up to 10 min · confirmed 2027
- Delivery
- Online via Qpercom in 2027
What is assessed?
- Commitment to Emergency Medicine and understanding of ACCS training
- Clear communication and ownership of portfolio examples
- Sound clinical judgement and initial management of acute illness
- Prioritisation, patient safety, escalation and reassessment
- Ethical and professional reasoning applied to the clinical context
- Teamwork and leadership across a multi-professional ED
ACCS Emergency Medicine guide library
Go deeper without losing the overview
The main hub keeps the application and interview picture together. These dedicated guides hold the longer career, portfolio and training material so you can jump straight to the question you are trying to answer.
Application roadmap
A dated ACCS Emergency Medicine ST1 plan from eligibility and Oriel through MSRA, interview, preferencing and offers, with actions for each time horizon.
Evidence & examples
Build truthful ACCS Emergency Medicine examples for commitment, judgement, teamwork, QI, teaching and research without inventing a self-assessment score.
Evidence pack
Editable factual drafts for Emergency Medicine tasters, QI, teaching, leadership and research, plus a compact index for interview-ready personal examples.
Getting involved
Arrange a useful ED taster and find realistic routes into quality improvement, teaching, research networks and trainee groups before Emergency Medicine training.
Working life
A clinician-led view of ED shifts, undifferentiated patients, decisions, interruptions, documentation, multidisciplinary work and consultant responsibilities.
On-call & nights
Understand emergency arrivals, competing risk, senior support, consultant involvement, crowding, handover, fatigue and recovery during ED nights and weekends.
ACCS & training
Follow Emergency Medicine training through the four ACCS specialties, intermediate and higher stages, capability-based progression, LTFT and CCT.
MRCEM & FRCEM
Understand MRCEM Primary, SBA and OSCE, later FRCEM SBA and OSCE, eligibility, timing, attempt limits and how examinations fit Emergency Medicine training.
Subspecialties
Compare Paediatric and Pre-Hospital Emergency Medicine, dual ICM training, trauma, toxicology, frailty, mental health, ultrasound and academic work.
ED workflows
Understand triage, focused assessment, resuscitation, referrals, disposition, safety-netting, handover, crowding escalation and governance in UK EDs.
Training programmes
Compare UK run-through EM programmes by geography, ACCS placements, case mix, nights, supervision, teaching, research, LTFT and trainee voice.
Societies & networks
A curated guide to RCEM, EMTA, EMSAS, TERN, PERUKI, APEM and the faculties supporting Emergency Medicine training, research and career development.
Is EM for me?
A balanced guide to EM career fit covering breadth, uncertainty, brief patient contact, procedures, interruptions, shifts, crowding, exams and sustainable working.
Current issues
Source-backed September 2026 guidance on crowding, corridor care, workforce, medicines, mental health, frailty, research networks and training quality.
2027 Round 1 · checked 30 October 2026
Before you submit: deadline, competence and priority status
Complete these national checks alongside the specialty's eligibility, evidence and selection requirements.
Application deadline and limit
Round 1 applications close at 4pm UK time on 19 November 2026. The national limit is five applications per recruitment round. Some specialties also require you to choose a single regional vacancy, so check the application route before submitting.
Foundation competence and CREST
If CREST is required, national guidance accepts valid 2024 or 2027 forms for 2027 recruitment. Required competence evidence must accompany the application; there is no later upload opportunity. Check validity against the specialty person specification and resolve any conflicting specialty instructions before relying on an older form.
Check your priority status in Oriel
For standard 2027 specialty recruitment, prioritisation applies to interview invitations and training offers. Check the status displayed in Oriel after applications close. Round 1 requests to review an incorrect status are due by 5pm UK time on 24 November 2026. Priority status does not replace eligibility or appointability requirements.
Recruitment · verified 30 October 2026
What is confirmed for ACCS Emergency Medicine in 2027
The 2027 process removes the Core Training entry option and confirms a fresh MSRA sitting, 40% MSRA and 60% interview weighting, and two online stations: portfolio and clinical/ethical. Detailed scoring anchors and the internal clinical/ethical sequence are not published.
2027 entry is run-through ST1
The applying page, reviewed on 8 October 2026, explicitly removes the Core Training option for the 2026/2027 recruitment round. The generic posts page still refers to Core Training; use the explicit cycle change and check the Oriel advert for the programme offered.
2027 eligibility and selection criteria are current
Applicants need a recognised medical degree, full GMC registration when applying, a licence at post start and recent Foundation competence through one of the stated routes. The 2027 person specification adds Emergency Medicine criteria covering clinical judgement, prioritisation, acute illness, safety, teamworking and leadership. Read the complete document for reapplication and support-form rules.
National Round 1 dates are confirmed
For 2027 Round 1, Oriel opens at 10am on 22 October and closes at 4pm on 19 November 2026. The published interview window is 11 January to 2 April 2027; first offers are due by 5pm on 6 April, with hold and upgrade deadlines on 9 and 14 April. Follow your Oriel invitation for the actual interview slot and booking deadline.
MSRA and interview weighting are confirmed for 2027
Eligible 2027 applicants must take a fresh MSRA; previous scores are not accepted. Total MSRA score shortlists if eligible applications exceed approximately 882 interview places. Final selection weights scaled MSRA at 40% and interview at 60%.
EM applicants use the January MSRA window
National 2027 guidance places applicants to Emergency Medicine in the January sitting. February is reserved for applicants applying only to General Practice and/or Core Psychiatry. Allocated windows cannot be changed by withdrawing another specialty application; follow your invitation for booking instructions.
Two 10-minute stations are confirmed for 2027
The 2027 applying page confirms portfolio and combined clinical/ethical stations, each lasting 10 minutes; the interview page says up to 10 minutes and online delivery via Qpercom. No official five-plus-five split is given within clinical/ethical.
There is no published ST1 self-assessment points grid
The current official ST1 pages do not publish a domain-by-domain portfolio points table or evidence-upload matrix. The portfolio station explores suitability and experience; this is different from a verified self-assessment score. Do not buy activities on the assumption that they award fixed points.
Recruitment prioritisation applies
The 2027 person specification states that the Medical Training (Prioritisation) Act 2026 applies. National guidance explains the stages at which priority status is used. Performance ranking and priority eligibility are separate questions, so check both the live rules and the status shown in Oriel.
Avoid portfolio theatre
What not to waste time or money on
A portfolio interview rewards credible understanding and defendable examples. Expensive activity, passive membership and unfinished prestige projects can consume time without improving the evidence the assessors can explore.
Do not invent a points grid
Competitor pages sometimes describe EM ST1 as portfolio-scored or imply fixed points for courses, publications and tasters. The official current pages publish a portfolio station, not an ST1 self-assessment table. Use the person specification as your evidence map.
Avoid duplicate certificates
Multiple overlapping acute-care courses add little if your required certification is current and you cannot show learning in practice. Pay for a course because it meets a real clinical or training need, not because its title sounds Emergency Medicine-specific.
A passive membership is not commitment
Joining a society may provide education or representation, but the subscription alone says little about your understanding of the specialty. Use groups for events, projects, support or trainee voice and discuss what you actually did.
Do not start a large project that cannot finish
A multicentre study, guideline rewrite or broad flow project needs governance and time. A small completed intervention or clearly defined network role is usually more useful than a grand plan with no outcome by interview.
Do not confuse exposure with competence
Watching procedures, attending resus or completing simulation does not confer independent competence. Describe the appropriate supervised level and what you learned about indications, teamwork and safety.
Do not sit an exam simply as a signal
RCEM examination engagement is desirable in the 2027 person specification, but exams have eligibility rules, costs and attempt limits. Training progression and genuine learning should drive timing.
Common misconceptions
Emergency Medicine myths that distort career decisions
These misconceptions often produce weak interview answers because they reduce the specialty to drama, procedures or a supposedly convenient rota.
“It is mostly resuscitation and trauma”
Resus and trauma are prominent but a large share of work is lower-acuity, frailty, mental health, paediatrics, diagnostic uncertainty, symptom control, discharge and referral. Breadth is the defining feature.
“Shift work guarantees work-life balance”
Shifts can give clear handover points and weekday time, but nights, weekends, rota gaps and recovery create their own burden. Sustainable working depends on the actual rota, staffing and life outside work.
“There is no continuity of care”
Long-term continuity is limited, but clinicians still follow episodes through results and disposition, review frequent attenders and learn from governance, complaints and outcome feedback. Continuity is different rather than absent.
“You must already have an ED job to apply”
The 2027 person specification requires understanding and commitment, not a mandatory Foundation ED rotation. Relevant acute work, a focused taster, curriculum knowledge and truthful reflection can establish an informed application.
“More courses mean a stronger portfolio”
The current process has no published course-points grid. Current life-support skills are desirable, but repeated certificates do not replace evidence of judgement, teamwork, learning and real contribution.
“The ED controls the four-hour performance problem”
ED processes matter, but exit block, inpatient beds, diagnostics, community capacity and social care strongly affect crowding. A sensible current-issues answer treats flow as a hospital and system responsibility.
“AI will replace emergency doctors”
Decision support and documentation tools may change workflow, but undifferentiated assessment, physical examination, procedures, communication, accountability and department-level risk remain clinical work. The practical questions are validation, bias, integration and safety monitoring.
Candidate-reported · not official guidance
Recurring themes from recent applicants
Public 2026 discussions are useful for understanding preparation problems, not for predicting exact questions. The official format and person specification remain the source of truth.
MSRA uncertainty dominates early preparation
Applicants repeatedly discuss changing shortlisting thresholds and try to infer a safe score from online samples. The official rule is capacity-based shortlisting; historical anecdotes cannot establish the next cut-off. Prepare for the assessment rather than aiming at an unofficial number.
Candidates look for a portfolio points table that does not exist
Recent applicants describe the portfolio station as vague and ask whether tasters, conferences or courses carry points. Use the published desirable criteria and prepare defendable examples. Do not copy scoring grids from other specialties or commercial summaries.
Specific reflection is more useful than activity count
Accounts from successful applicants without a Foundation ED rotation emphasise related acute-care exposure, focused specialty understanding and clear reasons for EM. This is anecdotal, but it aligns with the person specification's focus on commitment and transferable capability.
The short online format feels unforgiving
Applicants report that pacing, interruptions and follow-up can make ten minutes feel much shorter than expected. Practise concise first answers, leave room for probing and avoid spending half the station on context.
Post-interview feedback may feel limited
Some 2026 candidates reported scores or generic feedback that did not fully explain how to improve. Record your own immediate debrief and use the published criteria for a structured review rather than waiting for detailed commentary.
Resource map
Useful Emergency Medicine resources by stage
Start with official recruitment and curriculum material, then add the resource that answers your immediate question. More bookmarks do not create a better application.
Exploring the specialty
Use RCEM Career Pathways, the current curriculum and focused local exposure. Speak to trainees and consultants about routine majors, nights, crowding and career sustainability as well as resuscitation.
Building the application
Use the 2027 person specification, the evidence builder and factual confirmation drafts. RCEM QI and TERN can help identify genuine work, but local need and defined ownership matter more than a national label.
Preparing for MSRA
Use the official MSRA overview and current applicant guidance to understand format and rules. Question-based practice is available in the Interview Bank MSRA area; review why options are right or wrong instead of only tracking volume.
Preparing for interview
Use the focused portfolio and clinical/ethical guides for original timed prompts. The Emergency Medicine Question Bank and Example Bank provide specialty-specific practice routes without relying on recalled questions.
Starting training
Use ACCS curriculum material, RCEMLearning induction resources, local handbooks and the ePortfolio. Clarify supervision, assessment and escalation at each new placement rather than assuming the ED model applies in anaesthetics, ICM or medicine.
Examinations
Use RCEM exam regulations, blueprints, sample material, eligibility and the live calendar. Add courses or question banks only where they fit a defined study plan.
Research and later development
Use TERN, PERUKI, RCEM research opportunities and recognised subspecialty or dual-training guidance. Seek a supervisor and a defined role before committing time or assuming an output.
Focused preparation
Go deeper on the interview tasks that need practice
These focused guides break the broader interview into specific question types, decision structures and original practice scenarios.
EM portfolio station
The confirmed 2027 format includes a portfolio station of up to 10 minutes, but NHS England publishes no ST1 self-assessment points grid. Build a small set of examples that make suitability, ownership and learning easy to test.
EM clinical & ethical station
The confirmed 2027 ACCS EM format combines clinical and ethical judgement in a station of up to 10 minutes. Make the immediate risk, safe first actions, use of the team and professional reasoning visible.
Free practice questions
Original ACCS Emergency Medicine interview questions
These prompts are written from the published person specification and latest official station functions. They are not recalled interview questions.
Portfolio, commitment and suitability
- Which experience best tested whether Emergency Medicine suits you, and what did it reveal about the work?
- Tell us about a safety or improvement project. What was your exact contribution and what changed?
- Describe a time you coordinated colleagues under pressure without holding formal authority.
- How has an audit, paper or guideline changed a clinical decision you make?
- What do you expect to find difficult about ACCS Emergency Medicine training?
Clinical and ethical judgement
- A patient with possible sepsis wants to leave before treatment is complete. Talk through your immediate and ethical priorities.
- Two deteriorating patients need the resuscitation team at the same time. How would you allocate care and maintain oversight?
- A colleague appears impaired midway through a crowded night shift. What would you do now and after the department is safe?
- An older patient is confused, trying to leave and may have serious pathology. Explain your assessment and escalation.
- A specialty declines a referral while the patient continues to deteriorate. How do you keep the patient safe and resolve the disagreement?
Preparation plan
A focused ACCS EM preparation plan
- Read the 2027 person specification and mark every essential and desirable criterion you can evidence honestly.
- Prepare eight to ten strong examples with personal action, outcome, feedback and later change.
- Practise both MSRA sections until review of errors changes your reasoning, not only your question count.
- Use ten-minute portfolio and clinical/ethical mocks with interruption and follow-up.
- For clinical answers, make immediate risk, help, ABCDE, treatment, delegation and reassessment audible.
- For ethical answers, keep capacity, consent, confidentiality and professionalism tied to the patient's clinical risk.
- Know the ACCS years, ST3–ST6 development, MRCEM/FRCEM pathway, nights, subspecialties and current crowding pressures.
- Recheck the official recruitment hub when 2027 specialty dates, scoring and interview instructions appear.
Common questions
ACCS Emergency Medicine recruitment FAQs
What is confirmed for ACCS Emergency Medicine ST1 recruitment in 2027?
The 2027 process confirms a fresh MSRA, approximately 882 interview places if capacity-based shortlisting is needed, 40% MSRA / 60% interview weighting and portfolio plus clinical/ethical stations. Detailed interview scoring anchors remain unpublished.
When do 2027 Round 1 applications open and close?
The national timetable says applications open at 10am on 22 October and close at 4pm on 19 November 2026. Recheck Oriel and the EM recruitment page before submission.
Does ACCS Emergency Medicine use the MSRA?
Yes. Eligible 2027 applicants must take a fresh MSRA; previous scores are not accepted. It supports capacity-based shortlisting and contributes 40% of final selection after scaling.
What was the latest official interview weighting?
Confirmed for 2027: MSRA 40% and interview 60%, after scaling. Do not add an unscaled MSRA total directly to interview marks.
What is the ACCS EM interview format?
Confirmed for 2027: two online stations of up to 10 minutes each, portfolio and clinical/ethical. The official guidance does not publish an internal five-plus-five split for clinical/ethical.
Is there an official ST1 portfolio scoring matrix?
The current official ST1 pages publish a portfolio interview station but no domain-by-domain self-assessment points grid. Prepare against the person specification and do not assume competitor tables are official.
Do I need an Emergency Department job before applying?
No mandatory ED post is listed in the 2027 person specification. You do need informed commitment and examples of the required skills; a taster, acute-care work and trainee conversations can help close an experience gap.
Will a taster week score points?
No official current ST1 table assigns it fixed points. A focused taster can improve your understanding and give you specific reflection, while an attendance certificate alone is weak evidence.
Does audit or QI need to be in Emergency Medicine?
EM-specific QI is desirable in the 2027 criteria, but transferable work can still show that you understand standards, change and measurement. Be precise about your role and what happened.
Do I need a publication?
No publication is listed as an essential ST1 requirement. Research understanding is essential and EM research experience desirable; a defined, explainable contribution matters more than authorship you cannot defend.
Should I sit an RCEM exam before applying?
Engagement with relevant RCEM examinations is desirable in the 2027 person specification, but timing should follow eligibility, cost, training need and attempt limits. It is not a substitute for the rest of the criteria.
Which life-support course do I need?
The specification lists up-to-date demonstrable advanced life-support skills as desirable without naming a single mandatory provider in the page summary. Maintain certification appropriate to your current role and verify the complete document.
What are the four ACCS specialties?
Emergency Medicine, Internal or Acute Medicine, Anaesthetics and Intensive Care Medicine. The first two years commonly contain six months in each, though local ordering varies.
Is EM training run-through?
For 2027 entry, the official applying page removes the Core Training option, so applicants should follow the run-through ST1 route. References to core CT1 describe previous entry routes; existing core trainees should check their own progression requirements.
How long is Emergency Medicine training?
The usual full-time indicative route runs from ST1 to ST6. Capability-based progression, LTFT, time out and subspecialty or dual training can change the duration.
What exams are required?
The current sequence comprises MRCEM Primary, MRCEM SBA and MRCEM OSCE for Membership, followed later by FRCEM SBA and FRCEM OSCE for Fellowship, subject to current eligibility and equivalence rules.
How much paediatric Emergency Medicine is in training?
Paediatric care is part of general EM throughout training, and RCEM describes a six-month PEM placement during CT/ST3. A recognised additional PEM year is available for subspecialty accreditation.
Can Emergency Medicine be combined with Intensive Care Medicine?
Yes. EM and ICM have an approved dual CCT route with coordinated curricular and assessment requirements. It lengthens and complicates training, so use the current joint guidance.
Is Pre-Hospital Emergency Medicine a recognised subspecialty?
Yes. RCEM lists PHEM and PEM as recognised subspecialties. Entry, programme availability and timing require separate current guidance.
Can I train less than full time?
Yes, subject to the national and local process. Rotation, night work, exams and indicative completion date need individual planning with the programme.
What is Emergency Medicine on call like?
It is continuous shift-based acute care with unpredictable arrivals, multiple incomplete cases, repeated reprioritisation and fewer downstream services overnight. Senior and consultant presence varies by department.
How much patient contact is there?
A great deal. Contact is usually brief and intense rather than longitudinal, with repeated assessment, explanation of uncertainty, procedures, consent and safety-netting.
Is Emergency Medicine mostly procedures?
No. Procedures matter, but most shifts also require history, examination, clinical reasoning, communication, documentation, referral and disposition decisions across a broad caseload.
What should I ask when comparing regions?
Ask about programme status, hospital footprint, ACCS placements, nights, senior cover, paediatrics, trauma and DGH exposure, teaching, exams, QI or research, LTFT and realistic commute.
Is there a best Emergency Medicine deanery?
There is no reliable national ranking. The best fit depends on the rotations, support, geography and opportunities you value, and programme structures change.
What current issue should I discuss at interview?
Choose one you understand, such as crowding, corridor care, workforce, time-critical medicines, adolescent mental health or frailty. Explain the patient consequence and a proportionate team or service response.
How should I answer an ethical scenario?
Manage immediate clinical risk, establish the facts, assess capacity or consent where relevant, communicate clearly, use appropriate senior and multidisciplinary help, then document and address longer-term learning.
How should I structure a clinical scenario?
State the immediate threat, call for appropriate help, use a structured assessment, initiate time-critical treatment, prioritise investigations that change management and reassess. Make delegation and disposition explicit.
Can I use recalled interview questions?
Do not rely on recalled or proprietary questions. Practise original prompts mapped to the published criteria so you can respond safely when the wording changes.
Where can I practise ACCS EM questions?
Use the focused portfolio and clinical/ethical guides, then follow their links to the Emergency Medicine Question Bank and Example Bank for original specialty-specific practice.
Official sources
Official recruitment sources
- NHS England — ACCS Emergency Medicine recruitment hub
- NHS England — application and weighting page (2027)
- NHS England — interview format (2027)
- NHS England — EM recruitment timeline (2027)
- NHS England — ACCS Emergency Medicine ST1 2027 person specification
- NHS England — national recruitment timeline
- NHS England — MSRA overview
- RCEM — 2025-updated Emergency Medicine curriculum
- RCEM — training overview
- ACCS — curriculum overview
- RCEM — MRCEM examinations
- RCEM — FRCEM examinations
- RCEM — dual and subspecialty training
- RCEM — emergency department crowding
- RCEM — quality improvement
- RCEM — workforce
- EMTA — trainee representation and resources
- TERN — trainee emergency research network
- PERUKI — paediatric emergency research