UK Pathway · 8 min read
UK Emergency Medicine Training Pathway: ACCS, DRE-EM, Portfolio Pathway and CCT
A maintained, source-linked guide to UK Emergency Medicine training routes, including ACCS core and run-through training, DRE-EM, Portfolio Pathway and CCT.
By EM Gurus Editorial Team
Last updated 2026-08-13
Direct answer
Doctors completing a GMC-approved UK Emergency Medicine training programme can become eligible for a Certificate of Completion of Training (CCT). Entry may start with ACCS Emergency Medicine at CT1 or ST1, including a run-through option, or at later nationally recruited entry points where the current person specification is met. DRE-EM is a defined ST3 entry route. Portfolio Pathway, formerly called CESR, is a separate route to specialist registration for doctors who have not completed a GMC-approved UK specialty training programme and must evidence the required knowledge, skills and experience.
ACCS Emergency Medicine: core and run-through routes
The Acute Care Common Stem (ACCS) develops core acute-care capabilities across Emergency Medicine, Acute Medicine, Anaesthetics and Intensive Care Medicine. RCEM says ACCS Emergency Medicine recruitment may be to CT1 core (uncoupled) training or ST1 run-through training. Run-through recruitment covers progression towards ST6, provided curriculum, ARCP and examination requirements are met. Core recruitment covers the core stage and requires a later competitive recruitment step for higher specialty training. The programme content is the same, but the recruitment and progression arrangements differ.
DRE-EM: a defined ST3 entry route
Defined Route of Entry into Emergency Medicine (DRE-EM) is a national ST3 recruitment route, distinct from ST3 ACCS recruitment. Applicants must use the current national person specification and recruitment guidance for the route they are applying to; previous experience does not by itself establish eligibility. RCEM's CCT guidance includes a specific post-history route for ST3 DRE-EM entrants, so DRE-EM can sit within a GMC-approved training pathway leading towards CCT when all programme requirements are completed.
What CCT means
CCT is the completion award for an approved UK specialty training programme. RCEM states that, after an ARCP Outcome 6, the doctor submits the RCEM CCT application and also applies directly to the GMC. RCEM reviews the training record and makes a recommendation; the GMC decides on the CCT and entry to the Specialist Register. CCT is therefore the endpoint of approved training, not a synonym for every route to specialist registration.
Portfolio Pathway (formerly CESR)
Portfolio Pathway is the current name for the route formerly called CESR; RCEM records that the name changed on 30 November 2023. It is for doctors who have not completed a GMC-approved UK specialty training programme but can demonstrate the knowledge, skills and experience required for specialist practice. Applications go to the GMC. RCEM evaluates Emergency Medicine applications against the current curriculum and Specialty Specific Guidance and recommends an outcome, while the GMC makes the final specialist-registration decision. This is an evidence route to specialist registration, not a CCT training programme.
How to choose the right official route information
Use the national recruitment source for the entry level and round you are considering, the current RCEM curriculum for programme requirements, and the GMC and RCEM Portfolio Pathway guidance for specialist-registration evidence applications. Do not rely on an old label, an earlier recruitment round or a generic pathway summary to decide personal eligibility. A training programme director, postgraduate deanery, RCEM or GMC should resolve route-specific questions; the doctor retains human judgement and responsibility for decisions and submitted evidence.
Official sources
RCEM and NHS England sources reviewed 13 August 2026. GMC Portfolio Pathway guidance is linked as the regulator-owned reference surfaced by RCEM, but the GMC page could not be retrieved directly during this review.
- RCEM — Training Overview
ACCS scope, stages of Emergency Medicine training and progression to CCT.
- RCEM — Recruitment
Core and run-through ACCS options, later entry levels and DRE-EM recruitment.
- NHS England Medical Hub — Emergency Medicine
National specialty recruitment routes and links to current route-level information.
- RCEM — EM Curriculum
Current Emergency Medicine curriculum and transition documents.
- RCEM — Certificate of Completion of Training (CCT)
Outcome 6, RCEM recommendation, GMC application and entry-route records.
- RCEM — Portfolio Pathway (formerly CESR)
Current name, purpose, curriculum mapping and RCEM/GMC responsibilities.
- GMC — Specialist registration through the Portfolio Pathway
Regulator-owned application guidance linked by RCEM.
Common questions
Is ACCS Emergency Medicine always run-through training?
No. RCEM describes CT1 core (uncoupled) and ST1 run-through recruitment options. Core trainees need a later competitive recruitment step; run-through trainees progress within the programme if they meet the required curriculum, ARCP and examination outcomes.
Is DRE-EM the same as Portfolio Pathway?
No. DRE-EM is a defined ST3 recruitment route into Emergency Medicine training. Portfolio Pathway is an application for specialist registration based on evidence from doctors who have not completed a GMC-approved UK specialty training programme.
Is Portfolio Pathway the new name for CESR?
Yes. RCEM says the route was renamed Portfolio Pathway when revised GMC evidence-evaluation arrangements took effect on 30 November 2023. Older documents and conversations may still use CESR.
Does completing DRE-EM lead to CCT?
DRE-EM is an entry route into approved Emergency Medicine training. RCEM's CCT process includes ST3 DRE-EM entrants, but an individual must still complete all applicable programme, curriculum, ARCP and examination requirements before a CCT recommendation can be made.