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.
Educational use and limits
Educational guidance for doctors comparing UK Emergency Medicine training and specialist-registration routes. It is not personal eligibility, recruitment, immigration, employment, legal or regulatory advice. Requirements and recruitment rounds change: check the linked official guidance and use your own judgement, with advice from the responsible training body where needed.
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
Related articles
Educational guide, not clinical advice. Check current official guidance before acting.