Emergency Medicine

International College of Emergency Medicine

Training Program


All competences should be addressed and recorded in the portfolio with evidence of reflection, achievement by case review or formal learning, or in some cases by assessment. Assessment methods are suggested where relevant but it is expected that the trainee and trainer will discuss how to demonstrate completion of the curriculum. Assessment methods that best utilise trainer and trainee should be prioritised.

Years 1-3 (Rotations and Core training)

ACCS Years 1 & 2

The curriculum is designed to reflect real practice. The focus of the first two years is on presentations to the resuscitation room and on the key complaints of patients who present acutely across a variety of settings.

These settings include the Emergency Department, Intensive Care Unit, the Acute Medical Ward and those areas where anaesthetics are given. The EM trainee should ensure they are competent in BLS and ALS, and should complete an ATLS or equivalent course by the end of the second year of training. It is also recommended that the trainee achieves level two safeguarding children during EM ST1/CT1 training.

The management of the airway is a key skill of the EP and the period of training in anaesthesia will give the grounding needed to look after the airway safely and effectively throughout the EP’s training and subsequent practice. The knowledge, skills and behaviours needed to manage the airway of patients presenting to the Emergency Department will develop throughout the whole programme enabling the EP to be an integral member of the airwayteam.

The basic sciences that underpin EM are described in detail in the Basic Sciences Curriculum available on our website, and are primarily assessed by the FICEM Primary exam. 

The basic sciences that underpin practice are also assessed in the Intermediate Certificate and FICEM.

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ACCS Year 3 EM

This has two aims:

1. To consolidate the trainee’s EM practice by increasing experience of the common presentations. During this time trainees will become more expert in their diagnosis and management competences. They will develop an increasing realisation of the range of presentations and the impact of co-morbidities. They will appreciate atypical presentations especially in the elderly and immunocompromised and recognise apparent benign presentations that indicate potential serious pathology.

Trainees will be able to look after sicker patients with increasing confidence, using investigations more selectively with more accurate interpretation. Trainees will develop more detailed differential diagnoses focusing on the worst as well as the most probable. Trainees will supervise others, being supportive but also able to detect when greater input is needed for the safe care of the patient, and will develop a greater understanding of human factors and the non-technical skills needed for work in the ED. 

They will develop the leadership and supervisory skills to enable them to take on these roles in the next phase of training.

2. The trainee will focus on the common paediatric presentations to the ED and these are laid out in the same way as for adults, with additional areas that are unique to children. The trainee must have successfully completed an APLS course or equivalent during this third year (the earlier thebetter).

By the end of the third year the trainee will have completed all the assessments (including the FRCEM Primary and Intermediate Certificate) and be ready to work unsupervised (but with access to senior advice at all times) and to supervise others, ensuring safe, effective and timely care.

Transition arrangements for Defined route of entry EM trainees Trainees entering from an alternative core training programme will have successfully
achieved many competences, some of which are directly transferable to EM.

During the period of transition, to be ready for progression to ST4, the DRE-EM route trainee will need to achieve all of the required competences for ST4 entry. 

In addition to a period of one year spent within EM (which may be reduced by up to six months if a period of approved training within EM during core training has been undertaken and the requisite competences achieved- specifically NOT during Foundation training), the trainee will undertake up to one year achieving competences in acute medicine, ICM and anaesthesia. This one year period will comprise training periods of 3-6 months in each of these three elements.

This period may be reduced if the trainee has achieved the required competences during a period of training in one or more of these three components during their prior training

Common Competences

Generic competences for Emergency Medicine – core to higher and continuing practice level.

The generic competences relate to direct clinical practise; the importance of placing patient needs at the centre of care and of promotion of patient safety, team working, and high quality infection control. The curriculum includes the nontechnical skills required by Emergency Physicians to ensure safe clinical care.

These skills are under the sub-heading of EmNTS (Emergency Medicine non-technicalskills).

Many of these competences will have been acquired during the Foundation
programme and core training but as part of the maturation process for the
Emergency Physician these competences will become more finely honed and all trainees should be able to demonstrate the competences as described by the highest level descriptors by the time of their CCT/CESR-CP.