In addition to internal medicine training, there is an alternative route into physicianly training - via acute care common stem (ACCS).

The aim of ACCS training is to produce multi-competent junior doctors able to recognise and manage the sick patient, and who have the complementary specialty training required for higher specialty training.

ACCS is currently a three-year programme during which trainees will get experience of acute medicine, critical care, anaesthetics, emergency medicine and general medical specialties.

ACCS training (normally) follows foundation year 2, as does IMT. Recruitment to ACCS is done via separate streams, dependent on the parent specialty.

Please note the ACCS curriculum is under review and the Acute Medicine stream will be aligned to the new IMT programme. It is proposed that the new programme will be four years in duration with two years of common ACCS training followed by two years of IMT training. This will be subject to GMC approval. There will be a transition process for trainees who are already on the ACCS-AM programme or who have completed ACCS-AM previously to ensure they are eligible for entry to higher medical specialties.

While the first two years of ACCS will share a common curriculum, and any competences acquired are transferable, it is not possible to switch between ACCS career paths without a further competitive selection process.

Candidates are therefore advised to select their initial ACCS pathway of choice with care.

Please visit the ACCS website for more information.

There are three separate streams of training through the pathway of ACCS which share a common curriculum.

Recruitment to each of these streams will be handled separately, by different bodies and via different recruitment processes.

  • ACCS (acute medicine)
  • ACCS (anaesthesia)
  • ACCS (emergency medicine)

Recruitment to ACCS (acute medicine) is handled alongside recruitment for IMT and detailed in this website. Information about the other streams can be found on the 'Other ACCS streams' tab in this section.

Further information on ACCS training programmes can be found on the ACCS website.

Years 1 & 2

During the initial two years (CT1/CT2) of the ACCS progamme, you will normally spend between six and nine months in each of the four core medical specialties:

  • acute medicine
  • emergency medicine
  • anaesthetics
  • critical care medicine.

The time spent in each will depend on the region in which you are working, and your year of appointment.

Year 3

The third year (CT3) of the programme will be arranged as required, and will consist of four-to-six month posts in general medical specialties.

You must complete the full three years, with all competences signed off, to complete the programme and will not be eligible for ST3 medical specialties purely on the back of the first two years of ACCS.

Training content

ACCS training is described under headings of common competences, major and acute clinical presentations and practical procedures.

During the ACCS-AM module, trainees should cover a range of presentations and area of the ACCS syllabus.

These are competences that should be acquired by all doctors during their training period; for ACCS trainees, competence to at least level 2 descriptors will be expected prior to progression into further/higher specialty training.


Two (JRCPTB) formative assessments (mini-CEX or CbD) covering two of the six major presentations are to be completed during the acute medicine section of ACCS. The major presentations are:

  • anaphylaxis
  • cardio-respiratory arrest
  • major trauma
  • the septic patient
  • the shocked patient.

Ten (JRCPTB) formative assessments (mini-CEX, CbD, ACAT), plus eight-to-ten of the remaining acute presentations covered using ACATs, e-learning, reflective entries, teaching and audit.


Five (JRCPTB) DOPs, covering five of the (ACCS) 44 listed practical procedures not covered elsewhere. These are:

  • lumbar puncture
  • pleural tap & aspiration
  • intercostal drain insertion (seldinger)
  • intercostal drain insertion (open)
  • ascitic tap
  • abdominal paracentesis
  • DC cardioversion
  • knee aspiration
  • temporary pacing (external/wire)
  • large joint examination.

 For a full list of practical procedures please refer to the GMC ACCS curriculum (p185)

Please note that recruitment to ACCS-anaes and ACCS-EM posts is not coordinated by the IMT Specialty Recruitment Office.

ACCS-anesthesia (ACCS-anaes)

Anaesthesia posts - both in ACCS (anaesthesia) and in 'pure' anaesthesia core CT1 programmes - will be recruited to as one process. The recruitment is led by the Anaesthetics National Recruitment Office (ANRO) – based in Health Education West Midlands.

There will be one single 'anaesthetics' application form - that is, regardless of whether candidates would prefer to be considered for CT1 anaesthesia posts, or CT1 ACCS-anaesthesia posts (or both), they need only complete one application.

Those candidates assessed to be eligible will be guaranteed an interview (providing they have ranked enough regions).

Preferences for one type of post or other can be given at a later stage of the recruitment process.

Following interview, places in programmes will be allocated according to rank and expressed performance for programme.

Once a post in an ACCS-anaes programme is accepted (or held), there can be automatic upgrade to a higher preferenced programme within anaesthesia/ACCS-anaes, should one become available.

ACCS-emergency medicine (ACCS-EM)

Applications for CT1/ST1 posts in ACCS-EM are managed by the London and Kent, Surrey and Sussex recruitment team.

Following interview, places in programmes will be allocated according to rank and expressed preference for programme.

Once a post in ACCS-EM is accepted (or held), there can be automatic upgrade to a higher preferenced programme within emergency medicine, should one become available.