10/19/2025
Emergency Medicine training in United Kingdom
Emergency Medicine (EM) has rapidly become one of the most sought-after and dynamic specialties in the medical field. Twenty years ago, emergency departments were often managed by non-specialist doctors or physicians with backgrounds in internal medicine. Today, Emergency Medicine is a well-recognised and well-established specialty across many developed nations.
In several underdeveloped countries, however, EM training remains relatively new, and there continues to be uncertainty about pursuing a career in this field. In the United Kingdom, Emergency Medicine training is highly competitive — with the latest recruitment ratio being approximately 7 applicants for each available post. You need to have GMC registration to apply for training program.
This article aims to provide guidance for those interested in entering structured Emergency Medicine training in the UK, outlining key requirements and pathways.
Emergency Medicine Training Pathway in the UK
• Structured Training Programme:
Emergency Medicine in the UK is a run-through training programme, providing a continuous pathway from entry level to completion without the need to reapply between stages.
• Duration:
The training programme lasts six years.
• Annual Recruitment:
Applications open once per year, typically from the end of October to the end of November.
• Application Portal:
All applications are submitted through the national recruitment platform Oriel:
🔗 https://www.oriel.nhs.uk/Web/
Selection and Assessment Process
• Application Assessment Domains:
Your application is evaluated across two main domains:
a. Portfolio and MSRA (Multi-Specialty Recruitment Assessment) score
b. Interview performance
• Portfolio Assessment:
You will be awarded marks based on your achievements in the following areas:
◦ Research publications
◦ Additional qualifications (other than MBBS, excluding MRCEM)
◦ Teaching experience and recognised teaching qualifications
◦ Poster and oral presentations at conferences
◦ Leadership or management roles
◦ Completion of accredited resuscitation courses
• MSRA Examination:
The MSRA is a mandatory recruitment exam used across multiple specialties. Your score contributes significantly to your overall ranking and interview eligibility.
• Interview:
Candidates meeting the required MSRA threshold are invited for a panel interview, which typically includes clinical, ethical, and non-clinical scenarios.
• Offers and Allocation:
Following the interview, a combined score is calculated (portfolio + MSRA + interview). Candidates are then ranked nationally, and training offers are made according to rank and regional preferences. Offer cycles run weekly until all training posts are filled.
Examinations During Training
• MRCEM (Membership of the Royal College of Emergency Medicine):
Must be completed within the first three years of training.
• FRCEM (Fellowship of the Royal College of Emergency Medicine):
Must be completed before the end of the training programme.
Alternative Training Routes
1. CESR Pathway (Certificate of Eligibility for Specialist Registration)
• This is a non-structured, portfolio-based pathway designed for doctors who have not entered formal training but wish to demonstrate equivalent competencies to those of UK-trained Emergency Medicine consultants.
• Candidates are required to gather evidence of meeting all competencies outlined by the Royal College of Emergency Medicine (RCEM).
• Four mandatory rotations are essential during the CESR Pathway.
◦ Intensive Care Medicine (ITU)
◦ Paediatrics
◦ General Medicine
◦ Anaesthetics
• Further details can be found here:
🔗 https://rcem.ac.uk/certificate-of-eligibility-for-specialist-registration-cesr-and-combined-programme-cesr-cp/
2. DRE-EM Pathway (Defined Route of Entry into Emergency Medicine)
• The DRE-EM pathway allows direct entry into ST3 (Specialty Training Year 3) for suitably qualified doctors.
• Applicants are assessed based on their portfolio and shortlisted for interview if they achieve the required score.
• Successful candidates are then added to a pool for available training slots.
• More information is available here:
🔗 https://heeoe.hee.nhs.uk/emergency_medicine/specialist-trainee-year-3-em-defined-route-entry-emergency-medicine
I hope this article provides clarity and encouragement for doctors planning to embark on a training pathway and career in Emergency Medicine.
