Core vs ACCS

This is a guest post, written by Dr Elif Gecer - F2 Doctor - on how to choose between ACCS and Core Anaesthetics training.

Many of our wonderful readers have a wealth of experience and insight of huge value that we ourselves do not possess, be that as a result of changes implemented after we passed a certain stage, or because we haven't arrived there yet.

The process of applying to anaesthetics and the duration of the core training programme have changed significantly since we went through the process in person, so F2 Dr Gecer has graciously agreed to help us spread the word on what's actually involved, and how to choose from the available options.

If you have experience and expertise that you feel would be of value and would like to share with our audience, please ping us an email, and if you have thoughts on this article that would help prospective anaesthetists, please let us know in the comments!

Where to start

Applying for training can be a confusing and overwhelming time; this article aims to simplify the process of applying to Anaesthetics at a CT1 level and help you decide on which pathway is best suited to you.

Firstly, how does the application process work to become an anaesthetist?

To become an anaesthetist, applications are submitted via Oriel, typically during Foundation Year 2 or later.

• Invitations to sit the Multi-Specialty Recruitment Assessment (MSRA) are issued in December, with the exam taking place in January
• Upon successful interview performance, candidates can then rank their preferred posts, which include both Core Anaesthetics and ACCS Anaesthetics programmes

But what is the difference?

Core Anaesthetics

Core Anaesthetics is a three-year training programme representing ‘Stage 1’ of the pathway to achieving a Certificate of Completion of Training (CCT).

Upon completing CT3 and the Primary FRCA examinations, trainees become eligible to apply for Anaesthetics Higher Specialty Training (HST).

Those pursuing a dual CCT in Anaesthetics and Intensive Care Medicine (ICM) must complete an additional 12 months in medicine and 12 months in ICM—some of which may be fulfilled during core training, with the remainder completed before or during HST.

Acute Care Common Stem (ACCS) Anaesthetics

ACCS is a three-to-four-year programme shared by Anaesthetics, Emergency Medicine, and Acute Medicine, with Anaesthetics extending to four years.

The structure is as follows:

• Year 1: Two six-month rotations in Emergency Medicine and Acute Medicine
• Year 2: Two six-month rotations in Anaesthetics and Intensive Care Medicine
• Years 3–4: Dedicated Anaesthetics training including obstetric anaesthesia

Airway competencies (IAC) are generally achieved in Year 2, often just after half way through the year.

This pathway facilitates dual training in Anaesthetics and ICM, as the required 12 months of medicine are completed during Stage 1, eliminating the need for additional training before HST.

Parallel but separate

While Anaesthetics, Emergency Medicine, and Acute Medicine share the ACCS framework, each specialty has distinct competency requirements. For instance, pursuing Emergency Medicine requires applying specifically to ACCS(EM)—these pathways are not easily interchangeable.

What are the pros and cons?

Which should I choose?

If you are set on a career in intensive care or prehospital medicine, ACCS allows you to rotate through the compulsory acute medicine block early in your career, and therefore you can avoid going back to ward cover later on!

ACCS also enables you to gain a better appreciation for the allied acute medical specialties and will potentially expose you to working in environments you may not get in the Core Anaesthetics programme.

However, if you are someone who is set on single CCT in anaesthetics, the core anaesthetics programme is better for you.

• You can also avoid the non-anaesthetics specialties through this route if this is something you would prefer
• And finally, you are still able to go into dual training later on if you change your mind

Overall, anaesthetics training is very flexible with a broad array of options for specialist interest development, and hopefully this article has given you some guidance on how to decide on which pathway is best for you!

Further reading and guidance

Recruitment into anaesthesia

The College provides support to the anaesthesia recruitment process in the UK. This page has the most up-to-date information on recruitment and links on how to enter the anaesthesia training programme.

The Royal College of Anaesthetists

Considering a career in anaesthesia

Information for undergraduates who are considering a career in anaesthetics, and how to make an application.

The Royal College of Anaesthetists

Author

What Reddit has to say

While everything crowd-sourced from anonymous accounts in the depths of the internet should probably be taken with a sizeable dose of powdered saline, it can prove a valuable treasure trove of experience and snippets of wisdom.

Here are some of our favourites:

• If you want to do PHEM the 6 months each of anaesthetics, medicine, ED and ICU all "in a training programme or equivalent" are much easier to achieve in ACCS than anywhere else
• If you want to do ICU, you may prefer to get your 6 months medicine done early as it is uniquely painful to go back to being a medical SHO in your ST5 year
• With ACCS you get a couple of extra points for ST4 applications as “time in other specialties” vs core trainees
• The advantage of doing Medicine later, is you might manage to develop specialist interest areas- Eg Echo/cardiology, and generally get more out of it
• I went for core, as even though I’m interested in ICM I couldn’t stand the thought of not learning any anaesthetics for a whole year. I knew it would make me loathe being a doctor again, at a time where I had just started to enjoy my job again
• I have had lots of discussions with a current ST4 dual CCT, who is currently doing her acute medicine year. She says it’s completely ****, but at least she’s getting paid as an ST4, and is doing 4 months of cardiology. She said it’s tolerable, just to get the tick box for ICM. I specifically asked if she regretted doing it that way and she said no
• ACCS anaesthetics is a scam to get an extra year of service provision. I ranked all core jobs above ACCS, but didn't interview well enough to get a core job, took the ACCS job because I didn't want to go through applications again
• Its nice to come across the anaesthetists who have done ACCS rather than core because they tend to have a bit more appreciation for the *** show that is acute/emergency care right now
• The core VS ACCS debate depends if you want to do ITU - If you do, do ACCS, if you don’t, core is better
• I chose CAT because I specifically wanted to come back to do my medicine (for dual training) at Reg level where even though you’re a medical “SHO”, you’re certainly not treated like one, you’re given more freedom, you have more confidence to speak up and the job is just easier because your clinical and organisational skills are better than at ACCS ST1

So, as expected, a mixed bag of opinions (and emotions) that seem to depend quite heavily on personal circumstances, career intentions and the inevitable pot luck of the department you end up working in.

Hopefully you feel slightly more informed ahead of such an important decision - please fire away with any questions you might have, we'd be delighted to hear them.

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