CT1 core anaesthetics and ACCS Anaesthetics are two routes to the same ST4 post, and for 2027 they share one application and one interview. Core training is an indicative three years, CT1 to CT3.
ACCS Anaesthetics is four years, with two years across emergency medicine, acute medicine, anaesthesia and intensive care before two years in anaesthetics. Choose ACCS if you want the broader acute grounding and can give it the extra year, core if you want the shortest route.
Reviewed and updated 10 September 2026. Every interview mark below is taken from ANRO's August 2026 applicant guidance and is the 2026 position; ANRO publishes the 2027 guidance before applications open on 22 October 2026. The 2027 Round 1 dates are confirmed by NHS England.
Key takeaways
- Stage 1 of the 2021 anaesthetics curriculum is an indicative three years for core trainees (CT1 to CT3) and four years for ACCS Anaesthetics trainees, according to the Royal College of Anaesthetists.
- ACCS Anaesthetics trainees complete two ACCS years and then years three and four in anaesthetics, with a minimum of 30 months in anaesthetics by the end of the programme, according to the ACCS training site.
- Both routes need Stage 1 complete and the Primary FRCA before appointment to ST4; ACCS trainees do not need the Primary MCQ before entering their anaesthetics years.
- ANRO recruits both through one application and one two-station interview; you rank core and ACCS programmes together in Oriel.
- NHS England's 2025 ratio for the combined process was 12.56 to 1, or 6,770 applications for 539 posts. ACCS Emergency Medicine is a separate specialty with its own ratio of 14.23 to 1.
- In the general station, "why this route" is a commitment-to-specialty question. Answer it with what you have done, not with programme length alone.
What is the difference between CT1 anaesthetics and ACCS anaesthetics?
The difference is the first two years: core anaesthetics trainees spend all of Stage 1 in anaesthesia and intensive care, while ACCS Anaesthetics trainees spend two years rotating through emergency medicine, acute medicine, anaesthesia and intensive care medicine before two years in anaesthetics.
| Feature | Core anaesthetics (CT1 to CT3) | ACCS Anaesthetics |
|---|---|---|
| Length of Stage 1 | Indicative three years | Four years |
| First two years | Anaesthesia and intensive care | Emergency medicine, acute medicine, anaesthesia, intensive care |
| Years three and four | Year three in anaesthesia, then ST4 | Anaesthesia, minimum 30 months in anaesthesia across the programme |
| Exam before ST4 | Full Primary FRCA | Full Primary FRCA |
| Application and interview | One ANRO process | The same ANRO process |
| Person specification 2027 | Shared | Shared |
The Royal College of Anaesthetists describes Stage 1 as an indicative three years, CT1 to CT3, in which trainees complete the Primary FRCA, and ACCS as an alternative route to ST4. The ACCS site states the four-year length and the 30-month minimum.
How long is each route to ST4?
Core anaesthetics reaches ST4 after an indicative three years; ACCS Anaesthetics reaches it after four. Both then continue through Stage 2 and Stage 3 of the same curriculum to CCT.
The 2021 anaesthetics curriculum is the Royal College of Anaesthetists' training programme in three stages, of which Stage 1 is core or ACCS, and appointment to ST4 requires all Stage 1 outcomes and the Primary FRCA. anaestheticinterview's interview bank serves the CT1 entry point only; ST4 is a separate process.
So the ACCS route is one year longer to ST4 and the same length thereafter. Whether that year is a cost or an investment depends on what you want from it.
Do CT1 and ACCS anaesthetics share one application and interview?
Yes. ANRO's August 2026 guidance describes a single recruitment process for Anaesthetics CT1 and ACCS Anaesthetics: one Oriel application, one MSRA, one two-station interview and one selection score.
NHS England's 2027 person specification is titled for both, with the same 24-month cap on anaesthetics experience. You rank core and ACCS programmes together in your preferences and receive one offer.
Our application guide has the confirmed 2027 dates: applications 22 October to 19 November 2026, interviews between 11 January and 2 April 2027.
Is ACCS anaesthetics more or less competitive?
There is no separate published ratio, because ACCS Anaesthetics and core anaesthetics are one process: NHS England's 2025 table gives Anaesthetics CT1 as 6,770 applications for 539 posts, 12.56 to 1.
ACCS Emergency Medicine is a different specialty with its own recruitment and its own 2025 ratio of 14.23 to 1 (5,081 for 357). Do not confuse the two when you read forum threads.
Within the anaesthetics process, competition for a given programme depends on how many applicants rank it. Popular regions fill first on either route.
Who should choose ACCS anaesthetics?
Choose ACCS anaesthetics if you want a broad acute-care grounding, are considering dual training with intensive care medicine, or found in foundation that emergency and acute medicine were where you learned fastest.
- You want time in the emergency department and acute medicine before committing your whole week to theatre.
- You are interested in intensive care and want more exposure before deciding on dual CCT.
- You are willing to reach ST4 a year later in exchange for that breadth.
The ACCS site notes that trainees moving from ACCS do not need the Primary MCQ before entering their anaesthetic years, though the full Primary is still required by the ST4 interview date.
Who should choose core anaesthetics CT1?
Choose core anaesthetics if you are sure of the specialty, have already had acute medicine and emergency exposure you are satisfied with, and want the shortest route to ST4 and the Primary FRCA.
- You have done a taster week or rotation and know the daily work is what you want.
- You would rather sit the Primary FRCA early with continuous anaesthetic exposure.
- You prefer three years of one department's culture to rotating across four.
In practice, many candidates rank both and let the offer decide. That is allowed, but be ready to explain your first preference in the interview; anaestheticinterview's free application overview covers the single-process rules.
How do you justify the choice in the general interview station?
Justify the choice as a commitment-to-specialty answer: name the route, give two reasons rooted in your experience, acknowledge the trade-off, and show you understand where both routes lead.
For ACCS: "I have applied for ACCS first because my acute medicine job showed me how much I still had to learn about the sick medical patient. The extra year is worth that grounding, and it keeps intensive care open."
For core: "I have ranked core anaesthetics first. My taster week and my ICU rotation answered the questions ACCS would answer, and I want continuous anaesthetic exposure while I sit the Primary."
The assessors mark commitment, communication and teamwork out of 5 each, plus a global rating, in a station worth 50 marks. The general station guide covers the domains.
What do assessors listen for when you explain the route?
Assessors listen for evidence that you know what each route involves, that your reason is personal rather than borrowed, and that you have thought about the year's difference honestly.
A weak answer says ACCS "keeps my options open" with nothing behind it. A strong answer names the rotation that changed your mind and what it taught you. anaestheticinterview's general interview scenarios include the route question with model answers marked on the ANRO domains.
What about the Primary FRCA on each route?
The full Primary FRCA, all its components, is required before appointment to ST4 on both routes, according to the ACCS training site and the Royal College of Anaesthetists.
Core trainees sit it during CT1 to CT3 with uninterrupted anaesthetic exposure. ACCS trainees typically sit it during their anaesthetic years, and the ACCS site states that the Primary MCQ is not required before entering the anaesthesia years.
However, exam timing is a reason to prefer a route only if you have a reason to want the exam early or late. It is not a reason the assessors will find persuasive on its own.
How do you prepare for the interview whichever route you pick?
Prepare for the interview the same way on either route, because the stations, the domains and the marks are identical: rehearse a clinical judgement scenario A to E and prepare general station examples with outcomes.
ANRO's guidance is the document to read first. anaestheticinterview's bank has 340 questions across 37 scenarios for £97 with AI-marked spoken practice, and four free knowledge articles for the clinical station, including the unanticipated difficult airway.
Whichever route you rank first, the interview is 85% of the score and the two stations are the same. Spend the autumn on them.