Core anaesthetics and ACCS anaesthetics are two entry routes to the same Stage 1 of anaesthetic training, recruited through one application and one interview. The Royal College of Anaesthetists 2021 curriculum sets Stage 1 at an indicative three years from CT1 to CT3, while the ACCS route is a four-year programme that begins with two years of rotations across four acute specialties. At the general interview station the question is not which is better but why you chose yours.
Key takeaways
- ANRO recruits core anaesthetics and ACCS anaesthetics in one process, so one Oriel application and one interview cover both routes
- The 2021 curriculum sets Stage 1 at an indicative three years, CT1 to CT3, within an indicative seven years from appointment to completion
- ACCS anaesthetics is a four-year programme: two ACCS years of six-month placements in emergency medicine, internal medicine, anaesthetics and intensive care, then years three and four in anaesthetics
- ACCS anaesthetics trainees must undertake a minimum of 30 months of anaesthetics training by the end of the four-year programme
- Both routes finish Stage 1 the same way: all the learning outcomes plus the Primary FRCA, which is mandatory for entry to Stage 2 at ST4
- The Initial Assessment of Competence is the first of four critical progression points and normally takes between three and six indicative months
What is the difference between CT1 anaesthetics and ACCS anaesthetics?
The difference between CT1 anaesthetics and ACCS anaesthetics is how much time you spend outside anaesthesia at the start. Core anaesthetics puts you in anaesthetic training from day one; ACCS spends two years rotating through four acute specialties first.
According to the Royal College of Anaesthetists, doctors enter anaesthetics training through national recruitment at CT1 or ST4 level, and the ACCS curriculum is an alternative route to ST4 setting out a four-year programme of training in anaesthesia, internal medicine, emergency medicine and intensive care medicine.
The College notes that anaesthesia shares transferability with the other ACCS specialties in the early stages, so skills learned in the common areas transfer between the anaesthetic and ACCS programmes.
How long does each route take?
Core anaesthetics completes Stage 1 in an indicative three years; ACCS anaesthetics takes four. The 2021 curriculum describes training as outcome-based rather than time-based, with indicative rather than fixed durations.
- Stage 1, indicative three years, CT1 to CT3, with the Primary FRCA completed during this stage
- Stage 2, indicative two years, ST4 to ST5, with the Final FRCA completed during this stage
- Stage 3, indicative two years, ST6 to ST7, leading to the award of the CCT
- The indicative length of anaesthetic training is seven years from appointment to completion
- ACCS anaesthetics is a four-year programme, so the route to ST4 is one year longer than core anaesthetics
However, the extra year buys accredited time in three other acute specialties. The ACCS programme site states that ACCS is three years in total for emergency medicine and four years for anaesthetics, intensive care medicine and internal medicine.
What do you actually do in the two ACCS years?
The first two ACCS years are four six-month placements in emergency medicine, internal medicine, anaesthetics and intensive care medicine. The ACCS programme describes those years as gaining experience across all four placements while collecting evidence relevant to Stage 1 training.
After that, ACCS anaesthetics trainees join anaesthetics training to complete years three and four of the programme. The programme states that trainees must undertake a minimum of 30 months of anaesthetics training by the end of the completed four-year ACCS programme.
In practice that means your anaesthetic experience is concentrated later. It is worth being able to say that clearly, because ANRO scores knowledge of the training scheme you applied to.
When do you sit the Primary FRCA on each route?
On both routes the Primary FRCA is completed during Stage 1, and it is mandatory for entry to Stage 2 at ST4. The 2021 curriculum states that possession of the Primary FRCA is a mandatory requirement for entry into Stage 2.
The ACCS programme states the same gate from its side: trainees are not eligible for appointment to higher specialty training at ST4 anaesthetics until they have completed Stage 1 of the 2021 anaesthetics curriculum, meaning all the learning outcomes and the Primary FRCA exams.
The College divides the Primary into a multiple choice question paper and an objective structured clinical examination with a structured oral examination. The Final FRCA must be completed to progress to Stage 3 at ST6.
What is the Initial Assessment of Competence, and when does it happen?
The Initial Assessment of Competence is the first critical progression point in anaesthetic training and the anaesthetic element of the ACCS curriculum. The Royal College of Anaesthetists says it normally takes between three and six indicative months for most doctors to achieve.
Its purpose is to signify that the trainee has a basic understanding of anaesthesia, can give anaesthetics at a level of supervision matched to their skills and the case, and can be added to the on-call rota. The College is explicit that it is not a licence for independent practice.
Trainees new to the specialty are directly supervised at all times until they pass it. There is a second, obstetric assessment, the Initial Assessment of Competence in Obstetric Anaesthesia, usually attained after a block of obstetric training commenced after one year in programme.
Do you apply separately for ACCS anaesthetics?
No. ANRO's applicant guidance states that anaesthetics and ACCS anaesthetics applicants are recruited in one process and therefore require only one application. You preference the routes within the same Oriel application.
You also choose one cluster at application, England and Wales, Northern Ireland or Scotland, and are considered only for posts in that cluster. England and Wales use a single transferable score, so a candidate interviewed in one area can be offered a post elsewhere within it.
Applicants who want the other ACCS streams, acute internal medicine or emergency medicine, apply through those specialties instead. That is a useful line to know, because it shows you understand that ACCS is a shared stem rather than a single programme.
Which route should you choose?
Choose the route whose first two years you actually want, because that is the only part that differs. Both end at the same Stage 1 outcomes and the same Primary FRCA gate into ST4.
- Core anaesthetics suits a candidate who is certain about anaesthesia and wants concentrated anaesthetic time and an earlier run at the Primary FRCA
- ACCS suits a candidate who wants accredited emergency medicine, internal medicine and intensive care experience and accepts a longer route to ST4
- The interview and mark scheme are identical, so the choice does not change how you are scored
- The 2021 curriculum notes that successful completion of relevant anaesthetic elements is also recognised towards the intensive care medicine CCT programme
- Geography matters in practice, because you preference routes and regions inside one application
That said, there is no answer the panel is waiting for. ANRO's descriptor scores whether you made an informed decision, not which decision you made.
How do you justify your route in the general interview station?
Justify your route by naming what the route gives you and what it costs, then linking it to a plan. ANRO's Commitment to Specialty descriptor asks for knowledge of the anaesthesia and ACCS training scheme applied for and a clearly defined career development plan.
Here is a worked answer you could say aloud, for a candidate who chose ACCS.
'I preferenced ACCS anaesthetics. The programme is four years rather than three, with six-month blocks in emergency medicine, internal medicine, anaesthetics and intensive care in the first two years and then years three and four in anaesthetics, reaching at least 30 months of anaesthetics overall.'
'I chose it because the part of anaesthesia I am drawn to is the unwell patient before theatre, and my foundation experience in the emergency department was where I learned most about recognising deterioration. The cost is a year, and a later start on the Primary FRCA, which I have planned for.'
'Both routes finish Stage 1 the same way, with all the learning outcomes and the Primary FRCA before ST4, so my plan is the Initial Assessment of Competence in my first anaesthetic block, obstetric competence during Stage 1, and departmental quality improvement throughout.'
What should you not say about CT1 and ACCS?
Avoid answers that treat one route as a fallback or that get the structure wrong, because both undermine the informed decision the domain is scoring.
- 'I put ACCS as a backup.' Both routes are preferenced in the same application and neither is a consolation prize
- Describing ACCS as a separate interview. It is one application, one interview and one mark scheme
- Saying ACCS lets you delay choosing a specialty, when you have applied to an anaesthetics programme
- Getting the length wrong. Core anaesthetics Stage 1 is an indicative three years; ACCS anaesthetics is a four-year programme
- Claiming ACCS avoids the Primary FRCA. It is mandatory for entry to Stage 2 on both routes
- Naming a fellowship before naming the Initial Assessment of Competence, which is the progression point that actually comes first
How this comes up at the CT1 anaesthetics interview
The CT1 and ACCS route question sits in the General Interview station, 15 minutes across communication, commitment to specialty and teamwork, scored by two assessors for 50 marks. ANRO's guidance says applicants are asked about their training to date and their commitment to the specialty.
- Commitment to specialty: the route answer is direct evidence of knowledge of the training scheme and of career development, two of the four descriptor rows
- Communication: keep it under ninety seconds, because the station has two more domains to cover
- The mark scheme and the appointability threshold of 60 out of 100 are the same whichever route you preference
anaestheticinterview's 340 questions cover the general interview station with model answers and AI-marked spoken practice, which is the quickest way to test whether your route answer sounds like a decision or like an apology.