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Acute Care Common Stem (ACCS)

Acute Care Common Stem (ACCS) training is a broad-based training programme that equips trainee doctors with the skills and capabilities required to recognise and undertake initial management of the acutely unwell patient. 

It is the only sole core training route of entry to Higher Specialty Training in Emergency Medicine and is one of the core training routes to enter Higher Specialty Training in Anaesthetics, and is a core training route of entry to any of the medical specialties listed on the JRCPTB website.

The first two years are spent rotating through six-month placements in Emergency Medicine (EM), Internal Medicine (IM), Anaesthetics, and Intensive Care Medicine (ICM).

The third and fourth years are spent in the doctor in training’s chosen parent specialty, undertaking training to meet the requirements for entry into Higher Specialty Training.


There are currently seven ACCS training sites in Wales; two of these have ACCS trainees from all three parent ACCS specialties (Anaesthesia, Acute Internal Medicine, and Emergency Medicine); The Grange University Hospital (GUH), Cwmbran & Wrexham Maelor Hospital. Two of the training sites solely have ACCS trainees from Emergency Medicine, Prince Charles Hospital, Merthyr Tydfil, and Princess of Wales Hospital, Bridgend. The remaining three sites have trainees from both Anaesthesia and Emergency Medicine, namely Ysbyty Gwynedd, Bangor; University Hospital of Wales, Cardiff; and Morriston Hospital, Swansea.

A regional teaching programme exists for ACCS training encompassing all common aspects of the ACCS curriculum, as well as difficult to obtain knowledge and skills. This is undertaken throughout the year and commences with an induction meeting bringing together all the new ACCS trainees, as well as the key trainers. The teaching programme itself is a blend of virtual and face to face study days with lecture, workshops, hands-on skills, communications, as well as opportunities to achieve various required curriculum skills.

A unique collaboration exists with Cardiff University and Medical School with the intercalated BSc. (iBSc.) programme in Emergency Pre-Hospital and Immediate Care (EPIC), whereby these intercalating medical students attend the regional teaching programmes with opportunities to share training resources, such as equipment and various excellent online e-learning resources.

Each trainee site, as well as parent ACCS specialty, has a lead in order to ensure trainees and trainers in each site and specialty are supported to deliver ACCS training as thoroughly and robustly as possible. These individuals are further supported by a collection of ACCS trainee representatives who can further support and mentor the trainees with their training. All of these individuals are invited to attend the twice-yearly Specialty Training Committee where ACCS training in Wales is discussed and developed.

Finally, a number of future training opportunities exist from a foundation of ACCS training to undertake dual or sub-specialty training in Intensive Care Medicine, Pre-Hospital Emergency Medicine, and Paediatric Emergency Medicine, with all parent specialties of ACCS represented in all of these sub or dual specialty training programmes


“The ACCS training years allowed me to gain experience across acute care including improving my understanding of the interactions and challenges each of four ACCS specialties face. It truly is a brilliant springboard towards a career in anaesthesia, ICM, acute medicine or EM and helps trainees become more confident and competent in managing the critically unwell patient allowing them to feel more comfortable in some of the scariest situations we face as clinicians whatever their final career choices are”