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One of the questions that we are frequently asked as trainee representatives is whether it is better to come to Acute Medicine via the Acute Care Common Stem (ACCS) pathway or via Core Medical Training (CMT). Ultimately either route is perfectly acceptable and which you choose depends much more on your personal interests and how much quickly you wish to reach the ST3 stage. Alexandra Thomson-Moore, an ACCS trainee and the national ACCS trainee representative, has been kind enough to write the article below, giving her perspective on the matter.

Since the article below was written, the future of ACCS as a 3 year programme for Acute Medicine has become the subject of debate. At the time of writing (May 2011) the debate is ongoing. Until this is resolved trainees applying to ACCS to do Acute Medicine cannot be guaranteed 18 months of medicine in addition to the ICU, ED and anaesthetics posts. When deciding between ACCS and CMT you should think carefully about whether you are willing to accept the possibility that your training programme may be jeopardised further down the line.

It is possible to apply to become an Acute Medic at ST3 from either a CMT or ACCS (Acute Medicine stream) background. When deciding which stream to follow from the foundation a pragmatic view may be to apply to both streams and wait to see what job offers one receives. Where you have the liberty of choice, the pros and cons of each stream are set out below.

ACCS (AM) is a three year program. This gives you more time to achieve PACES and develop your CV for medical registrar interviews as well as giving you an additional year’s clinical experience to draw upon as a first year registrar. Where used sagely, you should be more competitive at an ST3 interview after ACCS. ACCS also gives a chance to look at Intensive Care Medicine (ICM). Currently it is possible to apply to a dual CCT programme to certify in both Acute Medicine and ICM at any stage from ST3 onwards. In the future, however, those considering dual certification will have to make this decision explicit at the beginning of ST3 and will not be able to add on an ICM CCT later.

Should you decide midway through your ACCS training that Acute Medicine is not for you it is quite possible to apply for other medical specialities at ST3 level, providing your CV allows you to be competitive in that speciality. It is also theoretically possible to switch ACCS streams to do anaesthetics or emergency medicine. However, it is not guaranteed that there will be sufficient flexibility in the posts in your training programme to allow this to happen.

The main disadvantage of ACCS is that you can feel as if you are treading water whilst you do six months of specialty which you know is not your lifelong career ambition (eg: anaesthetics or emergency medicine). At the same time your CMT friends are passing their MRCP and applying for ST3 jobs. However this is largely a problem of perception as your CMT friends may well look enviously upon both your acute experience and the time you have had to broaden your CV.

Another frustration can arise in the third year where one does a year of medical posts.  The posts may not be exactly what you would anticipate in an acute medicine training programme.  Whilst the same jobs may be found in a CMT rotation it can feel more frustrating in ACCS where one only has one year of these medical posts.  However, there is a requirement that all ACCS (AM) training programmes consist of medical posts that are relevant to Acute Medicine and all rotations are reviewed annually by the ACCS SAC (a committee overseeing training programmes) with any concerns are being addressed as they are identified.  Thus over time things should improve. Most deaneries allocate the third year rotation once you have committed to AM in the second year of ACCS so it can be hard to make an informed decision about this at the time of applying to/accepting an ACCS (AM) program. If you are concerned about this we would recommend speaking to the ACCS Training Programme Directors in the deaneries that you are applying to as they should be able to give you an idea of what posts will be on offer in your Acute Medicine year.

Finally it is worth mentioning that some deaneries have been slow to provide an ST2b year. This is now a national requirement and should be sorted out for anyone at the start of their ACCS program.