FRCEM CCT pathway after passing

Authoritative sources

• GMC — Specialist Register
• RCEM — Recommendation for CCT (CCT form)
• RCEM Emergency Medicine 2021 curriculum (v1.5)
• GMC — Emergency Medicine curriculum approval
• ISCP (Intercollegiate Surgical Curriculum Programme) — used by RCEM for ePortfolio

Facts last verified 30 May 2026.

TL;DR: the post-exam checklist

Passing the FRCEM SBA and OSCE is necessary for CCT but it is not sufficient. Before your training programme director (TPD) signs you off for an Outcome 6 ARCP, the panel needs to see entrustment at Level 4 across all 12 Specialty Learning Outcomes (SLOs) under the 2025 v1.5 curriculum, valid ALS and APLS (and ETC where regional), faculty status on at least one life support course, a led or co-led quality improvement project with completed QIATs, multi-source feedback, satisfactory ESLEs across ST4 to ST6, evidence of teaching and leadership, and your Special Interest Area (SIA) signed off.

Submit your CCT recommendation to RCEM via the ePortfolio no earlier than 6 months and no later than the day of your projected CCT date. RCEM takes up to 6 weeks to approve; the GMC then issues the certificate no more than 10 days before the CCT date. You must apply to the GMC Specialist Register within 12 months or you lose eligibility.

Does passing FRCEM mean I get my CCT?

No. FRCEM SBA and OSCE are the summative knowledge and clinical assessments, but CCT is awarded against the whole curriculum. The Royal College of Emergency Medicine (RCEM) recommends you to the GMC only after an ARCP Outcome 6 confirms you have met every SLO at the appropriate entrustment level, hold all mandatory certificates, and have completed the indicative 6 years of training (or longer for dual programmes). The OSCE date is not your CCT date. Your CCT date is the day your TPD certifies completion of training, usually anchored to the end of ST6.

What changed in the 2025 v1.5 curriculum update?

The GMC approved 16 RCEM-proposed amendments to the 2021 curriculum on 6 August 2025. The clinical syllabus and 12-SLO structure are unchanged. Practical changes that affect ST4 to ST6 trainees include: SLO5 now mirrors SLO3 by carrying explicit resuscitation Key Capabilities and descriptors so paediatric severe-illness evidence is properly captured; SLO12 was renamed from “Manage, administer and lead” to “Lead and manage”, with two new Key Capabilities emphasising team leadership over administrative process, mapped onto EMLeaders modules; supporting SLOs (education, QI, research, leadership) have updated descriptors that are now linked directly from the RCEM curriculum website. If your ePortfolio was opened pre-August 2025 you remain on the same syllabus, but your evidence must demonstrate the updated capabilities by your final ARCP.

What evidence does the ARCP panel actually look for at ST6?

The Higher Training ARCP Requirement Guide sets a clear minimum. For each year of higher training (ST4, ST5, ST6) the panel expects:

• One Multi-Source Feedback (MSF) completed within the first 6 months of the training year.
• At least three Extended Supervised Learning Events (ESLEs) per year, distributed across the patient-facing SLOs.
• Approximately one observed episode per week across the Clinical SLOs (MiniCEX, CbD, ACAT, DOPS).
• Entrustment Level 4 for every SLO by the final ST6 ARCP.
• Annual QI engagement via a QIAT form, with at least one led or co-led project across higher training.
• Documented teaching activity (TO1/TO2 feedback) and an educator role appropriate to your stage.
• EMLeaders engagement or equivalent leadership evidence using the LAT form.
• Annual educational supervisor report and form R / Scope of Practice.

Outcome 6 is awarded when every capability has been met. Outcome 5 means evidence is missing but recoverable. Outcome 7.1 to 7.4 carries a fixed-term extension. Outcome 3 (focused remediation) and Outcome 4 (release from programme) are rare at ST6 but possible if entrustment gaps cannot be closed.

Which life support certificates and faculty roles do I need?

By CCT you need a valid (in-date) Resuscitation Council UK Advanced Life Support (ALS) certificate, a valid Advanced Paediatric Life Support (APLS) certificate (or equivalent EPLS / European Paediatric Advanced Life Support), and a valid European Trauma Course (ETC) or ATLS provider certificate. Some deaneries require MIMMS (Major Incident Medical Management and Support) where pre-hospital exposure is limited. APLS is the most common late-stage stumbling block because it expires every 4 years and APLS provider courses book out 6 to 9 months ahead.

RCEM expects evidence of progression toward faculty / instructor status on at least one of these courses by the time of CCT. The usual route is instructor candidate (IC) at an ALS or APLS course, then full instructor with two further faculty sittings. The faculty letter from the course director is the document the panel wants in your ePortfolio.

Timeline table: training stage, what to complete, evidence and ARCP outcome

What is the Special Interest Area (SIA) and when do I lock it in?

The SIA replaces the older “special skills year” terminology. It is a structured period (typically 6 to 12 months WTE during ST5 to ST6) developing capability in an area you intend to bring to your future consultant job plan. Recognised SIAs include Paediatric Emergency Medicine (PEM), Ultrasound, Medical Education, Quality Improvement and Patient Safety, Leadership and Management, Pre-hospital and Retrieval, Toxicology, Older People’s EM, and Research. The SIA is agreed with your TPD, has explicit objectives in the curriculum, and is signed off by the local SIA supervisor. It does not extend your CCT date unless you take subspecialty PEM (12-month CCT extension) or formal dual ICM accreditation.

What are my dual CCT and subspecialty options?

Three formal extended routes are recognised by RCEM and the GMC:

• Dual CCT EM and ICM: joint with the Faculty of Intensive Care Medicine. Indicative training length 8.5 years. Competitive entry, usually at ST3, with dual ARCPs reviewed by both RCEM and FICM panels. You finish with two CCTs and consultant eligibility in either or both specialties.
• Subspecialty PEM: an additional 12 months of in-programme training, extending CCT date from 6 to 7 years. Posts are advertised regionally and require competitive appointment. Some trainees dual accredit, holding a CCT in EM and in PEM.
• Subspecialty PHEM: 12 months WTE during ST5 or above, often blended over 2 years as out-of-programme training (OOPT). Awarded by the Intercollegiate Board for Training in PHEM (IBTPHEM); does not extend the EM CCT date if done as an SIA, but does if done as additional time.

Acute Internal Medicine dual CCT is no longer a formally recognised RCEM route; trainees who want acute medicine exposure usually do this through SIA time or post-CCT fellowships.

What if I am on the Portfolio Pathway (CESR) not CCT?

The route formerly called CESR is now the GMC Portfolio Pathway. Since 30 November 2023 the legal standard is Knowledge, Skills and Experience (KSE) for specialist registration in the UK, not strict equivalence to a CCT. RCEM’s framework for assessing KSE maps directly onto the 12 SLOs of the EM specialty curriculum, so the evidence categories are the same: clinical case logs across the eight patient-facing SLOs, evidence under the four supporting SLOs (education, QI, research, leadership), valid ALS / APLS / ETC, MSF, audit and QI write-ups, teaching evidence, and a structured CV.

You submit the application directly to the GMC via GMC Online. The GMC routes it to RCEM for specialist evaluation; RCEM makes a recommendation; GMC makes the final decision. The current published target is 6 to 8 months from submission to decision, though complex applications run longer. The Combined Programme route (CESR-CP / Portfolio Pathway-CP) remains available for doctors in a recognised training programme who entered without a National Training Number; the evidence requirements are the same as CCT.

When can I apply for the Specialist Register?

Once Outcome 6 is awarded and RCEM has approved your CCT recommendation, the GMC will invite you to apply via GMC Online. The earliest the GMC will grant the application is 10 days before your CCT date, so the practical sequence is: confirm Outcome 6 around 4 to 6 weeks before CCT, RCEM letter follows in 2 to 6 weeks, GMC issues within 10 days of CCT date. Your name appears on the Specialist Register on the CCT date itself. It is a legal requirement to be on the Specialist Register before taking up a substantive NHS consultant post; locum consultant work is permitted in the gap but most trusts will not allow it without a confirmed CCT date letter.

What happens if I miss the 12-month application window?

Applications to the GMC Specialist Register must be submitted within 12 months of the CCT date. If you miss the window, your CCT eligibility lapses and you must apply through the Portfolio Pathway instead, demonstrating Knowledge, Skills and Experience against the current EM curriculum. This is avoidable: book the Specialist Register application into your CCT preparation timeline, not your post-CCT to-do list.

How do I evidence leadership and QI properly?

Leadership evidence under the renamed SLO12 is about decision-making and team behaviour, not committee minutes. The LAT (Leadership Assessment Tool) form sits in the ePortfolio and is used by supervisors to capture observed leadership during clinical shifts. Engagement with the EMLeaders programme (now hosted on eLfH) is expected, with completion of the core modules and reflective entries linked to SLO12 Key Capabilities. A rota lead, simulation faculty, or clinical governance lead role at ST6 is the most defensible evidence pattern.

For QI, the panel wants to see the QIAT form completed annually and at least one project where you led or co-led a full PDSA cycle with measured outcomes. A poster at the RCEM Scientific Conference or a published audit closes the loop. “Designed a survey” alone will not meet the standard.

What about teaching and educator roles?

You need a documented educator role appropriate to your level: an undergraduate clinical teacher, a regional teaching organiser, simulation faculty, or a foundation / ACCS supervisor in your final 12 months. TO1 forms (delivered teaching) and TO2 forms (designed teaching programmes) should be present from ST4 onwards. Completion of “Train the Trainer”, PGCert in Medical Education, or AoME membership is helpful but not mandatory. Educational supervisor recognition is not expected pre-CCT but is the next step many consultants take in their first post.

What are the common ST6 ARCP failure points?

Patterns the panels see repeatedly: APLS lapsed (and the next available course is post-CCT date); Level 4 entrustment missing on a Paediatric SLO because evidence has not been mapped from the rotation; QI project incomplete with no measured outcome; no MSF in the final year; SIA sign-off form missing from the ePortfolio even though the work was done; form R unsigned. The single highest-yield mitigation is a mock ARCP 6 to 9 months before your projected CCT date, run by your TPD against the Higher Training ARCP Requirement Guide checklist. Treat the mock as load-bearing.

How does the ST3 portfolio link to the ST6 CCT submission?

Your ST3 portfolio is the foundation of every SLO entrustment narrative you will build in higher training. If you are still consolidating ST3 evidence, the companion article on becoming an ST3 after FRCEM Final and portfolio prep covers the structure your ST4-to-ST6 ePortfolio should inherit. Trainees who reach ST6 with a sparse intermediate-training evidence base spend the final year backfilling, which is when CCT dates slip.

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