1. Application Information
Please read the specialty handbook linked here.
You are unable to request changes once you have submitted your application.
I confirm I have read the updated guidance for the 2024/2025 ACCS EM [Tickbox]
2. Additional Degrees and Qualifications
Please select the highest academic achievement you have been awarded
Academic Achievements
Please select the relevant option
- PhD/MD OR first-class honours achievement for additional undergraduate degree
- Undergraduate degree prior to starting medicine OR MSc obtained after qualifying
- No additional undergraduate degree or qualification
Qualifications
For each qualification:
- Subject
- Place of study
- Grade/Result
- Undergraduate or Postgraduate
- Date Qualification awarded
3. Relevant Additional Achievements and Prizes
Please select the appropriate option and then complete the boxes below where you enter details of any prizes, awards and other distinctions.
Relevant additional achievements and prizes
Please select the most appropriate option
- National prize or award since qualifying
- Undergraduate or Postgraduate academic achievement (e.g. prize, distinction, merit etc)
- Scholarship/Bursary or equivalent
- No additional undergraduate achievements
Name of Prize/Award from selection above
Awarding body
Date awarded
4. Presentations and Posters
Please select the highest option on the list that applies to you. After you have selected your option please complete the subsequent sections with details of presentations and posters you have delivered at either international, national, regional or local levels.
Where you have multiple presentations/posters within a field, please put the most recent first.
Include: Title of presentation/article/poster, name of meeting delivered, references, details of your contribution eg first author, joint lead, co-author, or contributor.
Presentations, posters or publications
Please select the most appropriate option
- Presentation of research at annual meeting of a national or international medical body OR first author in published paper
- Presentation of research at a regional meeting OR a poster at a national/international meeting OR co-author in a published paper
- Presentation of research or audit at a Trust meeting (not internal teaching) OR co-author in an abstract or paper submitted for publication
- No presentations, posters or publications
Presentations
Presentations at local level (Words allowed: 250)
Presentations at regional level (Words allowed: 250)
Presentations at national level (Words allowed: 250)
Presentations at International level (Words allowed: 250)
Publications
Publications as first author – Please include title, name of journal, references and date of publication (Words allowed: 250)
Publications as joint first author- Please include title, name of journal, references and date of publication (Words allowed: 250)
Publications as co-author – Please include title, name of journal, references and date of publication (Words allowed: 250)
Publications as named collaborator- Please include title, name of journal, references and date of publication (Words allowed: 250)
Posters
Posters delivered at local level (Words allowed: 250)
Posters delivered at regional level (Words allowed: 250)
Posters delivered at national level (Words allowed: 250)
Posters delivered at International level (Words allowed: 250)
5. Teaching, Researching, Audit and Quality Improvement
In the following section please provide details of any teaching you have provided. For each teaching post give details on the Course title, topic, methodology, target audience, length of time you taught and feedback you have received.
Teaching
Please select the most appropriate option that applies to your teaching experience
- Extensive teaching experience of peers, students, nurses, non-clinicians AND/OR formal training in teaching methodology (eg PGCertEd, MSc in MedEd)
- Designed or led local teaching OR was tutor for medical student group OR has been nominated to be a Life Support Course Instructor
- Taught mainly students
- No experience of delivering teaching
Please provide details of your teaching posts- what level you taught at, how long for and any feedback you have received (Words allowed: 250)
Research Audit and Quality Improvement
Please select the most appropriate option. Following this please list any audits and/or quality improvement projects (QIP) you have completed and the outcomes in the sections below
- Has completed an audit project / QIP. Has evidence of designing and leading an audit – including re-audit and implementation of recommendations
- Designed or led a completed audit project / QIP
- Currently completing an audit project / QIP
- No evidence of having participated in an audit project / QIP
Research- Include title, outcome and personal role. (Words allowed: 250)
Audit- Include title, outcome and personal role. (Words allowed: 250)
Quality Improvement – Include title, outcome and personal role. (Words allowed: 250)
6. Achievements Specific to ACCS Emergency Medicine
Please select the relevant option that is most applicable to you.
After this, please give details about your activities and achievements which demonstrate your commitment to the ACCS Emergency Medicine programme.
Please select the most relevant option of your achievements specific to ACCS Emergency Medicine
- Has passed MCEM Part A OR has attended EM specific conferences/training days OR presented at specialist society meetings
- Is sitting MCEM part A OR did a student elective or taster in EM OR Member of specialist society
- No evidence of participation in the EM world
Please provide evidence of activities and achievements which demonstrate your commitment to the EM ACCS programme. How will this programme benefit your career as an Emergency Physician. (Words allowed: 250)
Outstanding Achievements Outside Medicine
Please select the option that is more applicable to you
- Outstanding personal/sporting/creative/operational/innovative achievement at international level
- Outstanding achievement at national level
- Outstanding achievement at personal level OR student achievement/representation at national level where the extent of the achievement is unclear or limited OR not specific
- No relevant outstanding achievements
List any positions of responsibility you have held outside medicine. (Words allowed: 250)
Evidence of competencies (workplace based assessments (WBA), multi-source feedback (MSF), educational supervisor reports
Which of the following assessments have you got evidence from based on assessment of your practice in the 12 months prior to completing this form:
- Select all
- Educational supervisor reports
- Multi-source feedback report
- Workplace based assessment
7. Training Courses
Please give details of the relevant training courses you attended.
Please include the course title, organisation body and date for each course. Separate each course you have carried out by starting a new line eg
Course 1 title of course, organising body name, date completed
Course 2 title of course, organising body name, date completed
Course 3 title of course, organising body name, date completed
Please advise how many training courses you have completed
Please provide details for each course. You must include Course name, organisation body and date course completed (No word count specified)
8. Do you have any additional skills that can support your application
Please provide details of any skills you feel is relevant towards your career in ACCS EM
Please outline any additional skills [Words allowed: 250]
