ACCS Emergency Medicine- My Journey to Training
- Hamish Mckittrick
- May 5
- 5 min read
By Dr Hamish McKittrick - FY2
Dr Hamish McKittrick outlines his journey to choosing Emergency Medicine, offering a clear, fact-based overview for medical students considering specialty training. The blog explains how gaining broad clinical exposure, building a medical portfolio, and developing skills through audits, QIPs, electives, and teaching can support career decision-making. It highlights key features of Emergency Medicine, including varied clinical cases, fast-paced environments, and multidisciplinary teamwork. Dr McKittrick also shares insights into his experience in urgent and emergency care, alongside practical guidance on the ACCS Emergency Medicine application process, including MSRA preparation and interview structure for UK postgraduate medical training.
From the start of medical school, one of the most common questions I was asked was what specialty I wanted to do...all of it. I love the hands-on fix of surgery, the in-depth problem solving of medicine; as with most things in life, I couldn't decide. Yes, this was quite stressful at times because it meant that I couldn't focus all my energy on building a portfolio or experience in one area.
Emergency Medicine wasn’t something I had planned early on, but through a combination of experiences, it gradually became the specialty that made the most sense for me.
Over time, I realised it’s not about knowing what you want to do from day dot, but gaining exposure, seeking out opportunities, and working out what you enjoy. This way, when you do decide to commit, you not only know that you’ve kept a broad mindset, but you will also become a very well-rounded clinician.
Why I like Emergency Medicine
It’s variable
No two shifts are the same. You can go from managing a trauma call and intubating patients to putting in blocks for analgesia and neonatal resuscitation. Equally you may see patients with a cough, complex social needs, mental health and everything in between.
It’s fast-paced
You’re constantly making decisions, prioritising, and reassessing. It keeps you engaged and challenged. It might be fairly tiring, but won’t EVER be boring.
Teamwork
This is probably my favourite aspect of EM. It’s a serious team sport; you need everyone performing at their top. For me, it’s the crux of medicine- you’re working closely with the multidisciplinary team, experts from all specialties, and managing patients at their most unwell.
Extracurricular activities (often overlooked)
Most consultants/seniors I work with probably only spend 3 days on the 'shop floor' (the main area of ED where you see patients). There are so many opportunities outside of day-to-day clinical work; teaching, simulation, courses, pre-hospital care, paediatrics, and even work abroad. It’s a specialty with a huge amount of variety.
Advice for medical students
Enjoy medical school first and foremost
It’s easy to get caught up in applications and portfolios, but your main priority should still be learning and enjoying the experience.
Alongside that:
Get involved in societies – this is a good way to experience aspects of the speciality (eg wilderness medicine or paediatrics), build leadership skills and meet like-minded people
Try an audit or QIP – this was the bane of my life... I had started so many projects with no solid outcome. Over time I learnt the key is preparation and understanding. Make sure you CLEARLY outline the aims/objectives (double check they fit the criteria for ST applications) and lay out a timeline with your supervisor. I can't stress how important this is- it will save you so much time!
Make the most of electives and taster weeks - these are great opportunities to explore your interests further. Try it all and see how abstract you can go- you might not get the opportunity again.
Consider early courses/volunteering - St John Ambulance, Street Doctors, ILS; there are endless courses out there
Teaching and mentorship - this is important in all careers in medicine and you can start as early as year 1 of medical school through charities like Medics&Me, widening access initiatives, peer-mentorship and teaching other medical students in the year below you.
Not everything you do has to be directly related to Emergency Medicine- there are always transferable skills and once you have done projects and built skills it is much easier to pick up more in the future
My experience
Looking back, my portfolio wasn’t built around one standout achievement... it developed gradually over time.
One of the most valuable things I did was intercalating in Urgent and Emergency Care at Plymouth University, which included a 9-month placement embedded in the Emergency Department. This gave me the opportunity to complete a QIP, improve my clinical skills such as ultrasound-guided cannulation, but most of all gain a much deeper understanding of how ED functions day-to-day.
Read a blog about the Plymouth ED Intercalation here-
Alongside this, I worked as a Healthcare Assistant in ED for three years during medical school. This not only helped financially, but also gave me early exposure to acute care, helped develop practical skills like bloods and cannulation, and allowed me to build relationships within the department.
I also completed courses such as ILS, which helped build confidence in managing acutely unwell patients.
I attended the NW Major Trauma Conference, a low-cost regional conference, which was very inspiring and interesting, with talks from the likes of Prof Simon Carley and HEMS.
Outside of clinical work, I got involved in Medics&Me, which provided opportunities for teaching, as well as involvement in QIPs and research in medical education. I was also involved in teaching through the Ready Set FY1 programme, which allowed me to develop my confidence in teaching and communication.
Each of these experiences added something different- together, they showed a clear and consistent interest in Emergency Medicine.
Getting a training post
For ACCS Emergency Medicine, the application process is split into:
40% MSRA
60% Interview
Read more about the application to training here: https://rcem.ac.uk/recruitment/
You need to meet the MSRA cut-off to be offered an interview, so preparation for this is key. I used resources like Passmedicine and UKFPO papers, focusing on consistent question practice and understanding guidelines. I gave myself around 2–3 months to prepare. There's no point having a beautiful portfolio if you don’t get the cut-off mark!
The interview itself usually consists of two 10-minute stations:
Portfolio station – discussing your experience, QIPs, teaching, and achievements
Clinical/situational station – often based on ethical or real-world ED scenarios
Final piece of advice for building a portfolio: look at the EM person specification- this is what you are assessed on. Write out what you have done so far, identify where the gaps are, and plan how you are going to fill them. Then take opportunities when they come up, focus on things you enjoy, be proactive, and seek out support when needed.
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