Guide
There is no single procedure list running from ACCS to CCT. The list changes, the numbering changes, and the targets change.
Written by Dr Thomas Porter, emergency medicine registrar. Published 30 August 2026. Last reviewed 30 August 2026 against the 2025-26 requirement guides.
There is no single procedure list running from ACCS to CCT. RCEM publishes a separate ARCP requirement guide for each stage, and the procedures named in them are not the same set at a higher level of expectation. The list itself changes.
This matters for record-keeping more than it first appears. A logbook fixed to one stage’s list will report progress against the wrong checklist after a transition.
ACCS uses Learning Outcomes rather than Specialty Learning Outcomes, and practical procedures are LO5, not SLO6. The ACCS guide sets a minimum competency level for each procedure “at the end of ACCS”, expressed as entrustment level 1 or 2a rather than the level 3 and 4 that appear later.
The list is an acute-care one shared across the parent specialties: pleural aspiration, chest drains by both Seldinger and open technique, invasive monitoring, emergency vascular access, lumbar puncture, external pacing, cardioversion, fracture and dislocation manipulation, ultrasound-guided vascular access with fascia iliaca block, and procedural sedation.
Two details are easy to miss. Sedation is assessed with its own tool, the ACCS Sedation Assessment Tool, at a “Minimum of 1 done in any placement; more encouraged”. And on skills-lab training the guide is permissive rather than prescriptive: trainees “should ideally receive training in procedural skills in a clinical skills lab before performing these procedures clinically, but this is not mandatory”.
At ST3 the list changes to the emergency medicine set that runs through to CCT, and the target changes with it. The intermediate guide describes the trainee at completion of intermediate training as having the knowledge and psychomotor skills to perform the procedures safely and in a timely fashion, “with Supervisor ‘on call’ from home for queries, able to provide directions via phone and able to attend the bedside if required to provide direct supervision”. That is the wording of entrustment level 3.
The SLO6 table gives 3 for every procedure at ST3. The clinical SLOs follow the same pattern, with level 3 required at ST3 for the outcomes that carry a numerical level.
Higher training keeps the intermediate list and adds a procedure to it. POCUS for shock appears in the higher SLO6 table and not in the intermediate one, and it is the only entry with no level required until ST6.
The endpoint is stated plainly. At completion of higher training a trainee “would be able to manage with no supervisor involvement”, and will “be able to supervise and guide colleagues in delivering procedural skills”. The ARCP standard for ST6 is “Entrustment level 4 for every procedure and the SLO as a whole”.
Between those two points the tables are less prescriptive than trainees often expect. ST3 carries a number and ST6 carries a number; the ST4 and ST5 columns are marked with an asterisk rather than a required level, and the ARCP standard for those years is given as being “On track for minimum levels to be achieved for each procedure and the SLO as a whole”.
Sign-off travels. The same paragraph appears in all three guides, and it is explicit that it applies across programmes: a trainee signed off as able to perform a procedure independently is “not required to have any further assessment (DOPS) of that procedure”, and “This also applies to procedures that have been signed off during other training programmes.”
The logging expectation travels too, in the same sentence: they “would be expected to continue to record activity in their logbook”. A procedure signed off in ACCS does not need reassessing in higher training, and does need recording.
A record kept across the whole of training has to survive two changes of list and three sets of targets. In practice that means logging against the procedure actually performed rather than against a stage-specific checklist, so the same entries can be reported against whichever list applies at the time.
It also means that a logbook which cannot show the supervision present on each case loses most of its value at exactly the transitions where a supervisor is asked to judge whether a trainee is on track. The guide on what to record covers the fields that judgement needs.
Quotations are reproduced for reference with attribution. Requirements change, and the requirement guides are reissued for each training year: check the current documents on the RCEM website before relying on anything here. LogEM is an independent app and is not affiliated with or endorsed by the Royal College of Emergency Medicine.
LogEM is an independent app. It is not affiliated with or endorsed by the Royal College of Emergency Medicine.
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