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ACCS anaesthetics · Candidate guide

How I approached the ACCS anaesthetics application, MSRA and interview.

I scored in the top 10% of the MSRA and secured Core Anaesthetics training. This is what I learned about Oriel, Professional Dilemmas and the interview stage that ultimately carried most of the final score.

SUDr Stephen UnsworthUpdated 26 September 2026 · 9 minute read

Stephen’s central lesson: the MSRA is the gateway to interview. Once you’re there, your interview performance carries most of the final score.

Top 10%MSRA result · successful Core Anaesthetics applicant

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Understand the route first

Applying for ACCS anaesthetics

The first thing I would clarify is that ACCS is split into three streams: anaesthetics, emergency medicine and acute internal medicine. You apply to the parent specialty you want to enter, and each one has different recruitment criteria.

AnaestheticsThis is the process I went through.

Emergency medicineUses its own application criteria.

Internal medicineApply through the joint IMT/ACCS-IM recruitment process.

I applied through anaesthetics, so that is the process I can speak about. For August 2026 entry, Core Anaesthetics and ACCS Anaesthetics were recruited through one national application. We could preference Core, ACCS or both later.

Read the August 2026 CT1 applicant guidance →

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Oriel and eligibility

Completing your Oriel application

I found the Oriel application itself straightforward. It asked for personal details, my medical degree, employment history and declarations. The employment section took longer than I expected because I had to enter individual foundation placements and details such as the hospital address.

My practical advice is to put everything in a separate document first. I used Oriel and that document side by side so I could copy the information across instead of repeatedly typing it.

Before the application window closes

1Check the current person specification.
Do not rely on last year's eligibility rules.
2Confirm whether you need CREST.
Leave enough time for signatures and supporting evidence.
3Prepare your employment history separately.
Copy it into Oriel using a split screen.
4Submit before the final afternoon.
There is no advantage in testing Oriel at its busiest point.

If you need a CREST form, deal with it early. I know someone whose application was rejected because the required form was not submitted in time. A missing document can mean missing the entire recruitment cycle.

What is CREST? The Certificate of Readiness to Enter Specialty Training confirms foundation-level competence and is generally required if you cannot demonstrate it through a current UK Foundation Programme, an FPCC awarded within 3½ years of the post’s start date, or another accepted training route. Check which evidence you need →

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Portfolio and experience

No CT1 portfolio does not mean your achievements are irrelevant

There was no scored CT1 portfolio or academic-achievement section on Oriel for my application.

The invitation to interview is based on MSRA score alone.Dr Stephen Unsworth, describing his recruitment round

That did not make my previous experience irrelevant. Teaching, quality improvement, teamwork and specialty exposure became the evidence I could use in the general interview.

As there is no portfolio submission, the interviewers know nothing about your CV. You need to speak about your achievements succinctly and make clear why they matter.Dr Stephen Unsworth

The ST4 self-assessment criteria for August 2026 and February 2027 can help you plan development during a clinical fellow or critical care post after FY2, and identify themes to discuss at interview. This is a planning reference, not a CT1 scoring system.

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MSRA preparation

Exam-like questions train the decision, not only the knowledge

I used several clinical resources rather than relying on one source for everything. Revise MSRA was my main question platform because I found the interface easy to use and the questions representative in both their content and length.

Revise MSRA was the best resource. It had a user-friendly interface and exam-like questions in terms of both content and length.Dr Stephen Unsworth

Question length mattered to me because the exam is not just testing whether you know a fact. You have to recognise the important detail, choose between plausible answers and keep moving under time pressure.

For Professional Dilemmas, I used the official MSRA and older Situational Judgement Test examples. I read the explanations closely and looked for themes that kept appearing, rather than trying to memorise individual rankings.

I found PD harder to prepare for than the clinical paper, which is exactly why it is easy to neglect. If I went through the process again, I would protect more time for it. Clinical questions are easier to do ad hoc; PD needs more focused comparison of several defensible responses.

Practise both MSRA papers

Revise MSRA includes CPS and PD questions, timed mocks and concise revision notes.

See how Revise MSRA works →

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Selection weighting

Your MSRA score is key to getting an interview

For my August 2026 application, the MSRA contributed 15% of the final selection score and the interview supplied the remaining 85%.

MSRA · 15%Interview · 85%

That does not mean the MSRA is unimportant. In the 2026 guidance, there was no fixed MSRA cut-off: interview invitations depended on ranking and available slots, with other applicants placed on a shortlist reserve. A stronger MSRA score helped at shortlisting and contributed to the final selection score.

Getting an interview is the start of the most significant part of the application, rather than the end. To be competitive, you need to prepare properly for it.Dr Stephen Unsworth

I would start interview preparation before the MSRA result. An invitation is not the moment to begin.

Many candidates will have practised with anaesthetic supervisors, and some may have interviewed before. To be competitive, you need to practise too, including with colleagues you know less well.

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Interview blueprint

The scoring matrix tells you exactly where to spend your preparation time

The published scoring matrix was one of my most useful interview documents. I used previous scoring sheets to identify the content I needed to prepare and the 2026 matrix to see exactly where the marks came from.

The reflection marks come from the clinical station; this can catch you out if you are not expecting it. The general station includes questions on teamwork, so prepare examples of difficult team situations as well as good ones.

What happens at interview?

The published format has two 15-minute stations: Clinical Judgement and General Interview, with five minutes of reading time before the clinical station. Each station is worth 50 marks.

You need at least 60 out of 100 in the interview to meet the appointability threshold. Meeting that threshold does not guarantee an offer, and serious safety or professional concerns can still lead to exclusion.

Official interview format and scoring guidance →

Clinical judgementMake safe decisions at FY2 level.

Reflective practiceExplain what changed after the event.

Working under pressurePrioritise and escalate safely.

CommunicationMake the answer clear and professional.

TeamworkPrepare good and difficult examples.

CommitmentConnect experience to anaesthetics.

Open the 2026 CT1 interview scoring matrix →

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General interview

Choose evidence that is easy to score

The interview is time pressured. I came away feeling I could have said more, and I think many candidates will feel the same. A long tour of your CV wastes the limited time you have.

I prepared concise examples for teaching, quality improvement, teamwork and reflection. I did not assume the interviewers would infer why an achievement mattered. I explained what I had learned and connected it back to anaesthetics.

For example, a teaching project can show how you changed your explanation to suit a student's level of experience or improved a session using their feedback. It also links naturally to anaesthetics, where trainees have opportunities for one-to-one consultant supervision and teaching. A quality-improvement project does not need to be specifically anaesthetic if you can explain the transferable lesson.

I also think a taster day or anaesthetic placement makes commitment much easier to demonstrate because it gives you direct experience to reflect on.

You will probably come away from the interview feeling you could have said more. It is time pressured, so target your answers to the scoring matrix.Dr Stephen Unsworth

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Interview preparation resources

Know the training programme you are applying to

Topics worth preparing include the Core and ACCS curricula, the exams, audit, quality improvement, teaching and research. Think about how your own experience relates to each, rather than learning a list of achievements to recite.

Curricula and resources

RCoA Stage 1 curriculum and Stage 1 training: the syllabus and requirements of core training.
ACCS curriculum: the common-stem learning outcomes.
RCoA: A Career in Anaesthesia: the 10 November 2026 online event includes recruitment and interview preparation; recordings are available to registrants for six months afterwards.
RCoA Novice Guide: an introduction to the first months of anaesthetic training.
NovPod: the accompanying beginner’s podcast.

The novice resources help you understand the specialty; they are not a requirement to learn specialist anaesthetic management before a CT1 interview.

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Clinical judgement station

Think beyond the first clinical problem

The clinical scenario was pitched at FY2 level. I did not need specialist anaesthetic knowledge, but I did need to recognise when a case was developing towards airway support, intensive care input or a safe transfer.

Recognise
Identify the immediate threat.

→

Treat
Act as you assess.

→

Anticipate
Explain what may happen next.

→

Escalate
Call the right senior or team.

The station could also move into breaking bad news, conflict or communication. I would practise scenarios that go beyond a memorised A to E assessment.

If you can predict where the scenario is going, that shows insight. If you need prompting you can still score marks, but fewer.Dr Stephen Unsworth

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Preparation challenges

Preparing around full-time work

Balancing full-time work and preparation can be tiring and time consuming. The process runs over several months, roughly October to April, with uncertainty at different stages.

In my experience, published timelines for MSRA booking and results, and interview booking and outcomes, have not always been met. Be prepared for changes and keep checking official messages.

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Avoidable errors

Six mistakes I would tell another applicant to avoid

Submitting several specialty applications and spreading preparation too thinly.
Giving Professional Dilemmas much less attention than the clinical paper.
Waiting for the interview invitation before practising aloud.
Preparing long CV summaries instead of matrix-led answers.
Describing achievements without connecting them to anaesthetics.
Missing the likely escalation, airway or transfer issue in the clinical station.

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The practical plan

This is the three-stage plan I would use again

Before Oriel

Read the current person specification.
Confirm CREST requirements.
Prepare employment details.
Arrange specialty exposure.

Before the MSRA

Use representative questions.
Study official PD reasoning.
Plan PD time separately.
Complete timed mocks.

Before interview

Use the scoring matrix.
Prepare concise examples.
Practise with different people.
Anticipate escalation.

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Official figures · Revise MSRA editorial

How competitive is anaesthetics training?

NHS England reported the following figures for Anaesthetics CT1 in the 2025 recruitment round:

6,770Applications

539Training posts

12.6 to 1Applications per post, rounded

That is roughly one post for every 13 applications. Posts equalled about 8% of applications, but this is not a confirmed appointment rate or an individual applicant’s chance of success.

Source: NHS England’s 2025 competition ratios →

Applying for 2027? Latest ANRO guidance

This account refers to the 2026 process. For 2027, ANRO has announced an MSRA cut-off, with the score still to be published; interview capacity and prioritisation also affect invitations.

MSRA window
5–20 January 2027

Anaesthetics interview window
23 February–19 March 2027

Current interview and shortlisting guidance · 2027 recruitment dates · Prioritisation guidance

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Stephen's application FAQs

Four questions future anaesthetics applicants often ask

Did Stephen apply separately to Core and ACCS Anaesthetics?

No. For August 2026 entry, Core Anaesthetics and ACCS Anaesthetics used one national application. Applicants could preference Core, ACCS or both later in the process.

Read the exact August 2026 applicant guidance →

Was there a scored CT1 portfolio?

No scored portfolio or academic-achievement section was submitted through Oriel in Stephen's round. Previous experience still mattered because the interviewers could only score the achievements and reflections he communicated during the interview.

When should interview preparation begin?

Stephen recommends beginning before the MSRA result. The interview carried 85% of the final selection score in his round, so waiting for an invitation compresses the most important preparation into a short period.

Getting an interview is the start of the most significant part of the application, rather than the end.Dr Stephen Unsworth

What should structure anaesthetics interview practice?

Use the published matrix, not a generic list of interview questions. The 2026 matrix shows the six assessed attributes, the global ratings and the 100-mark total.

Open the exact 2026 interview scoring matrix →

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The MSRA gets you into the room. The interview decides most of the final score.

My final advice is to give both stages the time they deserve. The process is drawn out and can be stressful, but the parts you can control are straightforward: submit a complete application, prepare for both MSRA papers and start interview practice early.

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How I approached the ACCS anaesthetics application, MSRA and interview.

Applying for ACCS anaesthetics

Completing your Oriel application

No CT1 portfolio does not mean your achievements are irrelevant

Exam-like questions train the decision, not only the knowledge

Practise both MSRA papers

Your MSRA score is key to getting an interview

The scoring matrix tells you exactly where to spend your preparation time

Choose evidence that is easy to score

Know the training programme you are applying to

Think beyond the first clinical problem

Preparing around full-time work

Six mistakes I would tell another applicant to avoid

This is the three-stage plan I would use again

Before Oriel

Before the MSRA

Before interview

How competitive is anaesthetics training?

Four questions future anaesthetics applicants often ask

The MSRA gets you into the room. The interview decides most of the final score.

Compare another successful anaesthetics application