Complete guide to getting into Core Anaesthetics

Recruitment into Core Anaesthetics CT1 and ACCS Anaesthetics starting in 2027

Looking for a life of frequent tea breaks, self-rostering and being the one everyone looks to in an emergency?

Anaesthetics has always been a popular choice, but with competition ratios reaching 12.5 it's never been more important to know the recruitment process inside and out, to give yourself the best possible chance of getting in.

In this guide we'll cover everything you need to know, from the programmes themselves, past MSRA scores, what actually happens on the day of your interview and scoring matrices, we've got you covered. Let's get started.

Application Timeline

Estimated, based on patterns observed in previous years

The next recruitment cycle for Core/ACCS Anaesthetics CT1 will be Round 3. This will be recruiting for programmes starting in February 2027.

Will there be a Round 3 for Core/ACCS Anaesthetics in 2026-27?

There has been some speculation about whether there will be a Round 3 recruitment cycle this year. At least for ACCS/Core Anaesthetics CT1 it has been confirmed that there will be.

This will be for recruitment into training posts starting in February 2027.

Following this a new recruitment year will begin, starting with Round 1, for programmes starting in August 2027.

IMPORTANT - Dates for both of these rounds have not yet been formally released. We have estimated the dates below from patterns observed in previous recruitment years. This will be updated once dates are officially released.

	Round 3 Programmes Starting Feb 2027	Round 1 Programmes Starting Aug 2027
Applications Open	28th July 2026	22nd October 2026
Applications Close	14th August 2026	19th November 2026
Book MSRA via Pearson Vue	21st August 2026	14th December 2026
MSRA Window	3-10th September 2026	5-15th January 2027
Results Released	By 8th October 2026	By 16th March 2027

Overview

Core Anaesthetics and ACCS Anaesthetics share a single recruitment pathway which consists of four steps: (1) Longlisting, (2) Shortlisting, (3) Interviews and (4) Offers.

While they share a common recruitment pathway they are two distinct programmes with their own advantages and disadvantages.

ACCS Anaesthetics

ACCS Anaesthetics is an indicative 4 year programme consisting of two stages: ACCS Generic Training (2 years) followed by CT3/4 Anaesthesia completion stage 1 training (2 years).

While it is designed to be a 4 year programme, it is competency based, which means that it is technically possible to complete the programme quicker, if you can show you have met the prerequisite competencies.

The ACCS Generic Training normally consists of 4x 6 month blocks where you rotate through: Anaesthetics, Emergency Medicine, Acute Medicine and Intensive Care Medicine.

During the CT3/4 Anaesthesia completion stage 1 training you will normally rotate through Anaesthetics based placements only, developing competencies in preparation for higher Anaesthetics training.

A key advantage of ACCS Anaesthetics is that, on completion, it allows you to apply directly to Intensive Care Medicine (ICM) training, making it a good option for people who want to do dual ICM/Anaesthetics.

Core Anaesthetics

Core Anaesthetics is an indicative 3 year programme, it is also competency based, so again it is technically possible to complete it in less than 3 years, if you can show you have met the prerequisite competencies.

During training you will only rotate through Anaesthetic departments, making it the preferred option for many people who know they only want to do Anaesthetics in the future. At the end of the programme you will be eligible to apply directly to Higher Anaesthetics Training only.

Competition Ratios

Like most specialities, applicants for CT1 & ACCS Anaesthetics have grown rapidly over the past 5 years. Meanwhile the number of available posts has actually gone down, leading to a sharp rise in competition ratios.

Longlisting

For most candidates, longlisting is fairly straight forward. You submit your application online on the Oriel platform and are asked to select one cluster from (1) England & Wales, (2) Northern Ireland or (3) Scotland. You will only be considered for jobs for whichever cluster you choose.

Following this, as long as you have completed the Foundation Programme, or have equivalent competencies, and have a right to work in the UK, you move onto the next step: Shortlisting.

If you have not completed the Foundation Programme, or did so more than 3.5 years ago, it's worth checking out the official applicant guide to see exactly what you will require. Normally this will either be a Certificate of Readiness to Enter Specialty Training (CREST) or a Foundation Programme Certificate of Competence (FPCC).

Shortlisting

Shortlisting is when things start to get competitive. Shortlisting is the process of deciding who gets to proceed to interview, this is selected based solely on your Multi-Specialty Recruitment Assessment (MSRA) score.

The MSRA consists of two papers:

1. Clinical Problem Solving

Consisting of 86 clinical questions testing your medical knowledge.

2. Professional Dilemmas

Consisting of 50 situational judgement test questions, where you will be tested on your Empathy & Sensitivity, ability to Work under Pressure and Professional Integrity.

They are sat together in a single sitting, you can learn more about the MSRA in our complete guide.

The top n scoring applicants will then be offered an interview, n will change each round depending on interview capacity.

Anyone who has not been invited to interview will be given a status of 'Shortlist Reserve' on Oriel. This means that if a higher ranked applicant who was invited to interview withdraws their application, the next highest rank person on the Shortlist Reserve will be offered their interview place instead.

It is important to note that the MSRA is not just used for shortlisting, it will also make up 15% of your total selection score post-interview.

MSRA Score Distributions for Core and ACCS Anaesthetics

In recent years MSRA shortlisting cut-off scores (to get an interview) have drifted higher and higher. In 2024 you just had to be in the top 43^rd percentile to secure an interview, in 2025 you had to be in the top 20^th percentile. This extraordinary rise has been a function of three things:

1. Number of Applicants

The more people that apply for the Core/ACCS Anaesthetics, the higher the cut-off score will be. This is because MSRA scores are standardised around the mean. As such, the more people that apply, the more people there are with higher scores.

2. Interview Capacity

Interview capacity for Core/ACCS Anaesthetics is relatively fixed at around ~1400 +/- 200 each year. Because this does not scale with number of applicants, it results in a higher cut-off score to secure one of those interview places.

3. MSRA difficulty

The more difficult the MSRA is any given round, the more the distribution will drift to the left, resulting in lower cut-off scores. In practice this effect is minor compared with (1) and (2) as the MSRA difficulty level, and candidate performance, is fairly stable year on year.

You can explore real past MSRA score distributions, for Core and ACCS Anaesthetics, in the chart below.

Cut-off scores drift higher (to the right) as more people apply

Drag across the chart to see what percentile a given score would have placed you in

Interviews

Sub-Preferencing

Once you have been invited to interview you will also be invited to rank sub-preferences.

Sub-preferences consist of geographical regions within the cluster you selected. You can rank these in order of preference. This does not mean you have a training place, this depends on your interview performance.

The Interview

The Anaesthetics CT1/ACCS interview is conducted online. You will receive an invite to book an interview slot via Oriel. Slots are on a first-come first-served basis and they go very quickly. There is normally a 2-3 day window where you can book a slot, but the sooner you book it the better. Failure to book a slot within the 2-3 day window results in your application being withdrawn.

The interview itself consists of two stations: (1) Judgement Station and (2) General Interview Station. Each station is 15 minutes long.

Judgement Station (15 minutes)

Prior to starting the Judgement Station you will be given a clinical scenario. The scenarios are tricky and will often involve competing demands, time pressures, clinical mistakes & difficult colleagues.

There are two assessors, who will be assessing you independently on the following attributes:

1. Clinical Judgement & Decision Making
2. Reflective Practice
3. Working under Pressure

For each attribute, both assessors will score you out of 5. Their scores are then combined, giving you a total score of 10 per attribute.

Each assessor will then give you a global score out of 10. These again will be combined to give you a total global score out of 20.

The scores for each attribute and the global scores are all added together to give you a final score out of 50.

See the scoring matrix below:

Judgement Station Scoring Matrix

Attribute	Assessor #1	Assessor #2
Clinical Judgement & Decision Making	5	5
Reflective Practice	5	5
Working Under Pressure	5	5
Global Rating	10	10

Total Score	50

General Interview Station (15 minutes)

The General Interview Station is aiming to assess you on the following attributes:

1. Professional Behaviour & Communication
2. Teamwork
3. Commitment to Specialty

You will be asked general questions around the three topics, for example: 'When did you first realise you wanted to do Anaesthetics?'.

Scoring is the same as per the Judgement Station, with 5 marks per assessor per attribute, and 10 global marks per assessor, giving a total again of 50 marks to be gained.

See the scoring matrix below:

General Interview Station Scoring Matrix

Attribute	Assessor #1	Assessor #2
Professional Behaviour & Communication	5	5
Team Working	5	5
Commitment to Specialty	5	5
Global Rating	10	10

Total Score	50

Following the interview the total scores from both stations will be combined to give you a total interview score out of 100.

The interview score will then make up 85% of your final selection score, the other 15% will come from your MSRA score.

The top n scoring candidates, for each cluster, will then be offered a training place.

Offers

Once you have been sent an offer, you will have 48 hours to action it. You can do one of three things:

Accept

On accepting an offer you have secured your training place for Core Anaesthetics or ACCS Anaesthetics. You will automatically be withdrawn from any other specialty training programme applications you have submitted.

You can also choose to opt-in for upgrades. If you do, you may still be offered jobs that you ranked higher than the one you have accepted.

Hold

When holding you are reserving the job offer, without committing yet to accepting or declining it. This option is intended for people who have applied for multiple specialities as it allows you to wait to see what's happening with your other applications before deciding what to do with your current offer.

You can also choose to opt-in for upgrades. If you do, you may still be offered jobs that you ranked higher than the one you have put on hold.

Decline

On declining an offer you will be completely withdrawn from the process of applying for Anaesthetics. Your offer will propagate down to the next highest ranked candidate whose own offer is on hold and who ranked the job you were offered above their own. You can proceed with other specialty training programmes.

FAQs

Should I apply for Core Anaesthetics or ACCS Anaesthetics?

Both share a single application and recruitment pathway, so you don't have to choose one over the other at the application stage, you'll rank your preferences as part of the process.

The key difference is that Core Anaesthetics (3 years) leads mainly to Higher Anaesthetics Training, if you wanted to do Intensive Care Medicine you would need to do additional training to meet Stage 1 Medicine competencies.

ACCS Anaesthetics (4 years) lets you apply directly to Intensive Care Medicine (ICM) training as well as Higher Anaesthetics Training.

If you know you want to do Anaesthetics only, Core is often preferred. If you're interested in dual ICM/Anaesthetics, ACCS is often the better route.

What MSRA score do I need to get an Anaesthetics interview?

There's no fixed pass mark, the cut-off changes every round depending on the number of applicants and interview capacity. To give you a sense of the trend: in 2024 you needed to be roughly in the top 43rd percentile to secure an interview, while in 2025 this rose to around the top 20th percentile. You can explore the full historical score distributions in the chart above.

Why are the MSRA cut-off scores rising every year?

Three factors are driving this trend: (1) a growing number of applicants, which pushes the standardised cut-off higher; (2) interview capacity that stays relatively fixed at around 1,400 places, so it can't absorb the extra applicants; and (3) the difficulty of the MSRA itself, though this has only a minor effect as difficulty stays fairly stable year on year.

Does the MSRA only matter for shortlisting?

No. As well as deciding who gets an interview, your MSRA score makes up 15% of your final selection score. The remaining 85% comes from your interview performance. So a strong MSRA score continues to work in your favour even after you've secured an interview.

What happens if I'm not invited to interview?

You'll be given a status of 'Shortlist Reserve' on Oriel. If a higher-ranked applicant who was offered an interview withdraws, the next highest-ranked person on the Shortlist Reserve is offered their place. So it's worth keeping an eye on your status, as places can open up.

What does the Anaesthetics interview involve?

The interview is conducted online and consists of two 15-minute stations: a Judgement Station (assessing Clinical Judgement & Decision Making, Reflective Practice, and Working Under Pressure) and a General Interview Station (assessing Professional Behaviour & Communication, Teamwork, and Commitment to Specialty). Each station is scored out of 50, giving a total interview score out of 100.

How do I book my interview slot?

You'll receive an invite via Oriel to book a slot, on a first-come, first-served basis. There's usually only a 2-3 day booking window, and slots go very quickly, so book as early as you can. Failing to book within the window results in your application being withdrawn.

What are sub-preferences?

Once invited to interview, you'll be asked to rank sub-preferences, which are geographical regions within the cluster (England & Wales, Northern Ireland, or Scotland) you originally selected. Ranking these does not guarantee a place, where you end up depends on your final selection score.

What's the difference between Accept, Hold and Decline on an offer?

You have 48 hours to action an offer. Accept secures your place and withdraws you from other specialty applications (you can opt in for upgrades). Hold reserves the offer while you wait to hear from other applications, without committing yet. Decline withdraws you from the Anaesthetics process entirely and passes your offer to the next eligible candidate.

Can I still apply if I finished the Foundation Programme more than 3.5 years ago?

Yes, but you'll likely need to provide additional evidence of your competencies, usually a Certificate of Readiness to Enter Specialty Training (CREST) or a Foundation Programme Certificate of Competence (FPCC). Check the official applicant guide for the exact requirements for your situation.

And that's our complete guide to getting into Core Anaesthetics & ACCS Anaesthetics.

Good luck with your applications!

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