Anaesthetics is a very hands-on specialty. Day-to-day work involves a mix of practical procedures, problem-solving, pre-operative assessment, and being involved in the team to review the sickest patients in the hospital. As an anaesthetics trainee, you will receive plenty of supervision and one-on-one teaching. In this article, we discuss what the specialty offers and how to apply.

Our Webinar

Why chose Anaesthetics

• Daily 1-on-1 Consultant-led teaching
• Great mix of practical skills and diagnostic medicine
• What you do as a trainee accurately reflects your day-to-day practice as a Consultant
• No ward rounds (unless you also work within the Pain department, in which case you would have a Pain ward round)
• Very broad scope of practice in which you can choose to specialise within (e.g. Neurosurgery, Obstetrics, Paediatrics, Peri-operative, Pain) or remain as a generalist
• Incredibly varied – can interact with many different surgical specialties in one day
• Excellent opportunities to pursue other interests e.g. management, education
• Get to work as part of a multi-disciplinary team (surgeons, scrub staff, ODPs, midwives)
• Lots of exposure to the management of critically unwell patients and resusitation
• Plenty of Intensive Care experience and can dual train
• Excellent work-life balance
• Very supportive and diverse Consultant body- one of the largest in the hospital

What type of person would enjoy Anaesthetics?

• Able to keep calm and take on a leadership role in an emergency
• Effective team players with strong interpersonal and communication skills
• Practitioners who enjoy linking practical procedures directly to human physiology, pharmacology, and physics.

Training pathway

The Royal College of Anaesthetists introduced a new curriculum from August 2021, where training will be divided into 3 stages. The most recent competition ratio for Anaesthetics CT1 was approximately 12.56:1, while Stage 2 (ST4) was around 1.7.

Stage 1: CT1-3/ ACCS1-4

One intake for core anaesthetics. Interviews occur in January/February for the August intake. During core/ACCS training, you’re expected to complete the Primary FRCA. The Royal College of Anaesthetists is launching a major overhaul of the exam formats starting in July 2027. While the underlying curriculum and syllabus remain identical, the assessment structure is being modernized

The written Multiple Choice Question (MCQ) exam is being replaced by the Primary Applied Knowledge Test (AKT), moving to two sittings per year.

The separate OSCE and Structured Oral Examination (SOE) components are being replaced by a single clinical assessment called the Clinical and Anaesthetic Sciences Exam (CASE)

Stage 2: Specialty Training (ST) 4 & 5

You must re-apply for specialty training.

There are intakes twice a year: August & February. Interviews occur in March/April for the August intake & October for the February intake. During ST4 and ST5, you must pass the Final FRCA.

Written Component Changes

• Consolidated into a single Applied Knowledge Test (AKT).
• Replaces the old format of separate single best answer (SBA) and constructed response question (CRQ) papers.
• Reduces overall written exam time by removing duplicated testing formats. 

Clinical Component Changes

• Replaces the traditional Structured Oral Examination (SOE) viva with a Final Clinical Performance Exam (FCPE).
• Designed as a timed circuit of stations featuring simulation, role-players, communication tasks, and ultrasound application.
• Aligns more closely with everyday Stage 2 clinical challenges and decision-making

ST4 and ST5 focus on building on core anaesthetic skills– intermediate-level anaesthesia and intensive care skills, completing mandatory specialties like Cardiac anaesthesia, Neuro-anaesthesia, and general/specialist ICU

Stage 3: Specialty Training (ST) 6 & 7

Final specialty training years. Under go advance level training in anaesthetics and dedication to special interest areas (SIAs). Spend 12 months deep-diving into a chosen sub-specialty area, which could include advanced intensive care medicine, cardiac/neuro-anaesthesia, Liver transplant anaesthesia, or perioperative medicine.

Application process

The application process is managed by the Anaesthetics National Recruitment Office via Oriel. The selection process this year was split into two parts:

• Multi-Specialty recruitment assessment (MSRA) – 15%
• 30 Minute online interview 85%

· Cut-off scores for MSRA change every year, but the 2026 Cut-off Score was 567.

·  Scoring a 567 required applicants to place roughly in the top 24th percentile of all test-takers nationwide.

You can find more information about the eligibility criteria in the 2026 Anaesthetics CT1 Person specification.

The Interview

Continues to be online – with 2 stations, 15 minutes each

Clinical station: Focusing on clinical management by scenarios (15 minutes)

General interview station: Focusing on portfolio and motivation to do anaesthetics (15 minutes)- focusing on

• Communication & Professional Behaviour
• Commitment to Specialty
• Teamwork

Here is a link to the scoring matrix used in 2025

https://anro.wm.hee.nhs.uk/Portals/3/CT1%20Interview%20Scoring%20Matrix%202025%20FINAL.pdf

Portfolio

Previously, the portfolio directly accounted for a significant amount of the scoring and ranking however, it has been removed for the last few years for CT1(It becomes important for ST4 applications). It is instead being assessed in the interview itself. Here is a link to the previous self guidance for the portfolio station

https://anro.wm.hee.nhs.uk/Portals/3/Documents/National/CT1%20Portfolio%20Preparation.pdf?ver=2018-10-23-115528-717 So, although there is no formal station this gives you an idea of achievements that could be mentioned why demonstrating your strengths and commitment to the speciality

Interview tips

It is best to think of the interview like an exam and practice frequently. Know your portfolio inside out so you can quickly bring up examples for the interviewers, and go over practice questions with friends and colleagues also applying. The time will go by quickly, so the more succinct you can be, the better. Best of luck.

Useful Resources 

• Royal College of Anaesthetists
• Anaesthetics National Recruitment Office
• Acute Care Common Stem (ACCS) Route

By Dr Saarth Shiralkar (ST4 Anaesthetics in North West Deanery) Edited by Dr Rebecca Walsh (CT4 Anaesthetics North Central London Deanery)