RCEM 2025 updated: Promoting Excellence in Emergency Medicine Training guidance

This briefing synthesises the 2025 Royal College of Emergency Medicine (RCEM) standards for education and training, which aim to address significant challenges within the specialty, including high rates of burnout and attrition among trainees and trainers (1). The standards establish a framework for excellence, emphasising that high-quality patient care is inseparable from a positive learning environment that values and supports both learners and educators (1).

Key takeaways for clinicians and educational leaders include:

• Shared Responsibility: Quality in Emergency Medicine (EM) training is a shared responsibility across training sites, postgraduate EM schools, and individual trainees. Training sites must provide a safe, well-resourced environment, while schools manage programme quality and trainees engage as adult learners (1).
• Supervision is Paramount: High-quality supervision is fundamental to patient safety and trainee development. The standards mandate specific consultant-to-trainee ratios, require trainers to have protected time (0.25 PA per trainee) in their job plans, and recommend that trainees receive direct consultant supervision on a minimum of 50% of shifts (1).
• Protected Learning Time: Trainees must be allocated Educational Development Time (EDT) within their work schedules. The minimum recommendations are: 3 hours/week for ACCS, 4 hours/week for ST3, and 8 hours/week for Higher Specialty Trainees (ST4-6) (1).
• Environment and Culture: A positive safety culture is non-negotiable. Departments must have robust systems for raising concerns without fear of reprisal, learning from incidents, and ensuring adequate staffing and resources, including 24-hour on-site access to key supporting specialties like Anaesthetics, Intensive Care, and Acute General Surgery (1).
• Structured Training Experience: Rotations must be balanced to provide exposure to the full breadth of the curriculum, including paediatrics, trauma (with at least six months in a Major Trauma Centre or accredited Trauma Unit for HST), and a variety of departmental settings. Trainees must not be placed in isolation (1).
• Quality Governance: Both local and regional quality management processes are essential. Departments must have a Local Faculty Group (LFG) to monitor training, and postgraduate schools are responsible for ensuring all standards are met, with RCEM providing national oversight through mechanisms like ARCP externality (1).