Emergency Medicine ST4 13th November 2025

Emergency Medicine ST4 Interview Guide 2026

If you’re preparing for the Emergency Medicine ST4 interview, it’s essential to understand what to expect from the process. In this blog, we’ll cover how competitive ST4 entry is, the application process, key dates, and the interview format so you know exactly what to prepare for.

Emergency Medicine ST4 Application

Emergency Medicine ST4 is a direct entry point into higher specialty training for those who have already completed core training, such as ACCS Emergency Medicine or DRE-EM, and therefore, it has different eligibility requirements to Emergency Medicine ST3. To secure an Emergency Medicine ST4 post, you’ll need to show that you’ve built up plenty of relevant experience across the ACCS specialties. Specifically, you must have at least 36 months of training at ST/CT1-3 level in these areas, and within that time, you’ll need to meet some minimum requirements:

• 12 months in Emergency Medicine
• 3 consecutive months in Acute Medicine 
• 6 consecutive months in Anaesthesia
• 6 consecutive months in Intensive Care Medicine 
• 3 consecutive months in Paediatric Emergency Medicine 

If you don’t meet these requirements, ST3 may be a more suitable route. You can find out more about the entry requirements for ST3 in our Emergency Medicine ST3 Interview Blog.

Although ST4 is generally less competitive than ST3, it remains a selective process. In 2025, 104 applicants applied for 71 posts, resulting in a competition ratio of 1.46. While this suggests a good chance of securing a place, strong preparation is still essential to ensure success in the interview process.

Before submitting your application, carefully review the Emergency Medicine ST4 Person Specification to confirm you meet all eligibility criteria. You don’t want to miss any requirements, which could mean your application is rejected before you even reach the interview stage.

Emergency Medicine ST4 Self-Assessment

As part of your Emergency Medicine ST4 application, you’ll be required to complete a self-assessment, a crucial element of the selection process. This section allows you to score yourself based on your portfolio, covering 10 key domains. These domains include your prior experience in ACCS training posts, presentations and publications you’ve been involved in, teaching experience, and contributions to quality improvement projects.

Each domain is scored on a scale from 0 to 3, with a total maximum score of 30 points. Your self-assessment score plays a significant role in your overall application, so it’s essential to be both accurate and thorough. Providing clear and well-documented evidence is key—overestimating your achievements won’t help, and under-scoring yourself could put you at a disadvantage.

Once submitted, assessors will review your evidence to verify your scores, so double-check everything carefully before submission. Taking the time to ensure your self-assessment is detailed and well-supported can make a real difference in your Emergency Medicine ST4 application.

Boost your Emergency Medicine ST4 Application by Training in Teaching

You can earn up to 3 points in the teaching domain of your Emergency Medicine ST4 application. To achieve the highest score, you’ll need a master’s degree in medical education. However, you can gain an extra point for your Emergency Medicine ST4 application through ‘training in teaching.’ Attending a recognised course, such as the Medibuddy Teach the Teacher course, can help you secure this additional point. If you’d prefer an interactive environment with peers and tutors, we also offer the course in 1-day and 2-day live formats. 

Teach the Teacher Course by Medibuddy

This two-day CPD-accredited online course will earn you 12 CPD points on completion. It’s entirely flexible, so you can complete it in two days or multiple sessions over a longer period. On completion of the course, you’ll receive a certificate for your portfolio that is accredited for CCT, interviews and appraisals.

Find out more

Emergency Medicine ST4 Recruitment Timeline

You can find the 2026 Emergency Medicine ST4 recruitment dates below:

Emergency Medicine ST4 Interview Format

The Emergency Medicine ST4 interview follows the same structured format as the ST3 interview—a 30-minute panel interview designed to assess key skills such as clinical decision-making, ethical reasoning, communication, and prioritisation. However, as this is an ST4-level interview, the scenarios are more challenging than those at ST3, reflecting the additional experience expected at this stage.

The interview consists of the following three 10-minute stations:

Clinical/Ethical Scenario Station

Here, you’ll face a realistic clinical or ethical dilemma that tests how well you handle complex situations under pressure. Scenarios may involve managing a critically unwell patient, handling a high-risk discharge, or dealing with consent and confidentiality issues. You’ll need to demonstrate sound clinical reasoning, awareness of guidelines, and ethical judgment while justifying your decisions clearly.

Prioritisation Station

In Emergency Medicine, decision-making under pressure is vital. This station will assess your ability to triage and allocate resources effectively in a high-stakes environment. You might be asked to manage multiple critically ill patients, distribute limited staff resources, or decide which investigations to prioritise first. A structured, logical approach is key here.

Below is the type of Prioritisation Scenario you can expect to find in our Emergency Medicine ST4 Interview Question Bank:

Communication Station

Strong communication skills are fundamental in Emergency Medicine, whether interacting with patients, relatives, or colleagues. This station will test your ability to navigate challenging conversations, such as breaking bad news, de-escalating a conflict, or explaining a complex diagnosis in a patient-friendly way. Clear, empathetic communication is essential to scoring well.

How is the Emergency Medicine ST4 Interview Scored?

Each station is individually assessed using a structured scoring system, with your total interview score determining your final ranking.

Your performance across all stations contributes to your final ranking, so consistency is key. NHSE may also impose minimum score thresholds for each domain—failing to meet this standard in any one station could result in an automatic ranking of 0, meaning you won’t progress further in the process.

Thorough preparation across all three stations is essential to maximising your score. Understanding the interview structure, practising with mock scenarios, and refining your decision-making and communication skills will significantly improve your chances of success.

Good luck!