Authors: Nikki Abela / Editor: Liz Herrieven /  Codes: SLO12, SLO8 / Published: 13/07/2021

So you are thinking of acting up? CONGRATULATIONS – it means the end of your training is in sight.

According to the RCEM guidance, you would need to have passed FRCEM and be in the final year of training, so you’re nearly over the finish line.


You also, however, need permission from your Head of School and the Post-Graduate Dean. You don’t necessarily need permission from the GMC or the College, but you should advise your medical defence union that you are doing this to make sure you are covered.

Most trainees opt to act up in their final three months, but from my experience I would say if you are anything like me and have lots of leave you didn’t take (and will lose if you don’t take it), then do try and factor that into the timing period you plan to act-up for.

What this will mean may vary on where you work. At the bare minimum, it means you are wearing consultant scrubs, potentially a lanyard, and your “supervised” (i.e. when another consultant is around) shifts will be as a consultant in that hospital. Some places actually take trainees off the reg rota completely (without nights, if this applies where they work) and put them directly on the consultant rota. I have heard (but am not sure if it’s true) that some places also give financial remuneration for the added responsibility. Let’s be clear, you are not working as a locum, but acting up as a consultant, and should still have your national training number and should not have a CCT yet.

It would be unusual to be acting-up as the only consultant on the shop floor, but if this were to happen to say, cover absence due to sickness, RCEM acting up guidelines advise that another onsite consultant from another specialty should be around for support and an off-site EM specialist be available for remote support.

No matter what, you should always have a named consultant available for guidance, and this does not necessarily need to be your supervisor.

Now that we have gone through how it should work, what exactly should you be doing in your time as a kinda-consultant?

Most people immediately think about shift-lead shifts, or EPIC (Emergency Physician in Charge) shifts, but, to be honest, working night shifts as a solo reg or reg in charge are sometimes worse than a shift lead. This is because the shift lead is rarely the only consultant there, and generally is not expected to see as many patients as a reg on nights, so although it is noticeable that the “buck now stops with you”, it’s not a lot different to what you are used to.

A report of your period of acting up needs to be sent to the College as part of the paperwork needed to award your CCT, so keep a log of it.

The things I found most interesting were the things that go on behind the scenes that you don’t necessarily see as a reg – things like the senior staff meetings and the legal meetings around complaints. I was lucky enough to shadow one of the senior consultants for her non-clinical work and it was really eye opening to see the workings of the hospital and the department, beyond what is expected for the “management portfolio”. It also equipped me with insight for the less clinical questions that came up in my consultant interview shortly after.

And talking about that interview, if you are working in the same hospital you are pursuing a post in, this time is really critical in helping you get stuck into the workings of the hospital, and get to know the people that may be on your interview panel. I’m not saying it’s like an extended consultant interview, but it really is.

So make the most of it. This is your chance to try your hand doing what you have been training to do for such a long time. You are nearly there, and you have the chance to practice within the safety-net of being a trainee.. for now.

If your acting up went well, and you’ve got a Consultant Interview, we have some interview tips here.

Once you’ve got the job, we have some tips for your first Consultant job here.