Applying for PEM: Know before you go

Maybelle Kou, MD is the PEM fellowship director at INOVA Children’s Hospital and a member of the AAP Society on Emergency Medicine Program Directors Committee. She addresses the basics of applying.

So I’m interested in applying to Pediatric Emergency Medicine (PEM) Fellowships. Where do I start?

There are currently about 75 ACGME accredited PEM fellowships in North America with new programs developing yearly.

The Emergency Medicine Resident Association published a fellowship guide in 2016 that provides background. The Society of Academic Emergency Medicine also has a fellowship program directory here.

Since it can be confusing to apply, here are some other FAQ to demystify the PEM fellowship application process:

How do I find all the programs?

In ERAS, you will find two lists of PEM fellowships. The heading “pediatrics” or “emergency medicine” denotes the ACGME affiliated primary residency program it is attached to.

You can research programs on both lists, regardless of your primary specialty. Very few programs cater to EM applicants only. The ERAS site provides links to most of the program websites for more info.

How do I know which ones I can apply to? Must I apply only to programs accredited through my primary specialty? 

The short answer is no, but it is confusing. Here’s some background with apologies for the alphabet soup. You’ll want to apply to an ACGME accredited program.

  1. Fellowships gain ACGME accreditation either through the Pediatric Residency Review Committee (RRC) or the Emergency Medicine RRC. For example, if there is no onsite EM residency, a fellowship will apply for accreditation through an onsite Pediatric residency.
  2. ACGME program training requirements for Pediatric Emergency Medicine are the same regardless of Peds or EM RRC accreditation.
  3. In PEM, two regulatory boards oversee the two individual sets of applicants: the American Board of Pediatrics (ABP), and the American Board of Emergency Medicine (ABEM).
  4. All fellows completing fellowship applying for board certification in PEM do so through their primary board, regardless of the accreditation of the program where they trained.

Can I apply to programs that are accredited through the pediatric RRC if I am EM trained?

Yes. ACGME affiliation does not necessarily direct whom the program will train, e.g. there are fellowships accredited by the Pediatric RRC that train EM applicants, and fellowships accredited by the EM RRC that train pediatric applicants. This info is not available via ERAS but might be available on a program’s web page. When in doubt send a query to the program coordinator.

So why is there a difference in length of training?

The length of training is defined by the ABP and ABEM. The length of training for residents trained in pediatrics is 3 years, whereas it is 2 years for emergency medicine trained.

If your first residency is Pediatrics:

Fellowship Training length is 3 years because the ABP requires all subspecialty pediatric fellows  year to perform a year of scholarship and research.

If your first residency is Emergency Medicine:

Fellowship Training length is 2 years (ABEM requires scholarly activity during residency).

If I’m applying from EM what else should I know?

Be aware some training programs can’t offer a 2 year program for EM applicants and they are required to disclose the curriculum up front.

Don’t be put off by a program that has not yet trained an EM graduate.  Be resourceful to make sure you are getting the education you need, program directors are often willing to let you help shape your curriculum.

It’s a good idea to seek out EM trained fellows/graduates from the program who are willing to share their experiences even if there is a track record for training EM folks.

Lastly, if you are an EM applicant applying to programs that require a 3rd year, remember the third year doesn’t have to be a dealbreaker: you may have access to degree programs, such as an Masters in Public Health or Masters in Education. Also, networking from a large, established program with a solid research infrastructure is also an advantage.

Can they make me do research or a third year if the board doesn’t require it?

If the program requires research, then it is a requirement of the program and of the board. Make sure you know what you’re signing up for!

(I don’t like research. Why do I have to do research?)

Finding the right mentorship can help you channel your interests and even change your perspective about research! Be open minded about the opportunity. Even if you don’t see research in your future, a strong foundation in literature appraisal and research methodology will be helpful in your career. It is especially important if you go on to teach in an academic environment, or even in safety and quality.

Last thoughts for applicants from EM:

Remember that within PEM you can carve a niche e.g. education, prevention, EMS, ultrasound and disaster. A fellowship in PEM provides exceptional leadership training as well as an extra board certification. Many fellows go onto leadership positions both in and outside of academics.

When looking for places to train do reach out to the program leadership if you have questions, there are some hidden gems out there you may least expect.

Thanks to Anne Whitehead MD, Jessica Wall MD and Daniella Santiago-Haddock MD for input and links.