Ideal Length of Pediatric Emergency Medicine Training
Publication Title: Two Years or Three? Rethinking the Ideal PEM Training Timeline
Summary
- Question
- This study explored whether the current three-year pediatric emergency medicine (PEM) fellowship training model is optimal for pediatric residency graduates or if a two-year training duration could better meet workforce, financial, and competency needs.
- Why it Matters
- Pediatric emergency medicine is a critical subspecialty, ensuring high-quality care for acutely ill and injured children. However, the length of PEM training impacts workforce dynamics, trainee debt, and the readiness of new physicians. A national conversation is underway to determine whether reducing the fellowship from three years to two years might alleviate financial burdens, attract more trainees, and streamline entry into the workforce, while still maintaining clinical competency and scholarly engagement. The findings are significant for healthcare providers, educators, and policymakers as they shape future training standards.
- Methods
- The authors compared the existing three-year PEM fellowship model with a hypothetical two-year model. They evaluated key factors such as recruitment, clinical competency, scholarly activity, and career preparation. The discussion incorporated perspectives from program directors, fellows, and national task forces, as well as data on workforce trends and competency outcomes.
- Key Findings
- The three-year model provides fellows with more time for scholarly activities, such as research, quality improvement, and education, which are essential for academic and leadership roles. It also ensures adequate clinical exposure, particularly for trainees who enter with limited experience in managing critically ill patients. Conversely, a two-year model could reduce financial strain and attract trainees focused on clinical practice. However, data indicate that many fellows are not fully prepared for unsupervised practice after two years, raising concerns about competency and patient safety.
- Implications
- Maintaining a three-year model supports comprehensive training, enabling fellows to develop advanced clinical skills and engage in meaningful scholarly work, both of which enhance career readiness and the overall quality of PEM care. On the other hand, a two-year model could address workforce shortages and financial concerns but might require significant curricular adjustments to ensure competency. Policymakers and educators must balance these factors to optimize training outcomes.
- Next Steps
- The authors recommend further research to gather input from key stakeholders, including trainees, program directors, and patients. Future studies should evaluate the impact of training duration on clinical competency, career outcomes, and patient care quality to guide evidence-based decisions on fellowship structure.
- Funding Information
There was no funding for this work.
Full Citation
Jain P, Wilson P, Baghdassarian A, Bailey J, Caglar D, Nagler J, Ngo T, Roskind C, Langhan M. Two Years or Three? Rethinking the Ideal PEM Training Timeline. Pediatric Emergency Care 2026, 42: 407-411. PMID: 41714847, DOI: 10.1097/pec.0000000000003585.
This AI-assisted summary has been reviewed and approved by at least one of the study's authors to ensure it accurately reflects the research.
Authors
Priya G. Jain
First AuthorMelissa Langhan, MD, MHS
Last AuthorProfessor of Pediatrics (Emergency Medicine) and Emergency Medicine
Other Authors
Research Themes
Concepts
- subspecialty training;
- pediatric emergency medicine fellows;
- financial impact;
- emergency medicine fellows;
- pediatric subspecialty workforce;
- duration of training;
- clinical competence;
- subspecialty workforce;
- national conversation;
- balanced look;
- training duration;
- training timelines;
- educational leaders;
- accreditation bodies;
- optimal duration;
- national groups;
- training;
- subspecialty;
- decision;
- scholarly activity;
- career preparation;
- pediatric subspecialty training