Pediatrics Pediatric Emergency Medicine (PEM)
MED STUDENT (MS3/4)
JUNIOR RESIDENT
background
Senior RESIDENT
Resources
AUTHOR: Noah Bernhardson, MD, NRP Contributors: Melissa N. Frascogna, MD and Earl “Quinn” Cummings, MD Welcome to the Emergency Medicine Education Roadmap, your definitive step-by-step guide on how to succeed in Pediatric Emergency Medicine at every training level. Don’t know where to start? Click on “Background” or select your training level above. A full list of fellowships, conferences, and publications can be found in “Resources.” For pearls of wisdom from faculty and residents in the trenches, click on “Insider Advice.”
FELLOW
insider Advice
1 - SENIOR MEDICAL STUDENT M3-M4
• R esearch and apply to EM programs that have a PEM fellowship, a combined EM/Peds program, or a significant amount of pediatric experience. Many will be at academic programs. • D ecide if you want to practice emergency medicine with a pediatric focus or if you want to practice pediatrics in a more emergent setting. This will determine the best residency path to pursue. They will both lead to being double board certified, but the paths are different as far as personalities, time, focus, and layout. • I f you are serious about wishing to pursue PEM, you will want to have as much contact with PEM faculty mentors as possible during residency.
2 - JUNIOR RESIDENT PGY1
• F ocus on starting residency right, it is important to work hard within all rotations as it may be the last time you have exposure to such patients in a concentrated form. • M any programs have longitudinal pediatric rotations instead of the historic block rotations. Many programs are shifting to have a block rotation of peds in the PGY 1 year and then longitudinal in the following PGY2-3 years. This allows for the resident to work with peds during all of the seasons allowing for a variety of pathology to be seen in the pediatric population. • Th is also is resonated in some programs that have a PEM specific track that you can align yourself with in order to gather more mentorship and PEM focus experience throughout your residency. • Research:
– If your program has a PEM fellowship, try to find a faculty member or fellow within the program to mentor your ACGME required scholarly project. Not only will this get you started on your requirement early, but this will allow you to list it on your CV that you begin to compile it next year.
• Away Rotations:
– If your program does not have a PEM fellowship, you will likely have an away rotation in EM or a dedicated area of your department that focuses on PEM.
• Timing of National Boards:
– USMLE Step 3/COMLEX 3 should ideally be completed in R1 or early R2 to allow time to focus on the application process for PEM.
– Those in a 4 year residency may have more time, but it is advised to complete as soon as possible.
3 - SENIOR RESIDENT • R esearch: – Begin to wrap up research and prepare to present or publish early in R2/R3. • Conferences: – Attend PEM subsections at either ACEP or AAP conferences in October every year. ■ Advanced PEM assembly is held in March. ■ Information on each can be found on their respective websites below. ■ These provide a good networking and learning opportunity. ■ Try to make it to at least one of these opportunities in R2/3 if not R1/2. Timeline of Application Process: (Specifics can be obtained from NRMP Master Calendar) • Feb – April: – Investigate programs on AAMC/FREIDA website (under the Pediatric and EM sub selections as pediatric EM fellowships are listed under both) and the ERMA Match website
– Investigate requirements for each program (ie. Finished Step 3, number and type of letters recommendation, etc.)
• April-June: – Sign-up for MyERAS website ■ You will need your AAMC ID
– Sign-up for MyERAS token on the MyERAS main page for fellowship applicants
– Once given a Token then activate your application for the season
– Start working on your personal statement
– Update your CV to include: ■ Certifications: including medical licenses, PALS, ATLS, ACLS, etc. ■ Professional Society Membership: ie. SAEM, EMRA, ACEP, AMA, etc. ■ Medical Education including honors
Continued
■ Training/Work Experience : intern, residency, post residency work, moonlighting, etc. ■ Experience: • Volunteer • Research • Work ■ Publications: including abstracts, book chapters, articles ■ Hobbies and Interests
– Ask mentors for letters of recommendation which will be loaded directly into ERAS by the letter writer (they will not be able to upload until June after your have registered)
■ Usually need one from your residency program director ■ Recommended to have at least 1-2 from PEM attendings – some programs will require/recommend a letter from the PEM fellowship director ■ Have a copy of your CV, Personal Statement and AAMC ID available for letter writers ■ If anonymous, supply your letter writers with the email and address of where the letter should be sent • July :
– Mid July – ERAS opens for Fellowship application submission
■ Complete ERAS application, including your basic profile, USMLE scores, activities, awards, personal statement, and letters of recommendation. ■ Designate programs in MyERAS you wish to apply to – you can follow if they have downloaded and received each component of your application on the Programs tab. ■ Letters of Recommendation – You will need to register each person who is writing a letter. You will then receive a form which will instruct your writers on how to upload the document to the ERAS LoR Portal all electronically. ■ This process can take longer than you might think. Be sure to start early, and give your references plenty of time to write their letters and upload the documents to the ERAS site. ■ Programs can start downloading your application now so APPLY EARLY!
Previous
– EDFO (ERAS Fellowship Documents Office)
■ Request through MyERAS and EDFO a copy of your transcript and Dean’s Letter from your graduating medical school (do this as soon as possible as it may take several weeks to upload, you will also need contact information for your Dean’s office designee in order for EDFO to electronically send request). ■ Upload a photo of yourself. • August
– Finalize and submit your application if you have not already.
• Late August
– Sign-up and register for NRMP Match.
• August- October
– Receive invitations and attend interviews.
• Late October
– NRMP open for ranking.
• Late November/Early December
– Rank order list DUE.
• Mid December
– Match results available on NRMP website.
4 - FELLOWSHIPS Questions to consider when evaluating programs and interviewing 1. Will the program allow you to moonlight in EM to keep your adult skills while in the Fellowship? 2. Will moonlighting be scheduled as part of your fellow shifts or will you have a separate opportunity? a. Keep in mind that is you are coming from EM training, you will want to keep you adult skills up if you are planning of practice “regular” EM again. b. Some institutions will allow you to work at the primary teaching facility for the EM residency, while others require you to work outside of the system. Be sure to ask about how this works if you want to work with residents. Current or former fellows are a great resource for this so speak with a current EM-trained fellow about their individual experience. 3. What are the Research requirements for your PEM Fellowship? a. Ask about the track record for previous EM-trained fellows research completion and type. Given the short (2 yr) EM timeline for peds, you will need support from the fellowship program if you want to produce quality research especially if you are focusing on pediatric advocacy in a general EM environment. This environment necessitates solid scholarly experience as the building blocks for patient care education, QI and safety process design. 4. How will you be supervised during your clinical shifts and by whom? (EM faculty, Ped-PEM faculty, EM-PEM faculty) 5. Will you be allowed resident oversight or receive an associate professorship? Which years and what specialties will you be responsible for? 6. What are the characteristics of your clinical environment? (acuity, volume, trauma, etc) 7. What are the mean number, type and who has priority on procedures for that program? (PEM fellows, Anesthesia, Critical Care fellows) 8. Does the fellowship offer any EMS exposure specific for Peds? 9. What electives are available? Are these opportunities congruent with your long term interests? (global health, advocacy, research, etc) 10. How content were previous fellows from that program and where are they working now? (Ask to receive previous fellow’s contact information.)
5 - BACKGROUND Pediatric Emergency Medicine (PEM) is a small but growing specialty. There are two paths to PEM, one through EM and one through pediatrics. The pediatric pathway requires the successful completion of a pediatric residency followed by three years of fellowship. The emergency medicine path requires an EM Residency and a two year fellowship while the pediatric route requires the Pediatric Residency plus a 3 year PEM fellowship. While there are a few private children’s hospitals, most graduates of PEM fellowships will work in academic children’s hospitals.
6 - RESOURCES Memberships • Society for Academic Emergency Medicine (SAEM) • SAEM Residents and Medical Students (RAMS) • American Academy of Pediatrics (AAP)
Residency/Fellowship Resources • SAEM Residency Directory • SAEM Fellowship Directory • Electronic Residency Application Service (ERAS) • ERAS Fellowship Document Office • National Resident Match Program (NRMP) – Pediatrics • NRMP Fellowship Match Dates
Journals, Publications, Resources • Academic Emergency Medicine (AEM) • SAEM Pediatrics Community Group • SAEM/CDEM Pediatrics Curriculum
Conferences • Society for Academic Emergency Medicine (SAEM) Annual Meeting • Advanced Pediatric Emergency Medicine Assembly
7 - INSIDER ADVICE Dr. Earl Cummings, PEM Fellow, Medical University of South Carolina “Choose this field if you love working with complex kids, you may not make as much money as a community EM doc but to me it is worth it!”
Dr. Melissa Frascogna, PEM Fellowship Director, University of Mississippi Medical Center “There is a lot of impact to be had in this field, there is a relative current and growing need for PEM trained physicians. This is also a unique field comprising of two very different residency paths and therefore a synergistic one by its very nature.”