PEM FAQs
Paediatric Emergency Medicine is a recognised sub-specialty of Emergency Medicine (EM) and Paediatrics (see below). Training totals 12 months, consisting of time and competency based training. Recommended training time comprises:
- Six months Paediatric Emergency Medicine (PEM)
- Three months Paediatric Intensive Care Unit (PICU)
- Three months General Paediatrics
PEM training is also available via the paediatric CCT route: for further information contact the Chair of the College Specialist Accreditation Committee for PEM via the Royal College of Paediatrics & Child Health.
This page advises on 2 issues:
1) FAQs for application for PEM sub-specialty recognition, based on GMC guidance
- either pre-CCT, prospectively (most desirable option)
- or post-CCT, prospectively (application pre-CCT to complete post-CCT with grace period and extension CCT)
- or post-CCT, retrospectively (application post-CCT)(In this instance arrangements fall outside of deanery authority)
Target audience: doctors in training (CCT; CESR/CP; CESR) or post-training on the relevant Specialist Register, Training Programme Directors and Heads of Schools
2) The options for timetabling this training within current recognised Higher Specialty Training programmes, based on pragmatic solutions to encourage acquisition of PEM training by EM doctors.
Target audience: trainees, Training Programme Directors (TPD) and Heads of Schools
The following premises apply:
- All training for current and future trainees must follow the new joint sub-specialty curriculum (RCPCH and CEM) approved by GMC in July 2010, and in posts approved for sub-specialty training in PEM.
- Although training is competency based, the minimum period of training should not be less than 12 months FTE.
Section one: The process for applying for sub-specialty training in Paediatric Emergency Medicine
Candidates will only be successful in their application to the GMC for sub-specialty recognition if their sub-specialty training has been undertaken in GMC approved training posts (or overseas equivalent).
When should I apply for the sub-speciality training programme?
The College strongly recommends approaching your Deanery as early as possible, ie during ST4. Once appointed to a post, which can be in a Deanery other than your own, the Training department at the College should be informed so that your end of training date can be recalculated. Training time is likely to be extended by one year.
It is recognised that some trainees may discover later in training that they wish to sub-specialise. This will not prejudice their application but will restrict the timetabling options available (see Section 2). The College also recognises that some post-CCT doctors or existing consultants may choose to undergo sub-specialty PEM training. This is acceptable to the GMC, if undertaken in appropriately approved post, but difficult to achieve and TPDs and Heads of Schools should not advise existing trainees to defer PEM training until post-CCT.
Provided training is undertaken in an approved centre with an educational supervisor approved for PEM training and the competences are signed off at the final ARCP, the GMC is likely to approve an application for sub-specialty recognition. Applications should be made at the same time as the parent EM CCT application for those undertaking training pre-CCT. Trainees undertaking their sub-specialty training post-CCT make their application as soon as possible after completing training. Such applications require the applicant to hold specialist registration and will incur an additional fee.
Can I apply for PEM training as soon as I enter Higher Specialty Training in EM?
Yes, this is the best option. Apply to your Deanery during your ST4 year for a post, and permission to undertake training. The options for timetabling this 12 month full time equivalent training are provided in Section two.
Can I apply for PEM training later in my training?
Yes but there may be problems if you leave it until close to your end of training date. This may not allow your TPD enough time to timetable the training, as the training slots may be full at that point in time. You will also need to undertake the training in a compressed fashion, which is less satisfactory from an educational point of view. The Deanery is unlikely to support the extension of your end of training date if you leave it this late.
Can I apply for training post-CCT but while still a trainee?
This is a similar situation as that above, and less likely to be supported by your Deanery.
Can I apply for recognition post-(EM)CCT as a non-trainee (eg consultant)?
Yes. If you have undertaken training in a GMC approved sub-specialty training post and have evidence of satisfactory completion of the training, the GMC is likely accept your application. If the posts you train in were not approved for sub-specialty training (even if they were EM or paediatric training posts), or if you have gained the competencies in non training posts your application will not be successful.
If you plan to start training as a Specialist Registered doctor, you can apply to an approved PEM centre for a funded PEM post. This is a high risk strategy both in terms of likely GMC recognition and the practical aspects of securing a post.
The GMC application process for post-CCT sub-specialty accreditation is similar to a "mini-CESR". At the end of their training, trainees follow the guidance beginning at http://www.gmc-uk.org/doctors/subspecialty_page_1.asp?p=7 The College provides confirmation that it is satisfied that the trainee has successfully gained all competencies.
How do I apply for sub-specialty training?
Postgraduate deaneries are responsible for recruitment to Paediatric EM training posts. Trainees may undertake training outside their own Deanery providing they apply to their “home” Deanery and their EM School for permission. The College website provides information about the location of training sites in the UK. Appointment is by competitive application to nationally advertised posts. You must have local permission to take up the post so ensure your deanery and trainers are informed well in advance.
Who has responsibility for the training?
Postgraduate deaneries are ultimately responsible for the delivery of training and the assessment of competences via the normal ARCP process. You will however be allocated an educational supervisor within your department with responsibility for ensuring training is undertaken and the assessment system followed.
Can overseas training count?
Possibly. Sub-specialty training completed overseas can be recognised but should be prospectively sought from CEM and the GMC. The training that you do overseas must be in a post recognised for training in the country concerned; experience in a non-training post will not be accepted.
Those who are already on the Specialist Register in Emergency Medicine, who have completed an equivalent overseas training programme, may apply directly to the GMC for recognition following the guidance on the GMC website. Evidence of your appointment, training programme content and competences achieved will need to be supplied to the GMC who will ask the College to evaluate this evidence and provide a recommendation. Again it is best to seek guidance and approval in advance before you embark on your training.
Section two: Options for timetabling the twelve months full time equivalent training
Six months full time equivalent (FTE) in a paediatric ED
This training must be undertaken in a Paediatric Emergency Department (PED) approved for sub-specialty PEM training, under the supervision of a consultant PEM trainer. Guidance on eligibility to be a trainer can be found on the General Training Information page of the CEM website under the heading Quality Assurance and Educational Approval.
OPTION ONE (preferred model)
The training is split into two blocks of three months, one undertaken during ST4/5 and one at the end of training during ST7. This model allows different levels of learning and consolidation of knowledge and skills in the intervening period. For example, to consolidate skills such as the management and training aspects of leading PEM in a hospital / running a department according to national standards, as a consultant.
OPTION TWO
Training is taken as a single six month block during the last 18 months of training.
OPTION THREE
Training is spread over a longer period and completed less than full time: for example, two four month blocks, each containing 75% PED and 25% cover for General ED (either same Trust or another Trust on the training programme). In this model training could be apportioned in any way but must not:
a) Be too piecemeal – moving from day to day or within shifts is disruptive to learning. Changing between EM and PEM training within one day (eg daytime PEM followed by evening in main ED) is not possible. Blocks of days, or weeks, are recommended.
b) Be less than 6 months' FTE training
Three months full time equivalent in Paediatric Intensive Care Unit (PICU)
This training should be undertaken after a minimum of three months' FTE PED training in order to allow the trainee the best opportunity to learn.
OPTION ONE (preferred model)
A three month block
OPTION TWO
A six month block shared with general paediatric training (see below), with time apportioned 50:50.
Three months full time equivalent in general paediatrics
This training should be undertaken after a minimum of three months' FTE PED training in order to allow the trainee the best opportunity to learn.
In order to gain the required competences the training must include post-take ward rounds, clinics for common conditions (eg asthma, diabetes, neurology), new patient / rapid referral general clinics, and shadowing the paediatric on-call registrar. Therefore timetabling can be sessional rather than in blocks of time. This means that during the second half of the ED component, the 3 months of Paediatric ED and 3 months of general paeds can be mixed together and spread over 6 months, in order to maximise learning opportunities, so long as 3 months' WTE of each is achieved.
In order to experience a full range of clinical diversity, both in- and out-of-hours scheduling must occur. It is not acceptable for all out of hours work to be spent in ED.
OPTION ONE (preferred model)
A three month block (incorporating sessional commitments as above)
OPTION TWO
A six month block shared with PICU training (see above), with time apportioned 50:50.
OPTION THREE
Training is spread over a longer period and completed less than full time eg a four month block, containing 75% general paediatrics and 25% cover for general ED (either same Trust or other Trust on the training programme).
In this model training could be apportioned in any way but must not:
a) Be too piecemeal – moving from day to day or within shifts is disruptive to learning. Changing between EM and PEM training within one day (eg daytime PEM followed by evening in main ED) is not possible. Blocks of days, or weeks, are recommended.
b) Be less than three months' FTE training
Where can I find out more information?
The GMC provide guidance on their website for those wishing to apply for sub-specialty recogntion:
www.gmc-uk.org/doctors/aboutsubspecialtyrecognition.asp
Contact the Training Administrators at the College of Emergency Medicine:
training@collemergencymed.ac.uk
For a wealth of information about PEM in general, visit the Association of Paediatric Emergency Medicine website:
http://www.apem.me.uk/index.php
Where can I find details of courses relevant to Paediatric Emergency Medicine?
Courses of all types are advertised on the CEM website here. Courses of particular relevance to trainees are advertised here.
The RCPCH events page can be found at http://www.rcpch.ac.uk/events