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Defined Route of Entry into Emergency Medicine (DRE-EM)

What is DRE-EM?

Defined Route of Entry into Emergency Medicine, ‘DRE-EM’, was introduced in 2014.  It is an entry point into Emergency Medicine specialty training and has its own national selection process. The intention of DRE-EM is to increase recruitment to EM training whilst maintaining quality.

DRE-EM allows entry to ST3 via 2 routes:

Route 1 – from surgical training (UK approved with MRCS)

One route is to enter into EM specialty training, having successfully completed two years of a UK core surgical training programme or two years of a UK run through surgical training programme and have obtained MRCS.

Applicants should provide evidence of achievement of CT/ST1 competences in surgery at the time of application and CT/ST2 competences in surgery by the date the post commences. Entry via this route leads to a Certificate of Completion of Training (CCT) in Emergency Medicine.

Route 1a – from surgical training (UK equivalent)

Applicants who complete the equivalent of a UK Core Surgical Training programme (with evidence of achievement of CT/ST1 competences in surgery at the time of application and CT/ST2 competences in surgery by the time of appointment) and who do not have MRCS will train towards Certificate of Eligibility for Specialist Registration – Combined Programme (CESR-CP).

Route 2 – from ACCS specialties

The other route is to enter into EM specialty training with evidence of a minimum of 24 months at core trainee level (not including time spent within a Foundation programme or equivalent) in any ACCS specialties (Anaesthesia, Emergency Medicine, Intensive Care Medicine or Acute Medicine), of which at least 12 months must be in Emergency Medicine.

This route leads to a CESR-CP in Emergency Medicine.

Route 2a – from approved ACCS programmes

Some trainees may have applied and been selected on the DRE-EM route having switched from other specialties within approved ACCS programmes. There might be options for trainees in this category to train to CCT or CESR-CP.

The ST3 ‘year’ will normally last for 18-24 months depending on the competences each trainee still requires for entry to ST4.  ST4 Person Specifications are the same for DRE-EM and non-DRE-EM trainees and include having FRCEM Intermediate or MRCEM.

Sub-specialty Paediatric Emergency Medicine (PEM)

NB: the new Paediatric Emergency Medicine syllabus will come into effect from August 2018. It replaces the PEM sub-specialty curriculum 2010 (revised 2012).
See the Syllabus FAQs.

PEM Sub-Specialty Syllabus (August 2018) ARCP checklist
An ARCP checklist for the PEM sub-specialty training year for trainees who started training on 1 August 2018 or after is available here (PEM SS syllabus ARCP checklist).

PEM sub-specialty curriculum ARCP checklist
The ARCP checklist for trainees who started training before 1 August 2018 and who are not switching to the new PEM syllabus is available here: PEM SS ARCP checklist

Paediatric Emergency Medicine
Paediatric Emergency Medicine is a sub-specialty of both Emergency Medicine and Paediatrics. EM Trainees in the UK have the opportunity to apply for and, if successful, train in a sub-specialty training programme while retaining their NTN. When both parent specialty and sub-specialty training are completed successfully then the College will recommend to the GMC that the trainee be included on the specialist register with PEM as a sub-specialty.
Six months Paeds/PEM training is part of the EM curriculum during the CT/ST3 year. This six months training cannot count towards the twelve months training at sub-specialty level. This section of the website will be concerned with sub-specialty level PEM.

Who is this information for?
This information is designed for use by anyone interested in Paediatric Emergency Medicine (PEM). This includes the following:

  • Medical students
  • Foundation doctors
  • Acute Care Common Stem trainees
  • Trainees in Emergency Medicine
  • Trainees in Paediatrics
  • Heads of School, and Training Program Directors for Emergency Medicine and Paediatrics
  • Educational supervisors of any of the above

How can I train to be a Consultant in PEM?

If you plan to train in the UK you will have to decide in your Foundation Programme whether you want to approach this from the Emergency Medicine (EM) route or the Paediatric route. In both cases this would extend training to be a consultant by about a year.

If you choose to take the EM route, this currently means applying during Foundation Year 2 to enter the 2-year Acute Care Common Stem (ACCS) training (CT1 and CT2). In the next CT3 year all EM trainees spend the year based in an Emergency Department with a large proportion of time dedicated to PEM. Once you enter Higher Specialist Training (ST4-6) trainees can spend an additional year acquiring the competencies required to have PEM registered as a Sub-Speciality on the UK Specialist Register as a consultant. The training consists of 6 months in a PEM training ED, and 6 months based on the wards, in clinics and in Paediatric Intensive Care.

If you choose to take the Paediatric route, at ST4-5 level Higher Specialist trainees in Paediatrics can opt to spend an additional 2 years in their senior training, acquiring the competences required to have PEM registered as a Sub-Speciality on the UK Specialist Register as a consultant. PEM training is usually undertaken as ST6 and ST7 training. There is an annual round of national applications to ‘the Grid’ which is a competitive matching system between applicants and posts available. This is run by the Royal College of Paediatrics and Child Health. The 2 year training consists of 12 months in a PEM training ED, 6 months in the Paediatric Intensive Care Unit and 6 months in surgery / orthopaedics.

How do I train in PEM if I’m already on a Paediatric or Emergency Medicine training programme?

Paediatric Emergency Medicine (PEM) evolved as a sub-specialty of EM in 2002 and of paediatrics a few years later. In July 2010 a new GMC-approved curriculum for PEM training was launched by RCEM and the RCPCH. It is a joint curriculum for trainees of either background. This curriculum has been updated and is now the PEM SS syllabus.

Trainees from an EM background

Subspecialty training for PEM for EM usually requires extension of the predicted CCT date by an extra year. Training comprises one year, which will be spent gaining experience in a PED, and other areas such as PICU and General Paediatrics. This will lead to a CCT in Emergency Medicine, with subspecialty accreditation in PEM. The year’s training can be completed in a block, or spread out through higher specialist training.

How do I find out more?

Speak to an EM(PEM) or a Paed(PEM) consultant in your area, or approach your Training Program Director or Head of School.

Trainees from a Paediatric background

Trainees will undergo a two-year training programme, completed after “core training” and not usually requiring an extension of CCT date. This is called “grid” training and is a competitive entry process, usually undertaken in ST4-5. It comprises one year of which is spent training exclusively in a paediatric ED, with the second year requiring periods of training in paediatric intensive care medicine, anaesthesia, paediatric surgery and paediatric orthopaedics.

Which UK centres offer PEM training?

Click here for a list of PEM training centres and Lead PEM consultants and to see how many places there are for EM registrars, paediatric registrars and the department’s profile – the number of paediatric cases seen and whether there is a dedicated Paediatric ED.

RCEM trainers wishing to start a new rotation or become a trainer for Emergency Medicine trainees will find the documents below of use.

RCEM or RCPCH trainers wishing to start a new “grid” post or become a trainer for Paediatric trainees, please contact the RCPCH.

How do I find out more?

Speak to an EM(PEM) or a Paed(PEM) consultant in your area or approach your Training Program Director or Head of School or e-mail

You’ll find more information about Paediatric Emergency Medicine training by using the tabs at the top of this page.

About PEM

Why do we need to train doctors specifically in Paediatric Emergency Medicine?

  • Do you like treating kids?
  • Do you like treating emergency cases?
  • Do you like the ED environment?

Then maybe this is a career for you!

Do many children come to an ED each year?

Yes – about 5 million attendances each year – which is about 1 in 4 children! The vast majority of Emergency Departments in the UK see adults and children. Children make up 20-25% of attendances. Most Emergency Departments in the UK now have a separate area for children, but this varies from just a separate waiting area to a self-enclosed ED.

Children may present with either injury or illness, and the balance varies widely from department to department – each forming 30-70% of the total. The commonest presenting complaints of children to an ED are limb injury, head injury, difficulty in breathing, fever, rash, abdominal pain, fitting and dehydration.

Who normally treats these children?

Emergency Departments are staffed by Emergency Medicine (EM) trained doctors and nurses. Many departments have a core group of nurses with paediatric training. In at least half of UK EDs one or more of the EM doctors have sub-speciality training in PEM, usually either in larger EDs, or if there are no on-site paediatricians. Sometimes paediatricians are based in the ED; they are likely to have PEM training.

Core training for doctors in general EM training includes 6 months of PEM, and equips all EM consultants to deal with injuries and illness in children to a reasonable level. Core training for Paediatric training does not usually include specific time in the ED, or cover training in injuries.

Looking at the common presentations it can be seen that there is an overlap of skills needed.

There is evidence that an ED which can provide good clinical treatment for both injury and illness, in the right environment for the child and with staff competent and confident in the range of common presentations, children fare better. A study by Geelhoed showed that an increase in PEM consultants coincided with a decrease in the number of children admitted to hospital, in complaints to the department, and in average waiting times, while also being cost effective (Geelhoed G, 2008).

So what does PEM ‘as a sub-speciality interest’ mean?

As well as core (general) training, some trainees opt to undergo additional training in PEM, and are able to qualify on the UK Specialist Register at the end of their training for their base speciality “with sub-speciality recognition for PEM”. This is possible for both EM and Paediatric consultants. EM (PEM) consultants can see adult and paediatric patients, but Paediatric (PEM) consultants are only qualified to look after children. A similar system exists in Canada, the USA, Australia and New Zealand.

It is recommended that in EDs seeing more than 16,000 children per year, there should be at least one EM(PEM) consultant. Larger departments should also have a Paediatric (PEM) consultant (RCPCH, 2007). By the end of 2018 250 EM consultants had undergone additional training in this way, and there are 248 EDs in the UK.

Number of EM CCTs with sub-speciality interest in PEM issued since PEM training was recognised in the UK.

EM(PEM) consultants tend to work across the adult and paediatric areas of the ED. Some consultants (of either type) work solely in Paediatric Emergency Departments. Some Paed(PEM) consultant work in other areas too, such as the Paediatric Admissions Unit, or in General Paediatric Wards and Clinics.

PEM Consultant Census Report

In November 2013, the College undertook a census of practising PEM consultants – from both EM and Paediatric backgrounds. There was a 100% return rate and the results can be found in the document below.

What are the roles of a Consultant in PEM?

EM (PEM) consultants tend to work across the adult and paediatric areas of the ED. Some consultants (of either type) work solely in Paediatric Emergency Departments. Some Paed (PEM) consultant work in other areas too, such as the Paediatric Admissions Unit, or in General Paediatric Wards and Clinics. Some sample plans are shown below.

In general, their role is to provide clinical ED sessions with senior input into paediatric patient care and ensuring appropriate discharge and hospital admission, along with management and leadership responsibilities for children in the ED.

  • Running the paediatric part of the Emergency Department – seeing emergency cases, and supervising junior staff and Emergency Nurse Practitioners
  • Managerial responsibility for quality improvement, guidelines, department design and process for paediatric patients.
  • Establishing audit and research activities within and between departments.
  • Ensuring robust PEM teaching and training for all doctors and nurses within the department
  • Coordination of paediatric resuscitation courses

Liaison with other paediatric (medical, surgical, orthopaedic, critical care) departments in the hospital and the associated hospitals in the network.

  • Liaison with Child and Adolescent Mental Health Services (CAMHS)
  • Lead doctor for child protection within the ED.
  • ED review clinics in some departments
  • Providing a consultant led Urgent Referral / Rapid Access clinics in some hospitals
  • Emergency preparedness for a major incident involving children

If I do PEM training, does that mean I have to work in a dedicated Paediatric ED as a Consultant?
Not necessarily. Where you work will depend on the configuration of the ED in whichever Trust employs you.

If I do PEM training as a paediatrician, does that mean I can work in the adult ED?

No, only consultants on the Specialist Register for Emergency Medicine can practise adult emergency medicine.

What are the opportunities for Pre-Hospital Care as a PEM trained consultant?

At the moment, there are few. Adults comprise 90% of major trauma so having such a selected skill set is not really viable, unless you can do both adults and children. However with the right experience, it is possible that with the advent of Major Trauma networks (regionally and supra-regionally) there may be an increasing role in the future.

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

Target audience: doctors in training (CCT; CESR/CP; CESR) or post-training on the relevant Specialist Register, Training Programme Directors and Heads of Schools

  • 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)<

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 RCEM) 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.

The college has published a route for PEM accreditation by RCEM post CCT or post CESR in EMlink


To attain a CCT in Emergency Medicine, trainees must demonstrate a level of competence in managing children who present to an emergency department setting. It remains the case that the majority of children seen in emergency departments in the UK are seen in all age emergency departments and therefore it is important that EM practitioners are confident and competent in the management of children at the time of their CCT.

The college has published a Framework for Paediatric Emergency Medicine Training and assessment in ST4-6.

Pre-Hospital Emergency Medicine (PHEM)

Pre-Hospital Emergency Medicine is a sub-specialty of Emergency Medicine. Trainees in Emergency Medicine can apply for PHEM training in their ST4 year. PHEM training programme places are available through national recruitment, and consist of 12 months whole time equivalent training during ST5 year or above and including post-CCT. There are a small number of one-year pure PHEM posts nationally and the majority are blended training with a mix of EM/PHEM shifts (in total, one year of EM and one year of PHEM) over a two year OOPT. LTFT PHEM training is also available.

It is recommended that career advice is sought early for trainees who are interested in sub-specialty training in PHEM. Trainees can get more information from the IBTPHEM website  or by contacting the regional PHEM TPD for their region/neighbouring region representative from the PHEM Trainees Association.

RCEM Curriculum and Prehospital Emergency Medicine: A Guide for Trainees and Trainers

Our RCEM Curriculum and Prehospital Emergency Medicine: A Guide for Trainees and Trainers was published in June 2021.

Pre-Hospital Emergency Medicine recruitment

National recruitment for posts in August 2021/February 2022 is now closed. Applications for August 2022 training will open in September 2021.

Note for EM trainees who have completed their PHEM training

After you have finished your sub-specialty training, EM trainees may be allowed one day per month to maintain contact with their PHEM practice, agreed by the RCEM. This is at the discretion of your local School of EM and should not distract from completing your EM training. Military trainees should contact their DCA as days maintaining contact can also be permitted.

Note for EM trainees who have been specifically affected by COVID-19 FIMC cancellation – recommendation of maintenance of PHEM skills July 2020

IBTPHEM cancelled the FIMC examinations scheduled in July 2020 due to COVID-19 with a planned new date of Jan 2021. The recommendations to RCEM are that a minimum of 2 days per month are allocated to allow for maintenance of performance, skills and knowledge in order to meet the requirements of the exam.

The Training Standards Committee recommends the following for trainees undertaking PHEM sub-specialisation. There should be an agreed local negotiation to ensure a safe working pattern and local service provision should be met following discussion with an Educational Supervisor/Clinical Supervisor.

PHEM allocated 2 days per month or pro rata for LTFT, subject to local negotiation may be allocated as part of:

  • Agreed SPA time- half a day per week recommendation for HST
  • Study leave
  • Time out of Training time 1 day per month
  • A combination of SPA, study leave and Time out of Training Time (TOOT)

Time out of Training should not incur an extension to CCT as long as appropriate curriculum progress is maintained and the activities are accounted for and evidenced against the curriculum.

Dual Accreditation with Intensive Care Medicine

Intermediate and Advanced level accreditation in Intensive Care Medicine (ICM) is currently available for EM trainees as regulated by the Faculty of Intensive Care Medicine (FICM). This training is available on a competitive basis and leads to dual CCTs in ICM and EM but only when both training programmes have been completed. Not all programmes will be able to offer, or trainees able to pursue, dual accreditation. Training time is extended as guided by the FICM.

Once appointed to an ICM CCT post for the purposes of Dual accreditation trainees must ensure that they are registered with the Faculty of Intensive Care Medicine. Any queries should be directed to Trainees should also inform the RCEM so that CCT/CESR-CP date can be reviewed.

See the ICM Dual CCTs Guidance.

Further information can be found through the Faculty of Intensive Care Medicine at

Applying for sub-specialty training & time-tabling full-time equivalent training

+ 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 LETB/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 LETB/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 on the GMC’s sub-specialty webpage. 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/LETBs are responsible for recruitment to Paediatric EM training posts.  Trainees may undertake training outside their own LETB/Deanery providing they apply to their “home” LETB/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 LETB/deanery and trainers are informed well in advance.

Who has responsibility for the training?
Postgraduate deaneries/LETBs 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.

Does overseas training count?
Possibly. Sub-specialty training completed overseas can be recognised but should be prospectively sought from RCEM 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.

+ Options for time-tabling 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 RCEM 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.

Training is taken as a single six month block during the last 18 months of training.

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:

  1. 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.
  2. 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

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)

A six month block shared with PICU training (see above), with time apportioned 50:50.

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:

  1. 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.
  2. Be less than three months’ FTE training

Where can I find out more information?

For those wishing to apply for sub-specialty recognition, more information and guidance can be found on the GMC website.

To contact the Training Officers at the Royal College of Emergency Medicine please email

For a wealth of information about PEM in general, visit the Association of Paediatric Emergency Medicine website.

Where can I find details of courses relevant to Paediatric Emergency Medicine?

Courses of all types are advertised on this page. You can also find more events on the RCPCH website.

Further Resources


Royal College of Emergency Medicine
Royal College Paediatrics and Child Health

Association of Paediatric Emergency Medicine

The Association of Paediatric Emergency Medicine is a professional interest group for both EM and paediatric doctors. There are two conferences: the spring conference is usually part of the RCPCH annual conference and the autumn conference is usually part of the RCEM annual conference.


Advanced Paediatric Life Support courses

Useful references

Other useful websites

Pediatric Emergency Care Applied Research Network

Spotting the Sick Child

E-Learning resources

RCEMLearning is the College’s new e-learning platform. All content is open access, mapped to the College curriculum and compatible with any device.

Paediatric EM guidance (NHS Institute)

Out of Programme (OOP)

For a variety of reasons trainees may wish to spend some time outside of their EM training programme. All such requests need to be agreed by the Postgraduate Dean or nominated deputy in advance, so trainees are advised to discuss their proposals with their Educational Supervisor and Training Programme Director as early as possible. Trainees undertaking an OOP retain their NTN.

Out of Programme falls into five categories:

  1. Training (OOPT) enables a trainee to undertake clinical training that is not part of their training programme, either within the UK or overseas
  2. Research (OOPR) enables a trainee to undertake a period of research, normally for a PHD or Master’s degree
  3. Experience (OOPE)enables a trainee to gain clinical experience which is not approved by the GMC, e.g. experience different working practices, support overseas work and training (particularly in developing countries), or gain professional skills that would enhance future practice
  4. Career break (OOPC) enables a trainee to step out of training for personal reasons, such as ill health or caring responsibilities; or to pursue other interests, such as working in industry, developing talents in other areas, or entrepreneurship
  5. Pause (OOPP) enables a trainee to undertake a non-training NHS or other UK based patient-facing post with the opportunity to have any capabilities gained whilst out of programme recognised towards CCT. OOPP is a new out of programme initiative being piloted by Health Education England and is currently only available in England.

College approval for OOPs

Prospective College approval is required for all OOPTs and OOPRs, both in GMC-approved and non-GMC approved locations. The RCEM Training Standards Committee reviews all OOPT/OOPR applications to confirm that the post offers sufficient opportunities to meet curriculum and assessment requirements and that appropriate supervision for trainees is in place. The College will issue a ‘letter of endorsement’ stating the maximum time that may be recognised towards training.

The College recommends that trainees apply for prospective OOPT/OOPR approval at least three months before the post is due to commence to allow for the necessary deanery, College and GMC (for non-approved training locations) approval processes to be completed in time.

Trainees wishing to apply for prospective OOPT/OOPR approval will need to submit an OOPT/OOPR application form, signed by their Educational Supervisor and Training Programme Director, to the College Training Team at Please refer to the form and RCEM OOP guidance for further information and details of the documentation required in support of the application.

Prospective approval is not required for OOPC, OOPE and OOPP. However, trainees must still provide the College Training Team with details of the OOP, such as a copy of their deanery approval, so that their expected completion of training date may be adjusted as appropriate. If a trainee is undertaking an OOPP, the CCT date will be adjusted following the ARCP.

Chief Registrar and Clinical Fellow posts

The RCP Chief Registrar Programme can be undertaken either ‘in programme’ or as an OOPT, whilst Clinical Fellow posts must be taken out of programme. Both posts will require prospective College approval following the same process as above.

The RCEM Training Standards Committee has published a position statement on Chief Registrar and Clinical Fellow posts.

Sub-specialty training in Paediatric or Pre-Hospital Emergency Medicine

Sub-specialty training does not require College approval. However, trainees who have been appointed to a sub-specialty training post in PEM or PHEM will need to inform the College Training Team so that their expected completion of training date may be adjusted as appropriate.

Acting up as a consultant

Trainees who are within one year of their anticipated completion of training date are eligible to ‘act up’ as a consultant for a period of up to three months (WTE). Acting up posts allow trainees to navigate the transition from junior doctor to consultant, whilst maintaining the supervision associated with being a trainee. AUC posts count towards CCT and do not require GMC approval, providing the management part of the curriculum will be covered.

Trainees undertaking an AUC post must notify the College Training Team, and the Educational Supervisor will need to submit a short report to the College at the conclusion of the period of acting up before a recommendation for the award of the CCT may be submitted to the GMC.

Please refer to the College RCEM Acting Up Requirements Guidance on AUC for further information.

Further information

RCEM guidance on taking time out of programme
GMC guidance on taking time out of an approved training programme
COPMeD Gold Guide (8th edition)

For further advice on the College OOPT and OOPR prospective approval process, or to notify the College that you will be taking time out of training as an OOPE, OOPC or OOPP, please contact the RCEM Training Team at

Simulation Training

The Royal College of Emergency Medicine established a simulation specialist group in 2008 to explore the development of simulation training in delivering the RCEM curriculum. The group has focused on the development and delivery of a patient simulation curriculum for the College. The curriculum is best delivered using higher fidelity mannequins that simulate living, breathing patients and their vital signs. However much of the material can be delivered using more basic mannequins and some is best delivered using patient actors.

Simulation training has a particular focus on improving patient safety through an understanding of what are described as Non-Technical Skills. The group has also developed a range of resources for delivering Non-Technical skills training including workshops, written manuals and e-learning modules in addition to simulation.

Regional leads have been appointed to co-ordinate the delivery of simulation training for their respective schools. The regional simulation leads will provide advice and support for those members wishing to become simulation faculty and for those wanting access to training.

The group has developed a number of national courses as well as integrating the excellent work that was already on-going nationally. This process is continuing including the review and revision of established courses. All have or are in the process of gaining CPD approval.

Each course has a director who is responsible for content and advice on its delivery. They along with your regional leads will give advice and support to any member wishing to deliver a College approved simulation course.  There are a full set of educational materials including pre-course materials, simulation scenarios and evaluation sheets that are available to download (see simulation course materials).

Upcoming Simulation Courses and Events

Scottish Simulation Courses

These locally developed courses are led by Dr Roger Alcock and Dr Laura McGregor. Courses available:

For further information please contact Dr Roger Alcock ( or Dr Laura McGregor (

Simulation course materials

We recommend all members wishing to be faculty to attend the RCEM simulation faculty training course. In order to maintain RCEM simulation faculty status we ask that you teach on a minimum of 2 simulation courses per annum.

For access to course scenarios, please contact your regional simulation lead. These are also downloadable from the website.

Regional Simulation Leads

Useful information and resources for general departmental teaching

Course materials are available to download in the zip files below.

Faculty Development Course Materials (updated 29 April 2014) – open access zip files containing:

Download all three parts:
Faculty Development Course Materials (1 of 3)
Faculty Development Course Materials (2 of 3)
Faculty Development Course Materials (3 of 3) – containing:

  • CEM High Fidelity Simulator Directors Guide (4th edition)
  • EM Non-Technical Skills Observation Tool
  • Presentation – Human Factors and EMNts
  • Presentation – Intro to Debriefing
  • Presentation – Patient Safety and Simulation
  • Presentation – Simulation Good Practice
  • Presentation – The difficult debrief
  • Pre-course reading (4th edition)

ACCS Course Materials – open access file containing:

  • Course Directors Guide
  • Powerpoint Presentation. ” Introduction to Emergency Medicine Non-Technical skills.”
  • Dropbox video links
  • Example scenario
  • Acute Severe Asthma and Prioritisation

Other ACCS scenarios are here: Simulation – RCEM ACCS

More Course Scenarios are available for trained faculty covering a range of clinical scenarios and non-technical skills. Please contact your regional simulation lead or for copies of scenarios.

Supporting info for ST3-6 courses – open access zip file containing:

  • Course Director guidance
  • Business case template
  • Feedback templates
  • Intro Powerpoint presentation
  • Pre-course materials

ST3-6 Decision Making Under Pressure scenarios can be accessed via the links below.

RCEM approved scenarios for ST3-6

We have a range of scenarios covering a variety of clinical cases and non-technical skills. These can be accessed from your regional simulation leads or through

In Situ Simulation Scenarios Folder containing 10 in situ simulation scenarios.

CRUMPET: Cross Speciality Multidisciplinary Paediatric Emergency Training – open access zip file containing:

  • CRUMPET Powerpoint
  • Course Manual Simulation Training
  • Equipment list
  • CRUMPET Scenarios

Scenarios can be accessed through regional simulation leads or through or

CT3 PEM Course material

  • CT3 PEM Scenarios
    • Scenarios
      • RCEM ALTE
      • RCEM Asthma
      • RCEM NLS and PPH
      • RCEM Seizure
    • Additional resources
      • Candidate information
      • CT3 PEM Candidate certificate
      • CT3 PEM Faculty certificate
      • Faculty Information
      • X-rays

Communicating in difficult situations – course materials

These scenarios have been developed by Chris Busutitil and his team from the South of England deanery. They are designed to be used with simulated patients. These could be professional actors, amateur actors or willing colleagues. The files include actor briefs which should be given to the person playing the part of the patient/relative in advance. A faculty member, ideally the course director should meet with the person playing the simulated patient in advance to discuss and clarify their role. More information on the use of simulated patients can be found in the Royal College of Emergency Medicine Simulation Faulty manual, also available on this web page. Debriefing following the scenario should follow the College guidance in the Royal College of Emergency Medicine Simulation Faculty Development course.

Ultrasound Training

Welcome to the ultrasound training and practice section of the RCEM website. There is also a complementary section with additional resources on RCEMLearning.

Regional ultrasound leads

We want to ensure each of the regions of the United Kingdom and Ireland have leads for ultrasound training. The leads are primarily responsible for overseeing ultrasound training for emergency medicine trainees; however, they will also be tasked with promoting PoCUS and identifying problems to the Education Committee and Training Standards Committee. An up to date list of these leads can be found here: Ultrasound School Leads Ultrasound Regional Leads. The roles and responsibilities for the regional ultrasound leads can be found here: Roles and Responsibilities of the Regional Reps.

Training in point-of-care ultrasound

From 2010, the higher specialty curriculum for emergency medicine incorporated PoCUS as a mandatory element. This means that from 2013 trainees need to be signed off at CORE level prior to CCT being awarded. Regional panels will not allow an EM trainee to pass the final ARCP without Final Sign-off documentation being presented.

The pathway for training follows key steps which are shown here: Pathway for PoCUS. There are many applications for PoCUS; an application being a discrete focused use, for example evaluation of the abdominal aorta for abnormal dilation. For higher specialty training in emergency medicine there are four clinical applications, termed CORE (formerly Level 1):

  • Focused Assessment with Sonography in Trauma (FAST)
  • Assessment of the Abdominal Aorta for Aneurysm (AAA)
  • Focused Echocardiography in Life Support (ELS)
  • Ultrasound Guided Vascular Access (VA)

There are also two components to training that are mandatory for any PoCUS practice:

  • Understanding the Physics of Ultrasound
  • Good Governance in PoCUS

There are modules in RCEMLearning for all of the above (ELS is currently in development and will be available imminently).

The RCEM EMUS booklet is our core guide which includes information on the assessment process.

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