Information on all UK Training Programmes
+ 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:
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.
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).
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.
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.
+ The Paediatric Emergency Syllabus
The new Paediatric Emergency Medicine syllabus came into effect from August 2018. It replaces the PEM sub-specialty curriculum 2010 (revised 2012).
See the Syllabus FAQs.
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).
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 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.
This information is designed for use by anyone interested in Paediatric Emergency Medicine (PEM). This includes the following:
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.
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.
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.
Speak to an EM(PEM) or a Paed(PEM) consultant in your area, or approach your Training Program Director or Head of School.
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.
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.
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 training@rcem.ac.uk
You’ll find more information about Paediatric Emergency Medicine training by using the tabs at the top of this page.
Why do we need to train doctors specifically in Paediatric Emergency Medicine?
Then maybe this is a career for you!
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.
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).
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.
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.
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.
Liaison with other paediatric (medical, surgical, orthopaedic, critical care) departments in the hospital and the associated hospitals in the network.
Not necessarily. Where you work will depend on the configuration of the ED in whichever Trust employs you.
No, only consultants on the Specialist Register for Emergency Medicine can practise adult emergency medicine.
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.
+ What is 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 Out of Programme Training (OOPT). Less than full time (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 or a representative from the PHEM Trainees Association.
National applications for August start PHEM sub-specialty training open in the September the year before.
There are also national opportunities to undertake PHEM as an OOPE (Experience) Fellowship. Posts are advertised by individual PHEM organisations.
Experience undertaken in the prehospital environment is likely to benefit training in Emergency Medicine in a number of complementary domains described across the breadth of the RCEM Curriculum 2021. Our RCEM Curriculum and Prehospital Emergency Medicine: A Guide for Trainees and Trainers was published in June 2021.
EM trainees who have completed PHEM sub-specialty training should be released to undertake PHEM shifts in order to maintain competency and currency before CCT. This should not detract from their EM training and trainees should meet with their Educational Supervisor to ensure a safe working pattern and local service provision. The TSC recommends that 1-2 PHEM shifts are allocated per month (or pro rata for LTFT) from the ED clinical time. Some flexibility will be required as to how these shifts are spread over the year, recognising that the majority of PHEM shifts are 12 hours long and may not be offered on fixed days.
In addition, educational development time (EDT) hours can be used to attend PHEM educational opportunities. Military trainees who have completed PHEM sub-specialty training should have the same provision of PHEM shifts from their ED clinical time. PHEM shifts provide excellent opportunity to develop in a range of core emergency medicine skills. Trainees can evidence any relevant competencies in the RCEM curriculum during their PHEM sub-specialty training year or during their PHEM shifts.
+ 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 ficm@rcoa.ac.uk 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 ficm.ac.uk.
+ 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).
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.
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.
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.
This is a similar situation as that above, and less likely to be supported by your Deanery.
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.
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.
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.
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.
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 training@rcem.ac.uk
For a wealth of information about PEM in general, visit the Association of Paediatric Emergency Medicine website.
Courses of all types are advertised on this page. You can also find more events on the RCPCH website.
+ 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:
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 training@rcem.ac.uk. 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.
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 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.
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.
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 training@rcem.ac.uk.
+ 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.
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.
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):
There are also two components to training that are mandatory for any PoCUS practice:
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.
Information for applicants to UK specialty training.
Find out more
Promoting Excellence in Emergency Medicine Training provides recommendations which outline the Royal College of Emergency Medicine (RCEM) approach to improving its standards for medical education and training.
Find out more
All information on Benefits & Support for Trainees
Find out more
