From intern to “accepted”: A guide to preparing for fellowship in emergency medicine

Abstract

Introduction

The number of fellowship options for emergency medicine (EM) physicians continues to expand. While guides exist to help residents explore individual fellowship pathways, we aimed to create a comprehensive guide for all residents considering fellowship.

Methods

At the direction of the Society for Academic Emergency Medicine (SAEM) Board, 9 members of the Fellowship Guide Workgroup, including members of the Fellowship Approval Committee, and 2 members of SAEM Residents and Medical Students (RAMS) group collaboratively developed the guide using available evidence and expert opinion when high‐quality evidence was unavailable. The guide was reviewed and approved by all members.

Results

The guide offers advice to EM residents on how to conceptualize key aspects of their training with respect to preparation for fellowship, including scholarship, teaching, leadership, and electives. Additionally, it offers perspective on selecting a fellowship that matches the resident's interests and goals and successfully applying.

Conclusion

This fellowship guide for EM residents considering fellowship summarizes the best currently available advice for residents considering fellowship training after residency.

INTRODUCTION

Fellowship opportunities for emergency medicine (EM) physicians have increased substantially over time, and now include over 30 unique types of fellowships. ¹  The American Board of Emergency Medicine (ABEM) accredits 10 fellowships under EM, and several others are available to EM physicians under the purview of other American Board of Medical Specialties (ABMS) boards (e.g., clinical informatics, addiction medicine). ² Other EM fellowships (e.g., research, education, and geriatrics) are not currently accredited by a medical board but have a review and approval mechanism via the Society for Academic Emergency Medicine (SAEM). ³ Some newer or smaller fellowships (e.g., wellness, social EM) that are offered may lack an accreditation or approval mechanism due to lack of current consensus on the format and curricular best practices.

Fellowship training has become increasingly important for securing a job for both individual physicians as well as departments. With respect to individual emergency physicians (EPs), the recent expansion of the number of EM residencies is leading to an increasing supply of EPs, ⁴ which likely will make professional differentiation more important. Additionally, for EPs desiring to establish careers in competitive locations, completing a fellowship gives the EP a “leg up” on other applicants where there may be multiple high‐quality applicants. ⁵

For EPs pursuing an academic career, fellowship completion demonstrates a commitment to the specialized knowledge and expertise that can be leveraged to administer programs (e.g., global EM, pediatric EM) and provide educational value to trainees. Fellowship graduates also often have an early track record of success in creating scholarship and developing an academic niche essential for promotion at departments of EM that often advantages them over non–fellowship‐trained EPs during the hiring process.

For any hospital or group hiring EM physicians, fellowship‐trained EPs can provide valuable knowledge and skill sets. For example, an ultrasound fellowship–trained applicant may be able to offer expertise with setting up and running a robust ultrasound billing and quality improvement program.

Excellent resources exist for preparing for specific fellowship training programs, including the Emergency Medicine Residents Association (EMRA) Fellowship Guide, ⁶ EMRA Match, ⁷ the SAEM Fellowship Directory, ⁸ and Residents and Medical Students (RAMS) Roadmaps. ⁹ However, a practical, comprehensive overview for all residents considering fellowship training does not currently exist. Our goal is for this guide to fill that gap.

METHODS

The SAEM Fellowship Approval Committee received a directive as part of its 2021 yearly assigned goals from the SAEM Board of Directors to “assist residents in pursuing fellowship training” as well as “work with SAEM Resident and Medical Students (RAMS) to develop a resource guide for residents.”

SAEM committee members are selected based on subject matter interest and expertise. From May 2021 to September 2021, the Fellowship Approval Committee chair identified nine members with specific expertise in preparing for fellowship as a result of their role in mentoring residents and/or selecting candidates for fellowships. The Fellowship Guide Workgroup (FGW) met via virtual meetings and collaborated asynchronously via Google Docs. While individual members completed sections of the guide, the entire FGW contributed content, editing, and revisions to the full guide prior to submission. Where available, evidence‐based practice was suggested and cited; however, given the relative lack of literature in this area, many of the recommendations represent consensus of the FGW.

The FGW was assembled from members of the SAEM Fellowship Approval Committee and represented expertise from simulation, ultrasound, global EM, administration, and education fellowships. After initial formation, the FGW felt that the inclusion of resident perspectives would provide additional valuable insight to the work by ensuring that the guide was maximally relevant to the target audience, so two resident members with interest in pursuing fellowship after residency were identified from within RAMS for a total of 11 FGW members.

THINKING ABOUT FELLOWSHIP

Benefits of fellowship

In addition to increased competitiveness for jobs, EPs may find value in the opportunity to delve deeper into an area within EM during fellowship and become a subject matter area expert. Fellowship clinical loads are often around half of the typical number of clinical shifts for physician staff. This frees up significant time for fellows to focus on career development opportunities, including hands‐on experience with scholarship, skill development, and program administration. Some fellows may also value to the opportunity to trial academics, pursue clinical expertise, or focus more intensely on nonclinical work after the rigors of residency. Spending time on meaningful work outside of direct clinical care has been shown to decrease the risk of burnout and increase career satisfaction. ¹⁰

Resources for scholarship, additional didactic education, and mentorship opportunities enable fellows to begin to cultivate their niche and jump‐start their career. Attending fellowship in an environment primed for scholarship (e.g., research librarians, statisticians) allows fellows to use fellowship time to establish a foothold of scholarly productivity. Some fellowships may subsidize coursework or advanced degrees such as a master of business administration (MBA), master of education (MEd), or a master of public health (MPH) that serve as a strong marker of committed skills development. One of the strongest arguments for pursuing a fellowship is the opportunity for close mentorship from a leader within a chosen field of specialty, who can connect, sponsor, and coach fellows as they begin their career and serve as valuable resources long after fellowship is over. ¹¹ Fellowship allows for deep connections and networking with thought leaders in a particular subject area, enhancing opportunities for collaboration, scholarship, and eventual job prospects. ¹²

Fellowship training may serve as a significant “jump‐start” to an EP’s career. For example, a residency graduate with fellowship training may be hired directly into an administrative leadership role such as an assistant clinical site director, or assistant residency program director, while a new graduate without fellowship training may require several years of on‐the‐job experience before being considered for such positions. While fellows forgo a full attending salary during fellowship, landing a leadership position more quickly may help attenuate these losses, and certain fellowship‐trained doctors (e.g., toxicology, undersea and hyperbaric medicine) can earn a higher salary than non–fellowship‐trained doctors. ¹³ Fellowship can also open doors to competitive job markets or institutions that do not generally hire graduates directly out of residency.

Importantly, however, the benefits of fellowship may not accrue equally to all graduating residents. Residents offered a strong job opportunity immediately after residency with built‐in opportunities for leadership, mentorship, and on‐the‐job learning may receive many of the same benefits as attending fellowship training without the reduction in salary. Similarly, residents who may have had significant career experience prior to residency, those who are unable to identify a fellowship of interest in their preferred geographic area, or those primarily interested in locums work may accrue a more significant opportunity cost by pursuing fellowship. Each resident should consider the potential benefits of a fellowship in the context of their own career needs and aspirations.

Scholarship

Scholarship is broadly defined by Boyer ¹⁴ as the discovery, application, integration, or teaching of new knowledge; beyond just traditional research, it also encompasses other rigorous work like book chapters, online resources, curricula, and more. Some level of prior scholarship is seen as a plus for fellowship applicants, ¹⁵ as it suggests serious, sustained interest in advancing the field. The quantity and quality of scholarly productivity varies widely among fellowship applicants, however. While some applicants will have authored multiple publications, residents should not be deterred from applying for fellowship if their record of scholarship is limited, especially if they have other experiences that demonstrate sustained interest and commitment to the discipline. Most fellowships are structured to provide the mentorship and structure to support the applicant's academic development, from which future scholarship will follow.

Applicants considering a fellowship should identify opportunities for scholarship early in residency—query institutional faculty about ongoing or future projects that may require assistance. If the type of fellowship desired is already known, reach out to faculty working in that field to build a network while identifying opportunities. Residency leadership, senior residents, current fellows, and alumni are great resources to identify both people and projects within and outside the institution.

While scholarship within the subspecialty of the desired fellowship is ideal, gaining initial experience with the process is more important than the topic. This includes exposure to as much of the life cycle of various scholarly projects as possible, from conception, development of methods, ethics panel review, budgeting, implementation, data collection, analysis, manuscript development, submission, and revisions. Core skills involved in each of these stages are transferable between disciplines. Successfully participating in a scholarly project also demonstrates the ability to work as part of a team and meet deadlines, two traits that fellowship directors look for in high‐quality applicants.

Fellowship programs do not expect that applicants were first or last author on peer‐reviewed publications or that they published in high‐profile journals. It is understood that opportunities to engage in scholarly projects will vary by location, but it is expected that applicants showed initiative and reasonably took advantage of opportunities within their residency context. Participating in regional and national organizations can also help broaden their network and support the development of new scholarship. Many opportunities exist online and through virtual networks; interested residents should reach out to online educational organizations to see if help is needed. Residents should remember that the most important skills to get out of residency are clinical, this work should not suffer in the pursuit of scholarship. The best fellows, regardless of subspecialty, are first and foremost excellent clinicians.

Mentorship

Mentors play a critical role in helping residents prepare for fellowship during residency. From guiding the selection of projects to get involved in (or alternatively to avoid), to suggesting potential committees to join, to networking with their contacts across the country, mentors can be invaluable for assisting with all stages of the preparation for fellowship. ¹⁶

Often, faculty that can serve as great mentors exist within a resident's training institution and can be uncovered through word of mouth or expressing interest in their area of expertise. Residents with scholarly tracks at their program within their area of interest may find relevant mentors through track involvement, ¹⁷ although these are still only available at a minority of residency programs. ¹⁸ Occasionally, however, residents develop an interest in areas that are outside of the expertise of faculty members at their own program. In this case, a residency program director (PD) can often be a helpful facilitator to outside connections. National organizations, such as SAEM or the American College of Emergency Physicians (ACEP), can serve as a helpful link to potential mentors via their interest groups or attendance at relevant events at their national meetings. Some subspecialties (e.g., toxicology, global EM, pediatric EM) have their own national organizations that can offer valuable resources and connections. Even a cold email to a faculty member at another institution can be effective—most faculty would love to hear from an enthusiastic trainee who shares their interests and offers to collaborate on a project.

Leadership and committees

Leadership opportunities are generally considered some of the more meaningful additions to an applicant's curriculum vitae (CV), ¹⁶ and this is an area where society memberships (e.g., SAEM, ACEP, and the American Academy of Emergency Medicine [AAEM]) may be especially helpful. While membership alone confers relatively limited benefit, participation in resident councils or a leadership role in the resident section of a society may speak to responsibility and follow through. ¹⁹ In particular, engagement as a resident representative to an intended subspecialty group is useful, as it may yield networking and project opportunities in a desired field. By engaging in these organizations in a leadership capacity, an applicant begins to foster a deeper understanding of the current state of the subspecialty area, grow their leadership skills, and become more personally known to potential fellowship directors. Additionally, committee roles may help a fellow stand out from other applicants. ²⁰ Similarly, selection or service as chief resident is generally considered valuable, as it may be viewed as a sign of maturity, ²¹  leadership, and teaching skills. ¹⁶

Strategic extracurricular activities, especially those with leadership roles, will strengthen a fellowship application. Many subspecialties are represented in academies within national organizations like SAEM and provide an opportunity for networking and resources. Specialty organizations, such as the Wilderness Medicine Society (for wilderness medicine fellowships) or the Society for Simulation in Healthcare (for simulation fellowships) provide similar niche content, resources, and access to networking with potential fellowship directors. Involvement in societies is not a requirement for successful fellowship applications however, and not all applicants are members. ²⁰ Additionally, some programs rank extracurricular activities as the least impactful component of an application. ¹⁹

Teaching

While teaching experience is obviously critical for applicants pursuing an education fellowship, residents considering any type of EM fellowship should consider teaching experience at any level a valuable addition to their CV. The ability to confidently convey content to learners is applicable to nearly all types of EM fellowship. For example, emergency medical services (EMS) fellows may be required to teach content to prehospital providers, while palliative medicine fellows may need to teach nurses, physician assistants, and other physicians the skills that they acquire. Additionally, many fellowship‐trained EPs practice in academics, where they will teach medical students and residents, both clinically and in didactic sessions. A teaching log may be a valuable addition to a CV, indicating the content taught, the number and level of learners, and the frequency of participation. ²²

Elective time

For most fellowships, there are no strict requirements for how elective time in residency must be spent. Critical care fellowship is the major exception to this rule, as internal medicine critical care mandates 6 months of internal medicine rotations, ⁹ which often requires the use of elective time. Participating in the specialty of the intended fellowship for at least part of elective time is highly recommended, however, as it demonstrates a sustained, thoughtful commitment to an area of focus and suggests to fellowship directors an informed choice for career planning. Additionally, elective time offers the opportunity to pursue larger projects (e.g., scholarship, quality improvement work, away rotations) and achieve more than a resident schedule typically allows, which can bolster the competitiveness of an application for fellowship. While some applicants may choose to spend the entirety of their elective time on their intended area of fellowship, there is certainly no obligation to do so. Fellowship directors are aware that a variety of experiences can be extremely valuable to EP career development, and electives of interest such as a global EM rotation or a flight elective may develop critical clinical skills useful for any fellowship.

Additional coursework

Applicants considering a fellowship may be interested in completing coursework related to their intended area of specialty, either through a university or through a national specialty organization such as SAEM. For example, an applicant pursuing a research fellowship could bolster their skills with a statistics course or the SAEM Advanced Research Methodology Evaluation and Design (ARMED) program. ²³  While any additional coursework like this will likely be viewed by fellowship directors as further evidence of ongoing interest and commitment to developing specialty‐specific skills, residents should view educational programs such as this as strictly optional. Fellowship directors understand that resident schedules are extremely busy and that the fellowship period, with its lower clinical burden, is often the ideal time to pursue this coursework instead; many fellowships are explicitly designed to include time for the highest yield coursework.

CHOOSING A FELLOWSHIP

Criteria to consider

When it is time to choose potential fellowships, the first thing applicants should consider is which specific programs to target. Ideally, fellowship choice should be based on best “fit”: which program offers training that matches an applicant's individual passions, needs, and interests? As many EM fellowship programs do not have a central accrediting body that dictates their structure, there can be significant variability in the curricula and the types of applicants in which they are most interested. Fellowships’ geographical locations and organizational and departmental cultures (including their missions, visions, values, guiding principles, and strategic plans) may all influence the type of content delivered during fellowship. Applicants to critical care fellowship will also need to consider which path (e.g., anesthesia, surgical) is the best match for them, as their fellowship choice may influence where they practice and what types of patients they will see as an intensivist.

For some fellows, geographic considerations must take precedence over individual program attributes due to personal or family considerations. A fellowship can be a great way to “audition” for a faculty position, and many fellows seek programs in places they ultimately want to live long term. However, applicants with geographic limitations to their pool of potential fellowships should still scrutinize the curricula and learning environment at all programs being considered to ensure that each meets their minimal requirements for career development. Geographically limited applicants may also consider applying outside their strict region of interest to enhance their network of contacts and expand future job prospects.

Because fellowship programs can differ so drastically, the interview process is a crucial final step for vetting the programs at the top of an applicants’ list. Scrutinizing program websites prior to interviewing, speaking with fellowship directors and current fellows of the programs, and asking careful questions during the interview process to understand how the program is structured (e.g., weekly didactics vs. independent study) and what jobs former fellows have landed is essential to ensure a happy pairing. Other important questions to ask can include the number of available positions, length of fellowship (including whether this is flexible), any affiliated organizations (e.g., relationships with area EMS agencies, EM podcasts), and additional benefits (e.g., advanced degree subsidies, leadership roles, CME funding, moonlighting opportunities). Applicants should attempt to avoid choosing a fellowship based on similarity to current faculty and fellows alone—while this superficial fit may feel initially satisfying, ensuring a match with individual interests and career goals will ultimately be more successful. ²⁴

Accredited versus nonaccredited fellowships

Residents torn between multiple specialties for fellowship may wonder whether fellowships that are accredited and board eligible with the ABMS are preferrable to those that do not have accreditation and board eligibility (see Table 1 for a list of board‐eligible fellowships and Table 2 for a list of fellowships that are not board eligible).

TABLE 1.

Fellowships in EM that are board eligible with the American Board of Medical specialties as of October 2021 (through ABEM unless specified)

Anesthesiology critical care

Addiction medicine (through the American Board of Preventative Medicine)

Brain injury medicine (through the American Board of Psychiatry and Neurology)

Clinical informatics (through the American Board of Preventative Medicine)

Emergency medical services (EMS)

Hospice and palliative medicine

Internal medicine–critical care medicine

Medical toxicology

Neurocritical care

Pain medicine

Pediatric EM

Sports medicine

Surgical critical care (through the American Board of Surgery)

Undersea and hyperbaric medicine

TABLE 2.

Fellowships in EM that are not board eligible with the American Board of Medical Specialties as of October 2021 (list may not be exhaustive)

Administration

Aerospace medicine

Cardiovascular emergencies

Disaster medicine

Education

Flight medicine

Geriatrics EM

Global EM

Health policy

Injury prevention

Observation medicine

Occupational and environmental health

Research

Resuscitation

Sex and gender studies

Simulation

Social EM

Tactical medicine

Telemedicine

Emergency ultrasound a

Wellness

Wilderness medicine

Women's health

Note: Fellowships in italics are currently eligible for approval through SAEM.

^a Ultrasound has a separate approval process outside of SAEM, described below.

Both models have their advantages: accredited fellowships offer standardized curricula overseen by the Accreditation Council for Graduate Medical Education (ACGME) and the ABMS to ensure relatively uniform quality across all programs, while nonaccredited fellowships can offer a greater degree of customization, depending on individual applicant needs and interests. Both also have their disadvantages. Notably, ACGME‐accredited fellows in EM are still considered trainees by their training institution and may be paid on the trainee scale according to their postgraduate year at some programs. Depending on the structure and financial arrangements of the institution and physician groups, they may be able to work as attending physicians. For non‐ACGME programs, fellows are treated as junior faculty and paid accordingly (albeit often at a lower annual salary given their decreased shift load). There is more significant variation in structure and quality without the standardization that accreditation offers. Some programs may offer robust curricula and varied hands‐on experiences while others offer relatively limited career development opportunities and serve mainly as low‐cost, low‐commitment labor for their sponsoring institutions. SAEM has also developed a fellowship approval process for many nonaccredited fellowships (see Table 2) that provides some standardization across programs. ³ As discussed previously, closely examining each fellowship for competitive pay, mentorship, and leadership opportunities is even more essential for nonaccredited programs.

This unique set of advantages and disadvantages in pursing an accredited versus a nonaccredited fellowship makes it particularly important for potential fellows to critically examine their own passions and career goals as well as the specific offerings at each program; a highly regarded EM residency program does not necessarily mean that their fellowship offerings will be uniformly high quality as well.

Ultrasound

Ultrasound is unique among EM fellowships as it follows a novel non‐ACGME pathway of accreditation. In 2017, the ABMS approved the creation of focused practice designation (FPD). The FPD “recognizes the value that physicians who focus some or all their practice within a specific area of a specialty and/or subspecialty can provide to improving health care.” ²⁵ In 2018, the Advanced Emergency Medicine Ultrasound (AEMUS) FPD sponsored by ABEM was approved by ABMS as the first and currently only FPD for EM. The Emergency Ultrasound Fellowship Accreditation Council (EUFAC) was then created to accredit fellowships meeting specific standards of fellowship training. EUFAC began accrediting programs in November 2020 and currently has over 70 accredited fellowship programs. ²⁶ Graduates of an accredited fellowship program may sit for the AEMUS exam. Currently, there is a pathway for those who were fellowship trained prior to EUFAC or are not fellowship trained but have extensive experience. That pathway closes in 2025. While it is currently the only FPD offered in EM, its success may lead other fellowships to follow suit.

Novel fellowships

A variety of novel fellowships are currently offered to EPs. These fellowships may cover niche areas within EM or areas of emerging importance within the specialty. Notable examples of “novel” programs include EM cardiology, physician wellness, social EM, and resuscitation fellowships. ⁶ Despite their lack of formal accreditation or curricular best practices, novel fellowships can provide significant educational and career development value to a fellow if properly structured, and successful completion can be a stepping stone to a faculty position within or outside the institution. Academic skills, such as writing a manuscript or leading a committee, are readily transferrable between disciplines. However, the value of such training may not be immediately apparent to future employers who have not recognized nor implemented these types of fellowships.

Prospective applicants should pay particular attention to the organization and structure of the program, as these will be the greatest factor that determines the future value of the fellowship. A prospective fellow should closely evaluate how they will be spending their time in fellowship and whether it aligns with their personal and professional goals. Leadership opportunities on departmental and institutional committees, hands‐on activities, and graduate‐level coursework are likely to be particularly valuable for career development and eventual job prospects. An emphasis on scholarly work and publications in the peer‐reviewed literature will serve the candidate well if the future goal is to obtain a position in an academic environment. To that end, a careful assessment should be performed of the infrastructure provided to assist with scholarly work as well as clinical responsibilities. If structure is lacking a priori, the applicant should develop their own educational plan in conjunction with the fellowship director. This should occur prior to the start of the program to avoid misunderstandings and allow time for the requisite preparations to be made (e.g., curricular development, securing funding).

APPLYING FOR FELLOWSHIP

Preparing to apply

There is no firm timeline on when to start looking into an EM fellowship nor an agreed‐upon time to begin making contacts. Common advice for considering fellowship is for initial exploration to begin toward the end of intern year in 3‐year programs and second year in 4‐year programs. At this stage, efforts can be limited and sporadic, including identifying potential programs, talking with mentors, perusing websites, and potentially corresponding with fellowship directors at their own institution and outside. For fellowships with significant prerequisites, such as critical care, early residency is also an excellent time to map out how to use their time to ensure that all requirements are met prior to graduation. An updated CV should be maintained throughout residency to ensure a comprehensive listing of all activities and accomplishments. The focus for residents throughout residency should continue to be the mastery of the art of EM, however.

Applicants should generally begin reaching out to fellowship programs in May or June of the year preceding their final year of residency. Applicants should also begin to prepare their applications with the expectation to submit this completed application by July or August of that same time period.

The application process varies by type of fellowship. Most fellowships in specialties that are board‐eligible with the ABMS require residents to apply through and match into fellowships through the National Residency Matching Program (NRMP). Some nonaccredited fellowships (e.g., global EM) also use the NRMP ²⁷ ; for most other fellowships however, residents apply through separate, institution‐specific application processes. Ultrasound has a centralized application website, www.eusfellowships.com, which candidates use to apply to available fellowships and participates in the NRMP. ²⁸

For those residents applying for board‐eligible specialties recognized by ABMS, the ERAS timeline is available on their website. ²⁹ In early June, tokens become available for applicants and by early July applicants may begin submitting applications to programs. In late July, fellowship programs may begin reviewing applications. Interested applicants should register through the National Resident Match Portal (NRMP) and should submit their application documents to the program's fellowship email through the months of July and August. Programs tend to begin reviewing applicants and offering interview invites in August. The Match opens in mid‐August and rank order lists are due by early November. Match day for EM fellowships occurs in mid‐November. For those specialties not board‐eligible through ABMS, these specialties operate on a similar timeline to ERAS but are program specific and may vary by year. Fellowship acceptance notification typically occurs around mid‐November similar to the Match, although some fellowships use a rolling process that can allow residents to secure positions much later in the year. Figure 1 shows a graphical version of the suggested timeline for applicants.

FIGURE 1.

An approximate timeline for residents to consider when applying for most EM fellowships

Critical care

The application pathway to critical care fellowship is unique and varies greatly depending on the specific type of critical care fellowship applied for. Anesthesia and neurocritical care fellowships participate in the San Francisco Match, which requires applicants to get a very early start on applications: up to 21 months prior to the start of their fellowship. ⁶ Internal medicine pulmonary critical care participates in ERAS but not the Match, ⁹ while surgical critical care utilizes their own proprietary site, ³⁰  similar to ultrasound's. Residents considering a critical care fellowship should discuss with their mentor early which path is the best fit for their future and carefully review the specific application process for their intended fellowship to ensure no deadlines are missed.

Application tips

Similar to applying to residency, fellowship programs emphasize different factors to select future fellows. For example, one fellowship director may value previous scholarship experience, while another may place greater value on teaching and education proficiency. Prior to the official start of the application process, fellowship applicants should carefully investigate specific local expectations (and ensure their portfolio provides evidence of meeting them) if they are seeking to be recognized as a superior candidate at a particular institution.

The number of programs that applicants should apply to will depend on the fellowship type, but is usually no fewer than three and rarely more than 10. ³¹ Experienced mentors and current fellowship directors will usually offer the most salient advice as to the right number for an individual applicant. Applicants already in residency at a fellowship's home institution sometimes have an advantage, so applying to their own program's fellowship, if one is offered, may be beneficial. However, applicants should not apply to a program unless they would truly consider attending fellowship there.

If an applicant's file contains a particular deficiency (e.g., past disciplinary action, remediation), trusted mentors, including the residency PD, can be valuable sources of advice on how to proceed. In general, it is best to address the deficiency directly in the application, such as in the cover letter, and be ready to discuss it during the interview. A red flag on an otherwise strong application will often be overlooked if it seems the applicant has learned from the experience and shown mature efforts to ensure it will not happen again.

Fellowship applicants may require several letters of recommendation to complete their file. Ideally, these would include at least one letter from a mentor within their chosen specialty who they have worked with closely as well as a letter from their residency PD who can speak to their trajectory over the course of residency. While these are not strict requirements, lack of one or both types of letters may cast doubt onto an applicants’ commitment to the specialty or clinical competence.

For fellowships using ERAS, the cost to apply is currently $115 to apply to up to 10 programs, after which additional programs are charged on a per‐program basis. ³²  There is generally no cost to apply to nonaccredited fellowships that do not use ERAS. For programs that use the Match, there is currently an $85 registration fee. ³³ Previously, fellows also had to consider the cost of travel and hotels when interviewing for multiple fellowships, but the rise of virtual interviews will likely cut these costs for applicants drastically. Table 3 contains a helpful summary list of online resources that may be useful throughout preparation for fellowship.

TABLE 3.

List of useful resources for EM residents considering fellowships, including institutional offerings, dates, and application requirements

Resource	URL	Explanation
EMRA Fellowship Guide	https://www.emra.org/books/fellowship‐guide‐book/i‐title/	Discusses individual fellowships in great detail, from a description of the fellowship to career options available.
EMRA Match	https://webapps.emra.org/utils/spa/match#/search/map	Map of currently available fellowship opportunities and brief data on each.
SAEM Fellowship Directory	https://member.saem.org/SAEMIMIS/SAEM_Directories/Fellowship_Directory/SAEM_Directories/P/FellowshipMap.aspx	Map of currently available fellowship opportunities, including ability to show SAEM approved fellowships.
RAMS Roadmaps	https://www.saem.org/publications/saem‐publications/rams‐roadmaps	Guides to academic careers in EM, including many popular fellowship choices such as Simulation and Administration.
ABEM Subspecialties	https://www.abem.org/public/become‐certified/subspecialties	List of fellowships currently accredited through ABEM, along with dates and fees.
SAEM Fellowship Approval Program	https://www.saem.org/about‐saem/Services/fellowship‐approval‐program	Describes the approval process for fellowships and lists fellowships currently eligible for approval.
Society for Clinical Ultrasound Fellowships Homepage	https://eusfellowships.com	Information about current the Ultrasound fellowship application process.
NRMP EM Match	https://www.nrmp.org/fellowships/emergency‐medicine‐match/	Current timeline for fellowships participating in the NRMP Match.

CONCLUSION

Fellowship training can be an extremely beneficial addition to an emergency medicine physician's career. The invaluable mentorship, hands‐on experiences, didactic teaching, scholarship, and leadership opportunities often serve as a springboard, launching fellows more quickly into the forefront of their specialties. With proper preparation during residency, aspiring fellows can easily set themselves up for successful matriculation into a fellowship program well matched to their career goals and interests.

Schnapp BH, Cassara M, Fisher J, et al. From intern to “accepted”: A guide to preparing for fellowship in emergency medicine. AEM Educ Train. 2022;6(Suppl. 1):S23–S31. doi: 10.1002/aet2.10751