Postgrad Med J doi:10.1136/postgradmedj-2012-131714
  • Original article

Fellowships in international emergency medicine in the USA: a comparative survey of program directors’ and fellows’ perspectives on the curriculum

  1. Jamil D Bayram1
  1. 1Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  3. 3Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA
  4. 4Department of Emergency Medicine, University of Chicago, Chicago, Illinois, USA
  5. 5Department of Emergency Medicine, George Washington University, Washington, DC, USA
  6. 6Department of Emergency Medicine, Gwinnett Medical Center, Lawrenceville, Georgia, USA
  1. Correspondence to Dr Gabrielle A Jacquet, Department of Emergency Medicine, Boston Medical Center, One Boston Medical Center Place, Dowling 1 South Emergency, Boston, MA 02118, USA; gjacquet{at}
  • Received 15 December 2012
  • Revised 15 July 2013
  • Accepted 20 July 2013
  • Published Online First 20 August 2013


Objective Experts have proposed core curriculum components for international emergency medicine (IEM) fellowships. This study examined perceptions of program directors (PDs) and fellows on whether IEM fellowships cover these components, whether their perspectives differ and the barriers preventing fellowships from covering them.

Methods From 1 November 2011 to 30 November 2011, a survey was administered to PDs, current fellows and recent graduates of the 34 US IEM fellowships. Respondents quantified their fellowship experience in six proposed core curriculum areas: emergency medicine (EM) systems development, EM education, humanitarian assistance, public health, emergency medical services and disaster medicine. Analysis was performed regarding what per cent of programmes fulfil the six curriculum areas. A paired t test determined the difference between PDs’ and fellows’ responses. Agreement between PDs and fellows within the same programme was determined using a κ statistic.

Results Only 1/18 (6%) (according to fellows) to 2/24 (8%) (according to PDs) of programmes expose fellows to all six components. PDs consistently reported higher exposure than fellows. The difference in mean score between PDs and fellows was statistically significant (p<0.05) in three of the 6 (50%) core curriculum elements: humanitarian aid, public health and disaster medicine. Per cent agreement between PDs and fellows within each programmes ranged from poor to fair.

Conclusions While IEM fellowships have varying structure, this study highlights the importance of further discussion between PDs and fellows regarding delineation and objectives of core curriculum components. Transparent curricula and open communication between PDs and fellows may reduce differences in reported experiences.

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