Objective: Fellowship training in pediatric emergency medicine has been available since the early 1980s. Its availability increased rapidly in the late 1980s and early 1990s, but its growth has been much slower in recent years. In this report, we characterize and compare the training programs of today to those that existed 10 years ago. Our study deals with program content and design, focusing on five aspects of fellowship training: demographics, curriculum, clinical emergency department time, research, and benefits. The data gathered in this study are meant to assist programs, both new and old, in enhancing their fellowship training. Methods: A 43-question survey was mailed to all known pediatric emergency medicine fellowship program directors in March of 2000. Two additional attempts were made to obtain survey responses. Forty of the 50 program directors responded, for a response rate of 80%. Statistical analysis was performed, and the data were compared with data that were gathered in two previous studies of fellowship training programs conducted in 1988 and 1991. Results: Fellowship training in pediatric emergency medicine continues to grow but at a slower pace than previously experienced. The number of training programs has increased by 27% over the past 10 years; however, the number of first-year positions has only increased by 15%. Clinical fellow supervision has increased significantly over the years, likely as a result of changes in reimbursement. In 1990, 75% of fellows worked unsupervised in the emergency department versus 23% of first-year fellows, 56% of second-year fellows, and 74% of third-year fellows in the year 2000. The structure of the fellowship curriculum has become more standardized during the past 10 years, with numerous core rotations required by most programs. The percentage of programs offering protected research time has changed significantly over the years, with the amount of time increasing from 40% in 1988, to 95% in 1990, to 100% in 2000. The amount of clinical time has also increased with the transition to a 3-year program. Conclusions: Pediatric emergency medicine continues to expand as a pediatric subspecialty but at a slower rate. During the previous decade, fellowship training has become more structured, with greater emphasis being placed on fellow supervision, standardization of education, and research. These data are meant to assist new as well as established fellowship programs with the development of their training curriculum.