Funding and support: By JACEP Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. See related editorial

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Improving emergency department (ED) care for older adults is a critical issue in emergency medicine. Institutions throughout the United States and Canada have recognized the growing need for a workforce of emergency physician (EP) leaders focused on clinical innovation, education, and research and have developed specialized fellowship training in geriatric emergency medicine (GEM). We describe here the overview, structure, and curricula of these fellowships as well as successes and challenges they have encountered. Seven GEM fellowships are active in the United States and Canada, with five offering postresidency training only, one offering fellowship training during residency only, and one offering both. The backbone of the curriculum for all fellowships is the achievement of core competencies in various aspects of GEM, and each includes clinical rotations, teaching, and From the content. SWL contributed to ideas, content, and structure of this concept paper; provided information about fellowship experience; and participated in synthesis of information, manuscript initial drafting, and critical revision of the manuscript for important intellectual content. LCC contributed to ideas, content, and structure of this concept paper; provided information about fellowship experience; and participated in synthesis of information, manuscript initial drafting, and critical revision of the manuscript for important intellectual content. SC contributed to ideas, content, and structure of this concept paper and participated in synthesis of information and critical revision of the manuscript for important intellectual content. KB contributed to ideas, content, and structure of this concept paper; provided information about fellowship experience; and participated in synthesis of information and critical revision of the manuscript for important intellectual content. PM contributed to ideas, content, and structure of this concept paper; provided information about fellowship experience; and participated in synthesis of information and critical revision of the manuscript for important intellectual content. KRT contributed to ideas, content, and structure of this concept paper; provided information about fellowship experience; and participated in synthesis of information and critical revision of the manuscript for important intellectual content. DM contributed to ideas, content, and structure of this concept paper; provided information about fellowship experience; and participated in synthesis of information and critical revision of the manuscript for important intellectual content. PT contributed to ideas, content, and structure of this concept paper and participated in synthesis of information and critical revision of the manuscript for important intellectual content. TW contributed to ideas, content, and structure of this concept paper and participated in synthesis of information and critical revision of the manuscript for important intellectual content. NME contributed to ideas, content, and structure of this concept paper and par...