Emergency medical services (EMS) is increasingly recognized to be an integral part of the health care system. Given the expanding role and scope of EMS, there is need for structured education of emergency physicians interested in pursuing subspecialization in EMS. In 2001, a group of academic emergency specialists at the University of Toronto developed the first Canadian EMS Fellowship Program. This paper describes the development, current status, and future directions of this Program. The University of Toronto EMS Fellowship Program may serve as a template for the development of similar programs elsewhere in Canada and internationally.