Current Practices and Self-Reported Proficiency in the US Interventional Pulmonology Fellowships

BACKGROUND: Interventional pulmonology (IP) has expanded rapidly due to procedural advancements and recent ACGME subspecialty recognition. However, significant heterogeneity persists in training curricula and procedural exposure. This study aims to delineate current trends in the United States IP fellowship education. METHODS: We conducted a cross-sectional, multisurvey study between June 2024 and August 2025 involving IP fellows (2024 and 2025 cohorts) and program directors (PDs) across 43 accredited US programs (44% of PDs and 34% to 45% of fellows per administration responded). Electronic surveys assessed demographics, training structure, procedural exposure, and perceived proficiency. RESULTS: Compared with 2013, procedural breadth has increased. Fellows reported the greatest self-rated proficiency gains in complex procedures such as rigid intubation, stent placement, ablative therapies, tracheostomy, and pleuroscopy. Procedural volume to proficiency correlations were nonsignificant for most procedures. Only 43% of programs reported using validated instruments to evaluate procedural competence. At the end of the fellowship, there was a strong fellow-PD concordance on fellow proficiency, where PD rated equal or higher than fellows' self-assessment for most procedures. CONCLUSION: Despite accreditation, variability remains across IP programs on volume, procedural type, and structure of clinical experience. The findings reveal substantial expansion in procedural scope and training infrastructure, accompanied by persistent heterogeneity in program design and assessment practices. Future efforts should prioritize the development of standardized, validated evaluation frameworks and the establishment of objective benchmarks for procedural competence.