Heterogeneity in Procedural Training, Self-Assessed Competence and Supervising Skills Among New Pulmonary and Critical Care Fellows

BACKGROUND: Performing procedures relevant to a future career path is a core component of Internal Medicine training (e.g. central line, arterial line, thoracentesis, paracentesis, and lumbar puncture). Pulmonary and Critical Care Medicine, Pulmonary Disease, and Critical Care Medicine (P/CCM) fellows must demonstrate procedural proficiency and competency and are often tasked with supervising procedures performed by resident trainees. OBJECTIVES: To (1) determine the perceived level of procedural competence among P/CCM trainees at the start of their fellowship and (2) describe how P/CCM trainees are integrated into procedure workflows at their respective institutions, including supervision practices. METHODS: PCCM fellows received the annual Association of Pulmonary and Critical Care Medicine (APCCMPD) Fellow's survey between January - March 2025. RESULTS: Of the 2240 eligible fellows, 592 responded (26.4%). Several indicated they would have been comfortable at the start of fellowship performing central line (81%), arterial line (81%), paracentesis (74%), thoracentesis (40%) or lumbar puncture (42%) independently, or with a supervisor available if needed. The distribution of prior procedural experience was similar, with more than 5 procedures performed by 92% of respondents for central line, 86% for arterial line, 76% for paracentesis, 49% for thoracentesis, and 37% for lumbar puncture. Most respondents (90%) indicated they - as the primary fellow - are frequently tasked with supervising central line placement. Yet, at the start of fellowship, not all fellows were comfortable supervising procedures (58% comfortable supervising central line, 66% arterial line, 61% paracentesis, 29% thoracentesis, 30% lumbar puncture). Only 56% indicated a formal central line procedural competency assessment in their fellowship. CONCLUSION: Our survey highlights that pre-fellowship procedure training is heterogenous. P/CCM fellows identified variable comfort with performing and supervising common procedures. Fellowship programs must evaluate their own local practices to ensure fellows demonstrate procedural competence prior to asking them to supervise.