Pulmonary Hypertension Training in Pulmonary & Critical Care Medicine Fellowship: A National Survey

BACKGROUND: Pulmonary Hypertension (PH) is a heterogeneous disease with high morbidity and mortality. Despite advances in therapeutics, delays in diagnosis and misclassification of patients remain prevalent, leading to harm. Pulmonary and Critical Care Medicine (PCCM) physicians play an essential role in treatment of PH. However, the adequacy of PH education in PCCM fellowship has not been rigorously investigated. OBJECTIVE: To evaluate contemporary training of PCCM fellows including training environment, attitudes, and self-reported proficiency in core and advanced PH competencies. METHODS: We conducted a national, cross-sectional survey of PCCM fellows and Program Directors (PDs) between October 2024 and December 2025. The survey assessed demographics, training environment, clinical exposure, preparedness across core and advanced PH competencies, and attitudes toward PH education. Preparedness was measured using a 5-point Likert scale and dichotomized as proficient versus not proficient. An exploratory descriptive analysis was performed with results from a 2007 survey. RESULTS: 70 fellows and 42 PDs completed our 2024-2025 survey. Among core competencies, fellows reported high proficiency in PH classification (85.7%) and diagnosis (81.0%), with moderate proficiency in risk stratification (62.9%) and initial therapeutic strategy (55.7%). Proficiency was lower for right heart catheterization (RHC) interpretation (42.9%) and management of medication side effects (37.1%). There were low levels of proficiency in performing RHC (20.0%) and managing infusion therapies (<30%). Increasing fellowship training year was associated with improved self-reported proficiency in most competencies; however, only half of senior fellows reported competency in right heart catheterization (RHC) and initiation of PAH therapy. In descriptive analysis, fellows in both eras reported low levels of competency in RHC and management of infusion therapy. CONCLUSION: Despite broad access to PH expertise, contemporary PCCM fellows reported limited preparedness to provide comprehensive PH care. There was low proficiency in advanced competencies including performing RHC and titration of infusion therapy, and modest proficiency in core competencies such as risk stratification and management of PAH medication side effects. Our study highlights a need to improve PCCM training through standardized curriculum to improve the care of PH patients.