C56-15 From Lines to Lungs: Surveying Procedural Confidence in Fellowship Training

Abstract Rationale Graduating fellows from pulmonary and critical care programs are expected to independently perform a variety of medical procedures in the intensive care unit. There is significant variance in exposure and learning opportunities across training programs and comfort level performing these procedures varies. Methods An initial survey study was done in 2019 by Knox et. al and similar methodology was repeated for this follow-up study. A survey concerning the ACGME required procedures for pulmonary and critical care fellows was sent to graduating fellows and program directors at all ACGME-accredited fellowship programs in pulmonary, critical care and combined pulmonary critical care medicine. Fellows’ responses included individual numbers of each procedure performed and comfort level of performing each independently (surveyed using a Likert scale), while program directors responded regarding confidence in their graduating fellows’ ability to perform these procedures independently. Statistical analysis was performed using R software. Results In total, 73 fellows from 8 critical care programs and 43 combined pulmonary critical care programs responded of 299 total programs contacted. There were no fellow responses from pulmonary only programs. 39 program directors and assistant program directors from 35 unique programs of 299 programs contacted responded. Combined PCCM fellows performed higher numbers of every procedure compared to critical care fellows, though PA catheter insertion was low across all training programs. Fellows from combined programs agreed or strongly agreed that they were prepared for most procedures, with the exception of PA catheter insertion. Fellows from critical care only programs did not feel comfortable performing transbronchial needle biopsies (TBBx), transbronchial needle aspirations (TBNA), or PA catheter insertion. Program directors from all specialties strongly agreed or agreed that their fellows were competent to independently perform most procedures, though disagreed about competency regarding PA catheter insertion (all) and TBBx/TBNA (critical care only). Compared to 2019 survey data, there were mixed changes with increases in some procedure numbers and decreases in others. There is overall lack of exposure and confidence performing PA catheter insertion across all specialties. Conclusions Analysis of our survey data suggests a positive association between the number of procedures performed by graduating fellows and their self-reported confidence in independent practice. Although formal guidelines specifying minimum procedural requirements for fellowship completion are lacking, our findings may provide useful benchmarks for recommended procedural volumes that support the development of both confidence and competence. This abstract is funded by: None