B62-04 Identifying Gaps in Pediatric Lung Pathology Education: A National Needs Assessment of Pediatric Pulmonology Fellowship Programs

Abstract Rationale Accurate interpretation of pediatric lung biopsies, including recognition of normal histology and pathology, provides the foundation for understanding the pathophysiology of childhood interstitial and diffuse lung disease (chILD) and for guiding therapeutic decision-making. We aimed to evaluate program directors’(PDs) perceptions of fellows’ educational exposure, satisfaction, and opportunities in pediatric lung pathology and chILD across the U.S. We hypothesized that most programs would report low confidence in their fellows’ ability to identify key features of pediatric lung histopathology, reflecting the need for improved educational resources. Methods A confidential REDCap survey was distributed through a national professional network to accredited U.S. pediatric pulmonology fellowship PDs in September 2025. Demographics, educational opportunities, PDs’ perceptions of fellows’ confidence and satisfaction regarding lung histopathology and chILD exposure were collected. Associations between program size (1-3, 4-6, ≥7 fellows) and ordered response variables were analyzed using exact Jonckheere-Terpstra tests; categorical comparisons used Fisher’s exact test. Results 26 PDs participated. Small programs represented 61% (1-3 fellows). Educational opportunities varied, with 54% of programs holding scheduled lung biopsy review sessions, 35% reporting no structured opportunities, and 11% percent describing other learning experiences. PDs reported generally low confidence in fellows’ histopathology skills. More than one-third were not at all confident in fellows’ ability to identify inflammatory cells, special stains, or distinguish normal airway epithelium. Confidence was lowest for recognizing pulmonary interstitial glycogenosis (54% not confident) and correlating genetic variants with histopathologic patterns (54% not confident). In contrast, 85% were moderately or highly confident in fellows’ ability to provide longitudinal clinical care for such patients. A monotonic association was observed between three variables. Satisfaction with the number of lung biopsy cases available increased with program size (p = 0.0048), with 63% of PDs from smaller programs not satisfied compared with 10% from programs with ≥4 fellows. Similarly, satisfaction with fellows’ clinical exposure to chILD increased with program size (p = 0.0122). Dedicated ILD clinic access also increased with program size, with 6%, 20%, 75%, and 100% of programs reporting access among those with 1-3, 4-6, 7-9, and ≥10 fellows, respectively (Fisher’s exact p = 0.005). Despite variability, 65% of PDs rated pathology education as moderate, quite important, or essential to fellowship training. Conclusions PDs reported substantial variability and limited confidence in fellows’ training in pediatric lung pathology and chILD, particularly among smaller programs. These findings highlight the need for standardized, accessible educational initiatives to strengthen pathology training and diagnostic competency in pediatric pulmonology fellowships nationwide. This abstract is funded by: None