MON-457 - Thyroid Ultrasound and Fine Needle Aspiration Training in Endocrinology Fellowship Programs: A National Survey

Background:
ACGME requires endocrinology fellows to gain competency in thyroid ultrasound (US) and fine-needle aspiration (FNA), yet training practices vary and lack standardization. Prior work suggests gaps in preparedness and training resources. We conducted a national survey to characterize current educational practices in thyroid nodule evaluation and FNA.


Methods:
A survey instrument was developed based on investigator consensus and prior assessments. After IRB approval, fellowship program contacts were identified via public databases and program websites. Initial survey invitations were sent in April–May 2025 with reminder emails 3 times every 5 days. Non-responders and incomplete surveys were recontacted once in July 2025. Programs with invalid contact information (n=4) were excluded. Descriptive statistics were used to summarize responses.


Results:
A total of 158 programs were contacted; 89 responded (56.3%), including 8 partial responses, resulting in 81 complete responses (51.3%). Most were academic (88.9%), with mixed community–academic (8.6%) or community-based (1.2%) sites. Procedural volume varied, with 46/81 (56.8%) reporting < 25 FNAs performed per fellow and 34/81 (42.0%) reporting ≥25. Most programs (75/81, 92.6%) offered introductory non-clinical FNA sessions, typically combining didactic and hands-on instruction (66/75, 88.0%). Before clinical FNA, didactic (63/69, 91.3%) and hands-on (68/72, 94.4%) training were almost universal amongst respondents. Practice tools were used in 67/81 (82.7%) programs, including commercial (37/67, 55.2%) and home-made (30/67, 44.8%) models. Clinical FNA training occurred during both fellowship years in 55/81 (67.9%). FNAs were primarily performed in dedicated endocrine FNA clinics (45/81, 55.6%). Fellows process samples themselves in 26/81 (32.1%).

Importance ratings (5-point Likert scale) supported FNA education: didactics (mean 4.21, 78.8% rating 4–5); hands-on (mean 4.46, 88.6% rating 4–5); practice tools (mean 4.04, 77.5% rating 4–5); endocrine-division–based training (mean 3.79, 66.3% rating 4–5). Pre-clinical training adequacy was rated “right amount” by 63/81 (77.8%). The existence of barriers was reported to sessions (46/81,56.8%) and simulation use (44/81, 54.3%). Readiness for independent practice was reported as all graduates for thyroid US in only 44/79 (55.7%) and for FNA in only 44/80 (55.0%). For programs not using procedure checklists, the majority viewed the availability of one as desirable for both FNA (57.5%) and US (62.5%).


Conclusion:
Didactic, hands-on, and simulation-based FNA education is widely implemented and valued, yet variability in volume, curricula, and resources persists. Reported barriers and interest in checklists highlight opportunities to standardize educational approaches and support consistent competency in thyroid US and FNA across programs.

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