Competence in ultrasound is essential for pulmonary and critical care medicine fellows, but little is known about fellow-reported barriers to acquiring this crucial skill during fellowship training.How do pulmonary and critical care fellows acquire experience performing and interpreting ultrasound during their training, what is their perspective on barriers to acquiring ultrasound expertise during fellowship, and what is their comfort with a range of ultrasound exams?A 20-item survey including questions about procedural training and acquisition of ultrasound skills during pulmonary critical care fellowship was developed. The survey instrument was sent to pulmonary and critical care medicine fellowship program directors to distribute to their fellows at program directors' discretion.Four hundred and seventy-five responses were received. The most common method of learning ultrasound was independently performing ultrasound at the bedside. Fellows reported that the greatest barrier to acquiring ultrasound skills was the lack of trained faculty experts, followed by lack of a formal curriculum. Fellow comfort was greatest with thoracic ultrasound and least with advanced cardiac ultrasound.Significant barriers to ultrasound training during pulmonary and critical care fellowship exist, and future educational efforts should address these barriers at both program and institutional levels.