Guest authors: Matt Coster, MD, Hospitalist, MGUH, and Jay Park, MD, Hospitalist, MGUH

Point-of-Care Ultrasound (POCUS) refers to an ultrasound examination performed and interpreted at a patient’s bedside. POCUS is used to answer a clinical question generated after obtaining a patient’s history and physical examination, and has been demonstrated to improve diagnostic accuracy and shorten patients’ length of stay.

While POCUS is increasingly utilized across specialties, proficiency requirements vary. In general, competency includes the ability to obtain adequate images and interpret those images. POCUS training in residency or fellowship should include didactics, dedicated ultrasound rotations, and completion of a certain number of images. Competency should be evaluated through a practical exam that assesses the trainee’s skills in image acquisition and image interpretation. While assessing a trainee’s competence in POCUS at the bedside may be a bit more challenging than in a standardized testing environment, a recent study formulated a checklist of essential skills based on expert consensus, which may help evaluate trainee skills and provide feedback.

Competency in POCUS is demonstrated by the following:

1. Explains ultrasound findings appropriately, even if unsure of results (where applicable)

2. Appropriately applies basic ultrasound machine “knobology” (e.g., on/off, depth, gain)

3. Chooses the correct transducer

4. Able to store relevant images and clips

5. Appropriately cleans the machine and transducers

6. Conducts the appropriate types of scans

7. Applies appropriate clinical reasoning in the choice of scans

8. Attains minimal criteria

9. Scans adequately through the entire area of interest

10. Able to recognize key findings

11. Able to recognize when images are inadequate/insufficient for a given indication

12. Recognizes relevant artifacts

13. Able to determine when and what additional imaging studies/investigations are necessary

14. Able to appropriately determine patient disposition based on ultrasound findings

15. Able to appropriately manage unexpected or unknown findings on bedside ultrasound

16. Overall, able to determine appropriate next clinical steps

References:

1. Mozzini C, Di Dio Perna M, Pesce G, et al. Lung ultrasound in internal medicine efficiently drives the management of patients with heart failure and speeds up the discharge time. Internal and Emergency Medicine 2017;13(1):27-33.

2. American College of Emergency Physicians. Emergency ultrasound guidelines. Ann Emerg Med. 2009;53(4):550‐

3. www.hospitalmedicine.org

4. Ma IWY, Desy J, Woo MY, Kirkpatrick AW, Noble VE. Consensus-Based Expert Development of Critical Items for Direct Observation of Point-of-Care Ultrasound Skills. J Grad Med Educ. 2020;12(2):176-184. doi:10.4300/JGME-D-19-00531.