Training Guidelines for Physicians and Advanced Clinical Providers Performing Point-of-Care Ultrasound Examinations

Practitioners who perform and interpret ultrasound examinations at the point of care should be licensed medical practitioners who have a thorough understanding of the indications and guidelines for point-of-care ultrasound examinations as well as familiarity with the basic physical principles and limitations of the technology of ultrasound imaging. They should be familiar with alternative and complementary imaging and diagnostic procedures and should be capable of correlating the results of these other procedures and physical examination findings with the ultrasound examination findings. They should have an understanding of ultrasound technology and instrumentation, equipment calibration, ultrasound power output, and safety. Practitioners responsible for point-of-care ultrasound examinations should be able to demonstrate familiarity with the anatomy, physiology, and pathophysiology of those organs or anatomic areas that are being examined. They should provide evidence of training and requisite competence needed to successfully perform and interpret ultrasound examinations at the point of care. The training should include archiving, documentation, and reporting of ultrasound studies.

 

Practitioners in the emergency setting performing and/or interpreting point-of-care ultrasound examinations should meet the following:

I. Completion of ultrasound training as defined by the American College of Emergency Physicians (ACEP). Refer to the ACEP Ultrasound Guidelines.

  1. If completion of training occurred more than 36 months ago, both of the following must also be demonstrated within the previous 36 months:
    1. 10 AMA PRA Category 1 Credits™ and or American Osteopathic Association (AOA) Category 1-A Credits dedicated to point-of-care ultrasound; and
    2. Documentation of either:
      1. The performance, evaluation, interpretation, and reporting of a minimum of 150 ultrasound examinations in a variety of applications at the point of care; or
      2. Confirmation of ultrasound image acquisition and interpretation skills in a variety of applications at the point of care documented and confirmed by the departmental ultrasound director/chief (board-eligible or -certified emergency physician who has been given administrative oversight over the emergency ultrasound program from the emergency medicine chairperson, director, or group).                        

 

Physicians performing and/or interpreting point-of-care ultrasound examinations in other clinical settings should meet one of the following:

I. Completion of any residency or fellowship that includes structured ultrasound training at the point of care. This training includes the performance, interpretation, and reporting of at least 150* ultrasound examinations in a variety of applications at the point of care.

  1. If completion of training occurred more than 36 months ago, the following must also be demonstrated within the previous 36 months:

1. 10 AMA PRA Category 1 Credits™ or AOA Category 1-A Credits; and

2. Documentation of the performance, evaluation, interpretation, and reporting of a minimum of 150* ultrasound examinations in a variety of applications at the point of care.

II. If ultrasound training as defined above was not obtained, the following must be demonstrated within the previous 36 months:

  1. 36 AMA PRA Category 1 Credits™ or AOA Category 1-A Credits dedicated to point-of-care ultrasound that includes didactic and hands-on training; and
  2. Documentation of the performance, evaluation, interpretation, and reporting of a minimum of 150 to 300* ultrasound examinations in a variety of applications at the point of care. It is expected that in most circumstances, examinations will be under the supervision of or with support from (direct or telemedicine) a qualified practitioner who meets this training guideline.
    1. If the scope of practice is limited to less than 3 types of point-of-care ultrasound examinations, a minimum of 25 examinations per focused area is recommended.*

 

Advanced clinical providers performing and/or interpreting point-of-care ultrasound examinations in other clinical settings should meet the following within the previous 36 months:

I. 36 AMA PRA Category 1 Credits™ or AOA Category 1-A Credits dedicated to point-of-care ultrasound that includes didactic and hands-on training; and

II. Documentation of the performance, evaluation, interpretation, and reporting of a minimum of 150 to 300* ultrasound examinations in a variety of applications reflective of the examinations they perform in their clinical practice. Examinations must be under the supervision of or with support from (direct or telemedicine) a qualified practitioner who meets this training guideline.

  1. If the scope of practice is limited to less than 3 types of point-of-care ultrasound examinations, a minimum of 25 examinations per focused area is recommended.*

For nonphysician health professionals whose practice requires a formal practice physician affiliation agreement, the supervising physician must possess at least an equal level of ultrasound education and training as the supervised practitioner.

 

Maintenance of Competence in Point-of-Care Ultrasound

All practitioners performing point-of-care ultrasound examinations should demonstrate evidence of continuing competence in the interpretation and reporting of those examinations. A minimum of 50 point-of-care ultrasound examinations per year in a variety of applications is recommended to maintain the practitioner’s skills.

 

Continuing Medical Education in Point-of-Care Ultrasound

The practitioners should complete 10 hours of AMA PRA Category 1 Credits™ in diagnostic ultrasound specific to their scope of practice every 3 years.

 

*The number of cases was selected as a minimum number needed to gain experience and proficiency with ultrasound as a diagnostic modality. This is necessary to develop technical skills, to appreciate the practical applications of basic physics as it affects image quality and artifact formation, and to acquire an experience base for understanding the range of normal and recognizing deviations from normal. Depending on the number of applications being used at the point of care, the trainee should have performed and interpreted 25 ultrasound examinations per application. It is acknowledged that the training curve may settle below or above this recommended threshold and that learning is a lifelong process with improvements beyond initial training.

Cases presented as preselected, limited-image sets, such as in lectures, case conferences, and teaching files, are excluded. The ability to analyze a full image set, determining its completeness and the adequacy of the image quality, and performing the diagnostic process, distinguishing normal from abnormal, is considered a primary goal of the training experience.

 


Approved: 08/12/2019;

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