A POCUS program runs most effectively when there are at least two (to three) core faculty members who can consistently devote meaningful time to its development. Depending on the size of the fellowship, it’s reasonable for the POCUS director to negotiate 10–20% FTE of protected non-clinical time for program administration even in the absence of external funding. Division leadership should view this not as an unnecessary cost, but as a forward-looking investment in both the educational mission and future revenue opportunities, especially as faculty reach the level of competency required for billing.

Key faculty should be willing to invest time in strengthening their POCUS skills and knowledge by participating in workshops, completing online courses, or rotating with clinicians from other POCUS-performing specialties (Critical care, emergency medicine) unless they’ve already completed a dedicated 1-year POCUS fellowship. Shadowing experienced sonographers can also be incredibly helpful for refining image acquisition techniques. Another practical approach is to invite outside experts for hands-on sessions using your own ultrasound machines, which tends to be far more impactful than a one-time lecture or grand rounds talk.

When deciding on equipment purchases, remember that POCUS skills develop progressively over time. While a basic ultrasound machine with a single probe and limited image quality may seem cost-effective upfront, it can ultimately restrict the program’s growth. Inadequate image quality also makes it harder for beginners to clearly visualize and understand sonographic anatomy, which can hinder learning.

Have a clear plan for which sonographic applications you’ll be teaching and establish defined milestones for evaluation. For instance, in our program, we track trainees’ progress using a structured framework reviewed every six months.

Having a designated place to practice on volunteers helps. It could be the medical school simulation lab or a clinic room or simply a work room where you can use a foldable massage bed (as below).

Have fellows log their scans in the fellowship management system you use, such as New Innovations. If you’re using a POCUS middleware like Qpath, ensure they save studies under their name so they can be easily retrieved when needed.

Establish ways to provide feedback to the trainees – both by direct observation and retrospective image review. Here are the sample evaluation forms that we use.

Currently, there are no nephrology-specific “guidelines” defining the exact number of scans a trainee must perform to achieve POCUS competency. Most institutions rely on ACEP standards for credentialing, so we ensure that our fellows complete at least 25 documented and reviewed scans per sonographic application. According to the 2024 position statement by the International Alliance for POCUS in Nephrology (IAPN), basic POCUS certification which includes grayscale and color Doppler requires a minimum of 6 hours of didactic learning and at least 30 minutes of hands-on instruction per application (e.g., 30 minutes each for kidney, lung, and basic cardiac views), all under direct supervision. Trainees must also submit a minimum of 25 adequate studies per application, with adequacy verified by POCUS-certified faculty or credentialed experts at their institution. That said, competency goes beyond just numbers – continued, deliberate practice is essential for building lasting confidence and skill.