(Updated 2025)

This is one of the commonest questions I get. First, as previously mentioned, the American College of Emergency Physicians policy statement on emergency ultrasound recommends that a trainee should perform 25–50 ultrasounds per core application and a total of 150–300 scans as part of POCUS training. Recently, a study reported that EM residents who performed more than 300 scans performed better on observed structured clinical examination (OSCE) compared to those who performed less. Interestingly, plateau effect was noted around this number.

We all know that competency is not just about the number and the learning curve varies among trainees. However, there has to be some benchmark or threshold to grant POCUS privileges to physicians albeit with a quality assurance system in place. Hospitals typically use this EM guideline when reviewing nephrologists’ (or internists’) application for POCUS privileges. This is good for fellows who are trained in ultrasound during their nephrology fellowship and have relevant documentation available. On the other hand, practicing physicians and fellows without POCUS training have to rely on external certifications.

There are certifications available for basic as well as advanced POCUS. For example, POCUS certification academy offers certifications in individual sonographic applications after the applicant passes an online examination and submits the proof of performing a set number of scans. They do have a Nephrology bundle encompassing basic cardiac, IVC, lung, renal and DVT certifications. American College of Chest Physicians offers a well-organized certification program in collaboration with Society of Hospital Medicine. While this is relatively expensive, it’s worth the time and money. In addition, nephrologists proficient in advanced echocardiography can take the critical care echo examination administered by the National Board of Echocardiography (NBE). This makes hospital credentialing easier, especially if you perform advanced hemodynamic POCUS. Ultrasound Leadership Academy is another noteworthy program if you are looking for an online POCUS fellowship. It is a 12-month comprehensive POCUS curriculum designed as an alternative to a traditional ultrasound fellowship that includes prerecorded lectures, knowledge checks, hands-on practice and periodic mentoring sessions with faculty. The downside? The fee can be a bit steep. Plus, you need to be highly motivated since most of the learning is self-directed. If you’re the type who skips pre-course materials before attending an ultrasound workshop, this option might not be the best fit for you. However, the big perk is that you can do a fellowship without having to leave your job.

Transesophageal echocardiography (TEE) is increasingly becoming part of the POCUS toolkit in the ICU, particularly for hemodynamic assessment when transthoracic windows are limited and during cardiac arrest. If you’re a neph-crit like me and trained in TEE, pursuing advanced perioperative TEE certification is a practical way to demonstrate competency, especially when it comes to hospital credentialing. It’s worth noting that certification in critical care TEE can also be achieved without this exam by submitting 50 critical care TEEs after passing the NBE critical care echocardiography exam mentioned above. That said, this specific TEE exam goes a step further – it reflects proficiency in advanced hemodynamics.

Reminder: Training and certification matter, but nothing replaces continued scanning. Without it, POCUS skills decay rapidly. Hope this helps!