(Updated December 2023)

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. Downside is the fee but the advantage is that you can do a fellowship without having to leave your job.

No matter how you get trained/certified, continued scanning is the key to becoming an expert. Otherwise, POCUS skills decay super fast. Hope this helps!