(Updated 2026)
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. An EM-based study reported that 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. It is relatively expensive, but if you’re looking for a structured pathway with strong credibility, I think it’s well worth the time and investment. In addition, nephrologists proficient in advanced echocardiography can take the critical care echo examination (CCEeXAM®) 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 an intensivist (+/- nephrologist) and have trained in TEE, pursuing advanced perioperative TEE examination (PTEeXAM®) can be a practical way to demonstrate competency. It’s worth noting that critical care TEE certification can also be obtained without taking this exam: after passing the NBE critical care echocardiography exam mentioned above, you can pursue certification by submitting 50 critical care TEE studies. However, the advanced perioperative TEE exam goes a step further, with a stronger emphasis on hemodynamics. This may also be helpful from a credentialing standpoint, as some hospitals may otherwise limit TEE privileges to peri-cardiac arrest use only.
And if you’re an echo fanatic like me and want to explore echocardiography from all angles, you can take the NBE Examination of Special Competence in Adult Echocardiography (ASCeXAM®). I won’t lie – it’s a tough exam, especially compared with critical care echo. But if you’re already preparing for the advanced TEE exam, you’ve done a good chunk of the work for this one as well, so it may be worth taking the extra step. Beyond the credential itself, developing competency across the broader spectrum of adult echocardiography can help move you beyond the “just a POCUS person” label and build trust with colleagues when you’re using advanced echo at the bedside.
Reminder: Training and certification matter, but nothing replaces continued scanning. Without it, POCUS skills decay rapidly. Hope this helps!
