Chapter 2: Training and Credentialing

INTRODUCTION

Establishing a training program in point-of-care ultrasound (POCUS) is an exciting and rewarding experience. The impact of ultrasound on the clinical practice of medicine becomes so clear that many clinicians, after acquiring basic ultrasound skills, wonder how they got along without this technology. This chapter outlines the process for developing a POCUS training program and addresses the common questions encountered when starting a new program.

POCUS examinations are performed in real time by clinicians to answer specific questions in order to expedite and improve patient care. These studies are not intended to provide comprehensive surveys of anatomical areas, nor are they mere extensions of the physical examination.¹ POCUS is a diagnostic and procedural tool used to rule in or rule out specific disease entities for which timely treatment is crucial or to facilitate greater patient safety. As such, these studies require the highest levels of competence, accuracy, and clinical acumen.

In the last 10 years, there have been several guidelines put forth by national organizations like the American College of Emergency Physicians (ACEP) to increase the consistency and accountability of POCUS.¹ These guidelines and processes are meant to help standardize the practice of POCUS. These guidelines should not be seen as barriers but instead are meant to assist in program development and standardize practice in a way that adds value and improves patient care. The Clinical Ultrasound Accreditation Program (CUAP) is one process that can help guide new programs.²

STEPS TO ESTABLISHING A POINT-OF-CARE ULTRASOUND PROGRAM

In order to establish a high-quality POCUS program, it is suggested programs follow the following outline:

1. Select a POCUS leader.

2. Determine the type of POCUS examinations to be performed.

3. Develop a program implementation plan.

4. Obtain approval of the implementation plan.

5. Acquire an ultrasound machine.

6. Train the group.

7. Incentivize group members to complete training and credentialing.

8. Perform ongoing training and continuous quality improvement (CQI).

SELECTING THE ULTRASOUND DIRECTOR(S)

The ultrasound program director is an individual with expertise in POCUS who oversees the training program. This should ideally be a physician who has completed a fellowship in POCUS. Residency training programs should have an ultrasound program director who is fellowship-trained—or has met the same training requirements—as they are training the next generation of clinicians. ACEP and its CUAP recommend that, at minimum, the ultrasound director has completed a management course or an ultrasound preceptorship focused on POCUS management.

In some instances, the ultrasound director is someone from outside the group who is hired on an hourly basis. Whenever possible, it is advantageous to establish this role within the group because the process of training other group members is continuous and easier to accomplish when the ultrasound director is readily available. The group should acknowledge that the ultrasound director will invest a considerable amount of time on ...