One of the questions we often get asked is how to get certified or credentialed in point of care ultrasound.
EMUGs is not a credentialing or certification body. This should be the responsibility of your hospital’s governance and credentialing processes and be within your scope of practice. You could also choose to follow the structures outlined by ASUM and enrol in a CCPU or DDU.
The Australasian College for Emergency Medicine (ACEM) has clear guidelines on how best to go about demonstrating proficiency or competency in POCUS. With the 2022 ACEM curriculum putting more emphasis on improving POCUS skills in trainees, we have developed the POCUS Passport to support the needs of our community.
ACEM has selected eFAST, AAA, Needle Guidance (IV access), Focused Echo in Life Support (FELS) and Lung ultrasound as their core modules. Prior to commencing training in ultrasound, we suggest that you complete a physics and knobology module such as the UTEC module.
What are the core POCUS modules as indicated by ACEM?
ACEM has an Emergency Department Ultrasound Webpage. Specific documents that should be reviewed include:
Where do I find the ACEM documents outlining the requirements for how to get certified?
The credentialing process requires candidates to:
Perform and record a requisite number of accurate proctored emergency department ultrasounds and formative assessments; and
pass a summative assessment.
Once credentialed, emergency department sonologists must meet ongoing maintenance requirements.
What are the requirements for being credentialed in a POCUS module?
This should be determined at your local health service level. However, ACEM states that an emergency medicine sonologist or qualified sonographer can observe the candidate performing the ultrasound examination. This may be undertaken simultaneously as a Direct Observations of Procedural Skill (DOPS) assessment by FACEM Trainees.
A sonologist is a practitioner who has successfully completed this credentialing process or has successfully completed the Certificate in Clinician Performed Ultrasound (CCPU), or who possesses DDU (Diploma of Diagnostic Ultrasound), FRANZCR (Fellow of the Royal Australian and New Zealand College of Radiology) or equivalent, or qualifications such as the Postgraduate Certificate in Clinician Performed Ultrasound.
Who can supervise me and sign off my scans/assessments?
The POCUS Passport logbook is a google sheets document that you can save a copy of to your own google drive or locally on your own device. After performing a scan you will be able to enter the date, patient details and presenting complaint and particulars about the scan including if clinically indicated, your interpretation and if available a comparison to the gold standard.
The logbook is available here for download or for copying to your google drive (if logged in via your google account).
You should also backup your images for review either locally on a PACS server or another mutually agreed upon way by your supervisor. We highly recommend sonoclipshare.com as a way of sharing de-identified images with your supervisor and it also makes the review process quite efficient.
Your supervisor should then review your images along with your logbook (that can easily be shared as an editable google doc) and should be qualitatively assessed using a simple traffic light system assessing technical adequacy and diagnostic accuracy of examination, with reference to correlative imaging, surgical or clinical findings where available. The scan audit criteria are outlined in the individual modules along with the required number of scans.
How to use the POCUS Passport logbook
The 2 formative and final summative scans should be completed by your supervisors as you progress through your required number of scans and after the completion of your logbook respectively. Criteria and assessment sheets can be found in each of the individual modules and in the logbook which you can utilise if you wish so that everything is contained in one place.
We have decided to utilise the Ultrasound Competency Assessment Tool (UCAT) for supervisors to complete formative and summative assessments. For each formative and summative assessment the candidate will be assessed on the following domains:
On completion of the UCAT the supervisor should then complete the entrustment score. The concept of entrustable professional activities (EPAs) has emerged as an approach to the assessment of workplace performance. Assessment through EPAs is centred on entrustment decisions by clinical supervisors that link trainees’ execution of POCUS with the level of supervision in their progress towards independent practice.
For the satisfactory completion of the summative assessment the candidate should perform at a competent level with minimal prompting in the majority of all the domains. The candidate should also be rated as independent (I did not need to be there) in the entrustment score.
What are formative and summative assessments?
After completing the required education program, appropriate number of proctored scans and logbook and summative assessment you have completed the requirements as outlined in the ACEM Policy 733 - Credentialing for Emergency Medicine Ultrasonography. You should also discuss if this meets your local hospital scope of practice credentialing requirement with your supervisor.
Your supervisor can then complete the POCUS Passport certificate that outlines your completion of this module. This along with your logbook can be shown to other employers should you start at a new health service. Be mindful that there are ongoing currency requirements for each module and these requirements are outlined in each module.
Downloadable PDF here.
What is the POCUS Passport Certificate and how do I use this?
McKaigney, C., Bell, C., & Hall, A. (2019). LO85: Development of a competency based assessment tool for emergency department point of care ultrasound. CJEM, 21(S1), S38-S39. doi:10.1017/cem.2019.127
Bell C, Hall AK, Wagner N, Rang L, Newbigging J, McKaigney C. The Ultrasound Competency Assessment Tool (UCAT): Development and Evaluation of a Novel Competency-based Assessment Tool for Point-of-care Ultrasound. AEM Educ Train. 2020 Oct 3;5(3):e10520. doi: 10.1002/aet2.10520. PMID: 34041429; PMCID: PMC8138101.
Bell, C., Wagner, N., Hall, A. et al. The ultrasound competency assessment tool for four-view cardiac POCUS. Ultrasound J 13, 42 (2021). https://doi.org/10.1186/s13089-021-00237-3
Holzhausen, Y., Maaz, A., März, M. et al. Exploring the introduction of entrustment rating scales in an existing objective structured clinical examination. BMC Med Educ19, 319 (2019). https://doi.org/10.1186/s12909-019-1736-2
The POCUS Passport Includes;
Demonstration of the minimum image set that you need to acquire for each POCUS module and image review criteria for candidates and supervisors.
Summary of the required number of logged scans for each module including positive findings and ongoing maintenance requirements.
A downloadable logbook to record your scans to have reviewed and signed off by your supervisor or at an EMUGs finishing school.
Formative and Summative Assessment forms.
A downloadable certificate that can be signed by your supervisor or ED ultrasound lead once you have completed the ACEM requirement for proficiency in that module.
Take your POCUS Passport with you if you move hospitals or if you are required to show evidence of your POCUS competency to be signed off by that hospital’s Emergency Ultrasound Program as credentialed.