Demonstrating Competency / Certification

When it comes to POCUS, there is much confusion around the terms "certification" and "credentialing." We commonly encounter questions on how clinicians can become "certified" in POCUS. Most clinicians simply wish to use POCUS in their clinical practice (aka achieve privileging via local credentialing board), and believe certification is the means by which they can do so.

The purpose of any certification process should be the validation of a particular skill. There are multiple methods that allow for the validation of competency. Soni et al published a thoughtful paper in the Journal of Hospital Medicine that describes the nuance of demonstrating/validating POCUS competency. It specifically outlines the differences between intramural certification (that which can be achieved locally) and extramural certification (that which is commonly offered by third-party societies at a cost to the individual).

SPOCUS believes that certification should be minimally burdensome, both financially and in terms of removing clinicians from their practice. Intramural certification should therefore be considered the ideal method, as it also allows the primary stakeholders to best evaluate competencies while considering the dynamic factors that are unique to each practice setting.

A locally-validated log/repository of complete ultrasound exams, OSCE or SDOT logs, and focused professional practice evaluations (FPPE) all represent inexpensive, locally achievable intramural methods to validate competency.

Physician specialty organizations like ACEP, considered pioneers in the implementation of bedside ultrasound, have explicitly rejected the use of external certification as a measure of ultrasound proficiency in favor of a competency-based approach. ACEP's competency-based approach has been well-validated since its inception in 2001, leading the organization to unequivocally endorse a competency-based pathway and strongly oppose external certification.

As of the writing of this material, Google and PubMed searches for "POCUS bad outcomes," "clinical ultrasound medical errors," "POCUS harm to patients" and "Point of care ultrasound negative outcomes" doesn't return a single study demonstrating harm to patients.

Blaivas and Pawl analyzed lawsuits filed against emergency physicians for point-of-care emergency ultrasound over a 20-year period and found only 5 suits filed for ultrasounds performed at the point of care. In each case, the alleged breach of duty was related to the ultrasound NOT being performed when clinically indicated.

The take-home point: if leaders in medical communities feel that not formalizing an ultrasound program will protect them from litigation, litigation is much more likely to be pursued if clinicians DON'T perform the bedside exam, as bedside ultrasound appears to be a standard of practice.

SPOCUS will always champion patient safety as a top priority. We need to ensure we are using POCUS effectively, accurately, and appropriately. SPOCUS will therefore continue to support and advocate for well-validated methods of competency-based training and skill validation.

Competency-based clinical skill validation has been and continues to be effectively employed by universities and hospital credentialing boards for decades. There is an abundance of literature to support competency-based skill validation, and it carries with it none of the financial burden associated with external certification.