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Table 4 List of all curricular content items in Domains 4 with the median appropriateness score for Round 2, the degree of consensus, and the strength of the recommendation

From: International consensus conference recommendations on ultrasound education for undergraduate medical students

Domain 4 and curricular content items Median voting score Degree of consensus Strength of recommendation
Part I. Basic foundations of POCUS
 Students should be familiar with the following terms as they are related to the basic physics of ultrasound
  D4.1 Wavelength 8.43 VGC Strongly recommend
  D4.2 Amplitude 8.21 VGC Strongly recommend
  D4.3 Frequency 8.71 VGC Strongly recommend
  D4.4 Attenuation 8.66 VGC Strongly recommend
  D4.5 Refraction 8.48 VGC Strongly recommend
  D4.6 Absorption 8.29 VGC Strongly recommend
  D4.7 Scatter 8.41 VGC Strongly recommend
  D4.8 Transmission 8.52 VGC Strongly recommend
  D4.9 Resolution 8.74 VGC Strongly recommend
  D4.10 Reflection 8.53 VGC Strongly recommend
  D4.11 Aliasing 7.72 SC Recommend
 Students should be able to explain the fundamental principles of ultrasound for the following modes
  D4.12 B mode 8.78 VGC Strongly recommend
  D4.13 M Mode 8.75 VGC Strongly recommend
  D4.14 Color Flow 8.50 VGC Strongly recommend
  D4.15 Power Doppler 7.16 SC Recommend
  D4.16 Spectral Doppler 7.03 SC Recommend
 Students should demonstrate an understanding of the components and parts of ultrasound probes
  D4.17 Housing/body 8.31 VGC Strongly recommend
  D4.18 Piezoelectric crystals 8.23 VGC Strongly recommend
  D4.19 Marker/indicator 8.88 VGC Strongly recommend
  D4.20 Cord 8.57 VGC Strongly recommend
 Students should know the indications for and limitations of each of the following probes
  D4.21 Linear 8.81 VGC Strongly recommend
  D4.22 Curved array 8.79 VGC Strongly recommend
  D4.23 Phased array 8.81 VGC Strongly recommend
  D4.24 Endocavity 8.10 GC Recommend
 Students should demonstrate:
- appropriate storage of probes
- appropriate care of the probes
- cleaning and disinfection of the probes
  D4.24 Probe storage 8.78 VGC Strongly recommend
  D4.26 Probe care 8.88 VGC Strongly recommend
  D4.27 Cleaning/disinfection 8.88 VGC Strongly recommend
 Students should utilize the following transducer manipulations:
  D4.28 Slide 8.63 VGC Strongly recommend
  D4.29 Rock 8.48 VGC Strongly recommend
  D4.30 Sweep 7.97 SC Recommend
  D4.31 Fan 8.40 SC Recommend
  D4.32 Pressure/compression 8.55 GC Recommend
  D4.33 Rotation 8.64 GC Recommend
 Students should be familiar with the following image descriptions
  D4.34 In plane and out of plane 8.79 VGC Strongly recommend
  D4.35 Deep and superficial 8.86 VGC Strongly recommend
  D4.36 Medial and lateral 8.81 GC Recommend
  D4.37 Cranial and caudal 8.74 GC Recommend
  D4.38 Coronal 8.79 VGC Strongly recommend
  D4.39 Sagittal 8.79 VGC Strongly recommend
  D4.40 Transverse 8.84 VGC Strongly recommend
 Students should have the ability to discuss sonographic characteristics of tissues
  D4.41 Anechoic 8.84 VGC Strongly recommend
  D4.42 Hyperechoic 8.84 VGC Strongly recommend
  D4.43 Hypoechoic 8.78 GC Recommend
  D4.44 Isoechoic 8.76 GC Recommend
  D4.45 Mixed echogenicity 8.62 VGC Strongly recommend
  D4.46 Homogeneous 8.74 VGC Strongly recommend
  D4.47 Heterogeneous 8.74 VGC Strongly recommend
  D4.48 Solid 8.72 VGC Strongly recommend
  D4.49 Cystic 8.78 VGC Strongly recommend
 Students should demonstrate the ability to optimize an ultrasound image by utilizing the following machine adjustments
  D4.50 Presets 8.52 VGC Strongly recommend
  D4.51 Gain 8.81 VGC Strongly recommend
  D4.52 Time-gain Compensation 8.36 SC Recommend
  D4.53 Frequency 8.33 SC Recommend
  D4.54 Depth 8.84 VGC Strongly recommend
  D4.55 Focal point 8.22 SC Recommend
  D4.56 Probe marker 8.89 VGC Strongly recommend
 Students should recognize basic ultrasound artifacts used in clinical diagnosis and explain the cause of each
  D4.57 Reverberation (A and B lines) 8.72 VGC Strongly recommend
  D4.58 Comet tail 8.40 GC Recommend
  D4.59 Posterior acoustic shadowing 8.67 VGC Strongly recommend
 Students should understand the following additional basic common artifacts
  D4.60 Air artifact 8.67 VGC Strongly recommend
  D4.61 Mirroring 8.58 VGC Strongly recommend
  D4.62 Acoustic enhancement 8.66 VGC Strongly recommend
  D4.63 Acoustic shadowing 8.69 VGC Strongly recommend
  D4.64 Mirror image 8.57 VGC Strongly recommend
  D4.65 Twinkle 7.45 SC Recommend
 Students should describe the indications for each of the following
  D4.66 Brightness B mode 8.71 VGC Strongly recommend
  D4.67 Motion M mode 8.71 VGC Strongly recommend
  D4.68 Doppler flow 8.52 VGC Strongly recommend
  D4.69 Power Doppler 7.46 SC Recommend
  D4.70 Spectral Doppler 7.33 SC Recommend
 Students should be able to acquire images with
  D4.71 Brightness B mode (gray scale) 8.57 VGC Strongly recommend
  D4.72 Motion M mode 8.41 VGC Strongly recommend
  D4.73 Color Doppler 7.96 SC Recommend
  D4.74 Power Doppler 6.66 NC Not recommend
  D4.75 Spectral Doppler 6.14 NC Not recommend
 Students should be able to identify the following basic tissues by ultrasound
  D4.76 Fluid 8.81 VGC Strongly recommend
  D4.77 Fat 8.14 GC Recommend
  D4.78 Soft tissue 8.66 VGC Strongly recommend
  D4.79 Bone 8.78 VGC Strongly recommend
  D4.80 Muscle 8.60 GC Recommend
  D4.81 Cartilage 7.76 SC Recommend
  D4.82 Tendon 8.16 SC Recommend
  D4.83 Nerve 8.17 SC Recommend
  D4.84 Blood vessels 8.79 GC Recommend
 Students, when examining a patient with ultrasound, should demonstrate proper care for the patient through
  D4.85 Professional communication regarding use of ultrasound 8.86 VGC Strongly recommend
  D4.86 Obtaining informed consent 8.64 VGC Strongly recommend
  D4.87 Respect for patient privacy 8.88 VGC Strongly recommend
  D4.88 Respect for patient comfort 8.88 VGC Strongly recommend
  D4.89 Appropriate positioning of the patient 8.84 VGC Strongly recommend
  D4.90 Completion of documentation of findings 8.59 VGC Strongly recommend
  D4.91 An understanding of the principle of ALARA (As Low As Reasonably Achievable) 8.45 VGC Strongly recommend
  D4.92 Students should correlate ultrasound images with clinical findings 8.95 VGC Strongly recommend
Part II specific views, structures, and pathology
 Heart and vessels
  Views
   D4.93 Parasternal long axis 8.80 VGC Strongly recommend
   D4.94 Parasternal short axis 8.61 GC Recommend
   D4.95 Apical four chamber 8.54 GC Recommend
   D4.96 Subxiphoid (subcostal) 8.66 VGC Strongly recommend
   D4.97 IVC Transverse 8.20 SC Recommend
   D4.98 IVC Longitudinal 8.57 GC Recommend
  Structures and physiology
   D4.99 Left atrium, right atrium, left ventricle, right ventricle 8.77 VGC Strongly recommend
   D4.100 Mitral value 8.61 VGC Strongly recommend
   D4.101 Aortic valve 8.60 VGC Strongly recommend
   D4.102 Tricuspid valve 8.39 GC Recommend
   D4.103 Pulmonic valve 6.58 NC Not recommend
   D4.104 Myocardium 8.65 VGC Strongly recommend
   D4.105 Pericardium 8.68 VGC Strongly recommend
   D4.106 Descending aorta 8.39 GC Recommend
   D4.107 Aortic arch 7.11 SC Recommend
   D4.108 Abdominal aorta 8.63 VGC Strongly recommend
   D4.109 Aortic bifurcation into common iliac arteries 8.34 GC Recommend
   D4.110 Renal arteries 6.3 NC Not recommend
   D4.111 Dorsalis Pedis 6.88 NC Not recommend
   D4.112 Posterior Tibialis 6.81 NC Not recommend
   D4.113 Correlation of sonographic cardiac cycle with EKG 7.96 SC Recommend
   D4.114 Carotid arteries, including common carotid 8.26 VGC Strongly recommend
   D4.115 Inferior Vena Cava 8.61 VGC Strongly recommend
   D4.116 IVC size 8.33 VGC Strongly recommend
   D4.117 IVC respiratory variations 8.37 VGC Strongly recommend
   D4.118 Internal jugular vein 8.56 VGC Strongly recommend
  Clinical pathology
   D4.119 Poor contractility 8.67 VGC Strongly recommend
   D4.120 LVEF less than 40% 7.95 GC Recommend
   D4.121 LVEF greater than 40% 7.82 GC Recommend
   D4.122 Enlarged chamber size 8.36 VGC Strongly recommend
   D4.123 Enlarged left atrium 8.05 SC Recommend
   D4.124 Enlarged left ventricle 8.18 SC Recommend
   D4.125 Enlarged right Ventricle 8.11 SC Recommend
   D4.126 Distinguish between arterial versus venous flow on Doppler 7.93 SC Recommend
   D4.127 Ventricular Septal Defect 5.39 NC Not recommend
   D4.128 Patent Foramen Ovale 4.98 NC Not recommend
   D4.129 Presence of pericardial effusion 8.72 VGC Strongly recommend
   D4.130 Distinguish between pleural effusion and pericardial effusion 8.63 GC Recommend
   D4.131 Left Ventricular Hypertrophy 7.51 SC Recommend
   D4.132 Idiopathic hypertrophic subaortic stenosis 5.89 NC Not recommend
   D4.133 Right ventricular strain from PE 7.34 SC Recommend
   D4.134 Size of abdominal aortic aneurysm 8.35 GC Recommend
   D4.135 Abdominal dissection of an aortic aneurysm 7.07 NC Not recommend
   D4.136 Decreased vascular volume by IVC collapsibility 8.09 SC Recommend
   D4.137 Lower extremity deep venous thrombosis (DVT) 7.91 SC Recommend
   D4.138 Upper extremity deep venous thrombosis (DVT) 6.86 NC Not recommend
   D4.139 Carotid plaques 6.75 NC Not recommend
   D4.140 Carotid stenosis 6.39 NC Not recommend
 Lungs and chest
  Views
   D4.141 Anterior chest bilaterally 8.60 VGC Strongly recommend
   D4.142 Lateral and posterior chest 8.44 VGC Strongly recommend
   D4.143 Longitudinal across two ribs 8.47 VGC Strongly recommend
   D4.144 Costophrenic angles bilaterally 8.54 VGC Strongly recommend
  Structures and physiology
   D4.145 Visceral pleura 8.21 GC Recommend
   D4.146 Parietal pleura 8.24 GC Recommend
   D4.147 Lung sliding 8.77 VGC Strongly recommend
   D4.148 A lines—A Profile 8.75 VGC Strongly recommend
  Clinical pathology
   D4.149 B lines—B Profile 8.60 VGC Strongly recommend
   D4.150 Pneumothorax—absence of pleural sliding 8.16 GC Recommend
   D4.151 Lung point 8.37 GC Recommend
   D4.152 Pulmonary edema 8.20 GC Recommend
   D4.153 Pleural effusion 8.79 VGC Strongly recommend
   D4.154 Presence of consolidation 8.39 GC Recommend
   D4.155 Sliding curtain sign 7.51 GC Recommend
   D4.156 Acute respiratory distress syndrome (ARDS) 6.77 SC Recommend
 Abdomen
  Views
   D4.157 Epigastric 8.32 VGC Strongly recommend
   D4.158 Left upper quadrant 8.68 VGC Strongly recommend
   D4.159 Right upper quadrant 8.74 VGC Strongly recommend
   D4.160 Lower abdomen 8.51 VGC Strongly recommend
  Structures and physiology
   D4.161 Liver 8.74 VGC Strongly recommend
   D4.162 Size 7.75 SC Recommend
   D4.163 Parenchyma 8.09 GC Recommend
   D4.164 Portal vein 7.98 SC Recommend
   D4.165 Hepatic vein 8.00 SC Recommend
   D4.166 Gallbladder 8.54 VGC Strongly recommend
   D4.167 Stomach 7.35 SC Recommend
   D4.168 Pancreas 6.91 NC Not recommend
   D4.169 Right and left kidneys 8.77 VGC Strongly recommend
   D4.170 Size 8.11 GC Recommend
   D4.171 Cortex 8.07 GC Recommend
   D4.172 Pelvis 8.21 GC Recommend
   D4.173 Calyces 8.05 GC Recommend
   D4.174 Adrenal glands 5.44 NC Not recommend
   D4.175 Spleen 8.55 VGC Strongly recommend
   D4.176 Right and left costophrenic angles 8.63 VGC Strongly recommend
   D4.177 Hepatorenal space (Morison’s pouch) 8.70 VGC Strongly recommend
   D4.178 Peri-splenic area for fluid 8.61 VGC Strongly recommend
   D4.179 Small bowel 7.13 SC Recommend
   D4.180 Subdiaphragmatic space 7.64 SC Recommend
   D4.181 Peristalsis 7.72 SC Recommend
   D4.182 Abdominal lymph nodes 5.69 NC Not recommend
   D4.183 Splenorenal 8.11 GC Recommend
   D4.184 Appendix 6.48 NC Not recommend
   D4.185 Ileocecal junction 5.61 NC Not recommend
  Pathology
   D4.186 Ascites 8.75 VGC Strongly recommend
   D4.187 Hemoperitoneum 8.47 VGC Strongly recommend
   D4.188 Hydronephrosis 8.56 VGC Strongly recommend
   D4.189 Sonographic Murphy Sign 8.18 GC Recommend
   D4.190 Cholelithiasis 8.49 VGC Strongly recommend
   D4.191 Gallbladder polyp 6.86 NC Not recommend
   D4.192 Splenic infarct 5.34 NC Not recommend
   D4.193 Hepatic hemangioma 4.63 NC Not recommend
 Pelvis
  Views
   D4.194 Urinary bladder, longitudinal 8.74 VGC Strongly recommend
   D4.195 Urinary bladder, transverse 8.67 VGC Strongly recommend
   D4.196 Uterus, transabdominal, long 8.63 VGC Strongly recommend
   D4.197 Uterus, transabdominal, trans 8.58 VGC Strongly recommend
   D4.198 Transvaginal scan 5.56 NC Not recommend
  Structures and physiology
   D4.199 Bladder, volume 8.18 GC Recommend
   D4.200 Uterus 8.53 VGC Strongly recommend
   D4.201 Fetal number 7.79 SC Recommend
   D4.202 Fetal heartbeat 8.16 GC Recommend
   D4.203 Fetal position 7.16 SC Recommend
   D4.204 Fetal size 6.74 NC Not recommend
   D4.205 Placenta 7.07 NC Not recommend
   D4.206 Testes 6.38 NC Not recommend
   D4.207 Epididymis 6.02 NC Not recommend
  Pathology
   D4.208 Free fluid 8.63 VGC Strongly recommend
   D4.209 Loss of ureteral jets 6.75 NC Not recommend
   D4.210 Hydroureter 6.86 NC Not recommend
   D4.211 Distended bladder 8.49 VGC Strongly recommend
   D4.212 Urolithiasis 6.85 NC Not recommend
   D4.213 Ovarian torsion 5.58 NC Not recommend
   D4.214 Testicular torsion 5.64 NC Not recommend
   D4.215 Foley catheter position 7.82 SC Recommend
 Head and neck
  Views
   D4.216 Longitudinal 8.51 VGC Strongly recommend
   D4.217 Transverse 8.45 VGC Strongly recommend
  Structures
   D4.218 Muscles of the neck 7.55 SC Recommend
   D4.219 Thyroid lobes 8.25 GC Recommend
   D4.220 Thyroid isthmus 7.95 SC Recommend
   D4.221 Parathyroid gland 5.27 NC Not recommend
   D4.222 Lymph nodes of the neck 6.77 NC Not recommend
   D4.223 Trachea 8.12 GC Recommend
   D4.224 Esophagus 7.71 SC Recommend
   D4.225 Globe of the eye 7.85 GC Recommend
   D4.226 Optic nerve 7.62 GC Recommend
  Pathology
   D4.227 Thyromegaly 7.20 SC Recommend
   D4.228 Thyroiditis 6.38 NC Not recommend
   D4.229 Thyroid mass or cysts 7.16 SC Recommend
   D4.230 Enlarged lymph nodes 6.81 NC Not recommend
   D4.231 Presence of endotracheal tube 7.13 SC Recommend
   D4.232 Esophageal intubation 7.27 SC Recommend
   D4.233 Eye globe 7.71 SC Recommend
   D4.234 Rupture of the globe 6.36 NC Not recommend
   D4.235 Papilledema 6.87 NC Not recommend
   D4.236 Transcranial Doppler 4.86 NC Not recommend
   D4.237 Retinal detachment 6.95 NC Not recommend
   D4.238 Foreign body of the eye 6.70 NC Not recommend
 Musculoskeletal
  Views
   D4.239 Views in general 8.43 VGC Strongly recommend
   D4.240 Transverse 8.46 VGC Strongly recommend
   D4.241 Longitudinal 8.46 VGC Strongly recommend
  Views, specific joints
   D4.242 Elbow, long 7.09 SC Recommend
   D4.243 Elbow, trans 7.00 SC Recommend
   D4.244 Wrist, long 7.09 SC Recommend
   D4.245 Wrist, trans 7.11 SC Recommend
   D4.246 Knee, long 7.74 GC Recommend
   D4.247 Knee, trans 7.65 GC Recommend
   D4.248 Ankle, long 6.84 NC Not recommend
   D4.249 Ankle, trans 6.79 NC Not recommend
  Structures, in general
   D4.250 Dermis and SC tissue 8.07 GC Recommend
   D4.251 Tendons 7.70 SC Recommend
   D4.252 Ligaments 7.48 SC Recommend
   D4.253 Cortex of bone 8.18 GC Recommend
   D4.254 Joint space 7.75 GC Recommend
   D4.255 Fat pads 7.46 GC Recommend
   D4.256 Synovium 7.14 GC Recommend
  Specific joint structures
   D4.257 Triceps tendon 6.87 NC Not recommend
   D4.258 Olecranon fossa fat pad 6.33 NC Not recommend
   D4.259 Distal radius 7.16 SC Recommend
   D4.260 Distal ulna 7.16 SC Recommend
   D4.261 Quadriceps tendon 7.29 SC Recommend
   D4.262 Bursa, suprapatella 7.27 SC Recommend
   D4.263 Patella 7.77 SC Recommend
   D4.264 Patellar tendon 7.70 SC Recommend
   D4.265 Tibial tuberosity 7.15 SC Recommend
   D4.266 Achilles tendon 7.58 SC Recommend
   D4.267 Distal fibula 7.11 SC Recommend
   D4.268 Distal tibia 7.04 SC Recommend
   D4.269 Talo-Fib ligaments 5.94 NC Not recommend
   D4.270 Talo-Tib ligaments 5.91 NC Not recommend
   D4.271 Shoulder humeral head 7.59 GC Recommend
   D4.272 Shoulder glenoid 7.07 SC Recommend
   D4.273 Shoulder acromion 6.85 NC Not recommend
   D4.274 Shoulder clavicle 7.28 SC Recommend
   D4.275 Shoulder biceps tendon 7.17 SC Recommend
   D4.276 Shoulder supraspinatus tendon 6.87 NC Not recommend
  Pathology
   D4.277 Joint effusions 8.28 GC Recommend
   D4.278 Bursal fluid 7.57 GC Recommend
   D4.279 Calcium deposition 6.49 NC Not recommend
   D4.280 Soft tissue edema/cobblestoning 7.96 GC Recommend
   D4.281 Soft tissue abscess or cyst 8.19 GC Recommend
   D4.282 Soft tissue solid mass 7.47 SC Recommend
   D4.283 Clubbing of the fingers 5.48 NC Not recommend
   D4.284 Carpal tunnel—median nerve 6.51 NC Not recommend
   D4.285 Joint dislocation 6.30 NC Not recommend
   D4.286 Tendon impingement syndrome 5.67 NC Not recommend
   D4.287 Tendonitis 6.20 NC Not recommend
   D4.288 Complete tendon tear 6.77 NC Not recommend
Part III. Procedures/protocols
 Procedures
  D4.289 Peripheral vein cannulation (PVC) 8.23 GC Recommend
  D4.290 Central venous cannulation (CVC) 7.59 SC Recommend
  D4.291 Pericardiocentesis 6.44 NC Not recommend
  D4.292 Paracentesis 7.29 GC Recommend
  D4.293 Thoracentesis 7.23 GC Recommend
  D4.294 Arthrocentesis 7.04 SC Recommend
  D4.295 Lumbar puncture 6.71 NC Not recommend
  D4.296 Visualize any body cavity/fluid collection before needle 7.95 GC Recommend
  D4.297 We should not add specific skills 5.87 NC Not recommend
  D4.298 Students should be able to use ultrasound to visualize fluid-filled cavities 8.75 VGC Strongly recommend
  D4.299 Students should be able to use ultrasound to guide a needle safely into a fluid-filled cavity, as demonstrated on patients or a phantom model 8.59 VGC Strongly recommend
 Protocols
  D4.300 E-FAST protocol 7.75 GC Recommend
  D4.301 RUSH protocol 6.88 SC Recommend
  D4.302 CLUE protocol 6.14 NC Not recommend
  D4.303 BLUE protocol 6.39 NC Not recommend
  D4.304 Students do not need to learn specific ultrasound protocols 4.80 NC Not recommend