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
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 |