Emergency medicine point-of-care ultrasound (POCUS) is the medical use of ultrasound technology for the bedside evaluation of emergency medical conditions and diagnoses [1]. POCUS performed and interpreted by emergency physicians is a fundamental skill in emergency medicine [1]. POCUS has established indications in assessment for free intraperitoneal fluid in trauma and identification of pregnancy location as examples. Point-of-care ultrasound use in the emergency department (ED) is associated with improved patient outcomes and increased patient satisfaction [2]. Physicians can become proficient in POCUS with modest training, and its use has been shown to improve diagnostic accuracy, reduce procedural complications, decrease inpatient length of stay, and improve patient satisfaction [3]. Ultrasound has been identified as a core skill required for graduating EM residents in the USA [2]. Emergency medicine has only recently been introduced in Guyana, a small English-speaking country in South America. As part of the development of emergency medicine in Guyana over the last 14 years, a POCUS training curriculum was introduced into the residency training program at Georgetown Public Hospital Corporation (GPHC) [4]. The curriculum was adapted to account for the limited resources available at the hospital. There are many challenges introducing a curriculum, especially if it is a short program [5]. The curriculum utilizes superuser direct observation of resident image acquisition and interpretation, structured observed ultrasound examinations, and minimum numbers of each of the core applications to achieve competency for graduation [4]. This curriculum is especially helpful where wireless Internet connectivity or image archival middleware is not available. POCUS has a wide range of application in the ED. It is incredibly important for diagnostic accuracy. Therefore, it is important to evaluate the competence of the physicians that most frequently use POCUS.

Competency is the ability of healthcare professionals to integrate knowledge, skills, values, and attitudes into individual patient care [6]. Applied to POCUS, competency requires combining medical knowledge, ability to acquire appropriate images, and cognitive aptitude to employ clinical ultrasound for optimized patient care and clinical outcomes [7]. Determining competency in POCUS is difficult. Methods of determining competency include traditional testing, testing using simulator models, video review, observation of bedside skills, over-reading of images by experienced sonologists, and monitoring of error rates through a quality assurance process [1]. There are several published efforts to assess and ensure competency during residency [8,9,10,11,12]. There is some data to show attrition of POCUS skills after residency. Kimura et al. retested thirty internal medicine physicians, deemed proficient at graduation and having passed a practical examination that confirms imaging skills and knowledge base when a score of ≥ 80% correct is attained [13]. None of the physicians (13) who had finished their residencies 2 or more years prior achieved the 80% pass mark. They concluded that learned skills in cardiac ultrasound diminish notably within 2 years of nonuse [13].

Resources are limited at GPHC leading to increased dependence on POCUS for patient care. There is limited access to cross-sectional imaging. While POCUS is currently a measured competency integrated into the residency program, that has not always been the case. Initial graduates received ultrasound training but did not complete an organized ultrasound curriculum. The ultrasound curriculum is designed to assure competency of residency graduates at the time of graduation. But the effectiveness of the training for persistent ultrasound competency has not previously been assessed. We aim to assess POCUS competency in senior emergency medicine residents and residency graduates of the Masters in Emergency Medicine Program at Georgetown Public Hospital Corporation to better inform residency training curriculum and improve ultrasound-specific continuing education efforts.