POCUS COC Alternative Pathway Application

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* 1. Please enter your name and contact information.

Name *

Company

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State/Province *

ZIP/Postal Code *

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Email Address *

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* 2. How many years have you personally been using point-of-care ultrasound in your clinical practice?

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* 3. Describe your past training in point-of-care ultrasound, including courses attended (names, dates) and applications learned.

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* 4. Have you earned at least 35 hours of CME credits from live, hands-on POCUS courses, either as an attendee or faculty member?

Yes

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* 5. Please provide proof of CME credit from participation in live, hands-on POCUS training by uploading certificates here or by emailing POCUS@hospitalmedicine.org.

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During a typical 1-month period of working as a full-time clinician providing care to patients, how frequently, on average, do you perform the following point-of-care ultrasound applications?

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* 6. Cardiac

	0	0-1	1	2	3	4	5	6	7	8	9	10	10+
Left ventricular systolic function	Left ventricular systolic function 0	Left ventricular systolic function 0-1	Left ventricular systolic function 1	Left ventricular systolic function 2	Left ventricular systolic function 3	Left ventricular systolic function 4	Left ventricular systolic function 5	Left ventricular systolic function 6	Left ventricular systolic function 7	Left ventricular systolic function 8	Left ventricular systolic function 9	Left ventricular systolic function 10	Left ventricular systolic function 10+
Right ventricular systolic function	Right ventricular systolic function 0	Right ventricular systolic function 0-1	Right ventricular systolic function 1	Right ventricular systolic function 2	Right ventricular systolic function 3	Right ventricular systolic function 4	Right ventricular systolic function 5	Right ventricular systolic function 6	Right ventricular systolic function 7	Right ventricular systolic function 8	Right ventricular systolic function 9	Right ventricular systolic function 10	Right ventricular systolic function 10+
Pericardial effusion	Pericardial effusion 0	Pericardial effusion 0-1	Pericardial effusion 1	Pericardial effusion 2	Pericardial effusion 3	Pericardial effusion 4	Pericardial effusion 5	Pericardial effusion 6	Pericardial effusion 7	Pericardial effusion 8	Pericardial effusion 9	Pericardial effusion 10	Pericardial effusion 10+
Valve assessment	Valve assessment 0	Valve assessment 0-1	Valve assessment 1	Valve assessment 2	Valve assessment 3	Valve assessment 4	Valve assessment 5	Valve assessment 6	Valve assessment 7	Valve assessment 8	Valve assessment 9	Valve assessment 10	Valve assessment 10+
Inferior vena cava	Inferior vena cava 0	Inferior vena cava 0-1	Inferior vena cava 1	Inferior vena cava 2	Inferior vena cava 3	Inferior vena cava 4	Inferior vena cava 5	Inferior vena cava 6	Inferior vena cava 7	Inferior vena cava 8	Inferior vena cava 9	Inferior vena cava 10	Inferior vena cava 10+

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* 7. Pulmonary

	0	0-1	1	2	3	4	5	6	7	8	9	10	10+
Pleural Effusion	Pleural Effusion 0	Pleural Effusion 0-1	Pleural Effusion 1	Pleural Effusion 2	Pleural Effusion 3	Pleural Effusion 4	Pleural Effusion 5	Pleural Effusion 6	Pleural Effusion 7	Pleural Effusion 8	Pleural Effusion 9	Pleural Effusion 10	Pleural Effusion 10+
Pneumothorax	Pneumothorax 0	Pneumothorax 0-1	Pneumothorax 1	Pneumothorax 2	Pneumothorax 3	Pneumothorax 4	Pneumothorax 5	Pneumothorax 6	Pneumothorax 7	Pneumothorax 8	Pneumothorax 9	Pneumothorax 10	Pneumothorax 10+
Pulmonary Edema	Pulmonary Edema 0	Pulmonary Edema 0-1	Pulmonary Edema 1	Pulmonary Edema 2	Pulmonary Edema 3	Pulmonary Edema 4	Pulmonary Edema 5	Pulmonary Edema 6	Pulmonary Edema 7	Pulmonary Edema 8	Pulmonary Edema 9	Pulmonary Edema 10	Pulmonary Edema 10+
Pneumonia	Pneumonia 0	Pneumonia 0-1	Pneumonia 1	Pneumonia 2	Pneumonia 3	Pneumonia 4	Pneumonia 5	Pneumonia 6	Pneumonia 7	Pneumonia 8	Pneumonia 9	Pneumonia 10	Pneumonia 10+
Thoracentesis	Thoracentesis 0	Thoracentesis 0-1	Thoracentesis 1	Thoracentesis 2	Thoracentesis 3	Thoracentesis 4	Thoracentesis 5	Thoracentesis 6	Thoracentesis 7	Thoracentesis 8	Thoracentesis 9	Thoracentesis 10	Thoracentesis 10+
Chest tube (any size)	Chest tube (any size) 0	Chest tube (any size) 0-1	Chest tube (any size) 1	Chest tube (any size) 2	Chest tube (any size) 3	Chest tube (any size) 4	Chest tube (any size) 5	Chest tube (any size) 6	Chest tube (any size) 7	Chest tube (any size) 8	Chest tube (any size) 9	Chest tube (any size) 10	Chest tube (any size) 10+

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* 8. Gastroinestinal (GI)

	0	0-1	1	2	3	4	5	6	7	8	9	10	10+
Peritoneal Fluid / Ascites	Peritoneal Fluid / Ascites 0	Peritoneal Fluid / Ascites 0-1	Peritoneal Fluid / Ascites 1	Peritoneal Fluid / Ascites 2	Peritoneal Fluid / Ascites 3	Peritoneal Fluid / Ascites 4	Peritoneal Fluid / Ascites 5	Peritoneal Fluid / Ascites 6	Peritoneal Fluid / Ascites 7	Peritoneal Fluid / Ascites 8	Peritoneal Fluid / Ascites 9	Peritoneal Fluid / Ascites 10	Peritoneal Fluid / Ascites 10+
Gallbladder	Gallbladder 0	Gallbladder 0-1	Gallbladder 1	Gallbladder 2	Gallbladder 3	Gallbladder 4	Gallbladder 5	Gallbladder 6	Gallbladder 7	Gallbladder 8	Gallbladder 9	Gallbladder 10	Gallbladder 10+
Paracentesis	Paracentesis 0	Paracentesis 0-1	Paracentesis 1	Paracentesis 2	Paracentesis 3	Paracentesis 4	Paracentesis 5	Paracentesis 6	Paracentesis 7	Paracentesis 8	Paracentesis 9	Paracentesis 10	Paracentesis 10+

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* 9. Urinary

	0	0-1	1	2	3	4	5	6	7	8	9	10	10+
Hydronephrosis	Hydronephrosis 0	Hydronephrosis 0-1	Hydronephrosis 1	Hydronephrosis 2	Hydronephrosis 3	Hydronephrosis 4	Hydronephrosis 5	Hydronephrosis 6	Hydronephrosis 7	Hydronephrosis 8	Hydronephrosis 9	Hydronephrosis 10	Hydronephrosis 10+
Bladder volume	Bladder volume 0	Bladder volume 0-1	Bladder volume 1	Bladder volume 2	Bladder volume 3	Bladder volume 4	Bladder volume 5	Bladder volume 6	Bladder volume 7	Bladder volume 8	Bladder volume 9	Bladder volume 10	Bladder volume 10+
Catheter placement/confirmation	Catheter placement/confirmation 0	Catheter placement/confirmation 0-1	Catheter placement/confirmation 1	Catheter placement/confirmation 2	Catheter placement/confirmation 3	Catheter placement/confirmation 4	Catheter placement/confirmation 5	Catheter placement/confirmation 6	Catheter placement/confirmation 7	Catheter placement/confirmation 8	Catheter placement/confirmation 9	Catheter placement/confirmation 10	Catheter placement/confirmation 10+

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* 10. Gynecological

	0	0-1	1	2	3	4	5	6	7	8	9	10	10+
Intrauterine Pregnancy	Intrauterine Pregnancy 0	Intrauterine Pregnancy 0-1	Intrauterine Pregnancy 1	Intrauterine Pregnancy 2	Intrauterine Pregnancy 3	Intrauterine Pregnancy 4	Intrauterine Pregnancy 5	Intrauterine Pregnancy 6	Intrauterine Pregnancy 7	Intrauterine Pregnancy 8	Intrauterine Pregnancy 9	Intrauterine Pregnancy 10	Intrauterine Pregnancy 10+

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* 11. Vascular

	0	0-1	1	2	3	4	5	6	7	8	9	10	10+
Abdominal Aortic Aneurism (AAA)	Abdominal Aortic Aneurism (AAA) 0	Abdominal Aortic Aneurism (AAA) 0-1	Abdominal Aortic Aneurism (AAA) 1	Abdominal Aortic Aneurism (AAA) 2	Abdominal Aortic Aneurism (AAA) 3	Abdominal Aortic Aneurism (AAA) 4	Abdominal Aortic Aneurism (AAA) 5	Abdominal Aortic Aneurism (AAA) 6	Abdominal Aortic Aneurism (AAA) 7	Abdominal Aortic Aneurism (AAA) 8	Abdominal Aortic Aneurism (AAA) 9	Abdominal Aortic Aneurism (AAA) 10	Abdominal Aortic Aneurism (AAA) 10+
Deep Vein Thrombosis (DVT)	Deep Vein Thrombosis (DVT) 0	Deep Vein Thrombosis (DVT) 0-1	Deep Vein Thrombosis (DVT) 1	Deep Vein Thrombosis (DVT) 2	Deep Vein Thrombosis (DVT) 3	Deep Vein Thrombosis (DVT) 4	Deep Vein Thrombosis (DVT) 5	Deep Vein Thrombosis (DVT) 6	Deep Vein Thrombosis (DVT) 7	Deep Vein Thrombosis (DVT) 8	Deep Vein Thrombosis (DVT) 9	Deep Vein Thrombosis (DVT) 10	Deep Vein Thrombosis (DVT) 10+
Peripheral IV Access	Peripheral IV Access 0	Peripheral IV Access 0-1	Peripheral IV Access 1	Peripheral IV Access 2	Peripheral IV Access 3	Peripheral IV Access 4	Peripheral IV Access 5	Peripheral IV Access 6	Peripheral IV Access 7	Peripheral IV Access 8	Peripheral IV Access 9	Peripheral IV Access 10	Peripheral IV Access 10+
Central Line Placement	Central Line Placement 0	Central Line Placement 0-1	Central Line Placement 1	Central Line Placement 2	Central Line Placement 3	Central Line Placement 4	Central Line Placement 5	Central Line Placement 6	Central Line Placement 7	Central Line Placement 8	Central Line Placement 9	Central Line Placement 10	Central Line Placement 10+
Peripherally Inserted Central Catheter	Peripherally Inserted Central Catheter 0	Peripherally Inserted Central Catheter 0-1	Peripherally Inserted Central Catheter 1	Peripherally Inserted Central Catheter 2	Peripherally Inserted Central Catheter 3	Peripherally Inserted Central Catheter 4	Peripherally Inserted Central Catheter 5	Peripherally Inserted Central Catheter 6	Peripherally Inserted Central Catheter 7	Peripherally Inserted Central Catheter 8	Peripherally Inserted Central Catheter 9	Peripherally Inserted Central Catheter 10	Peripherally Inserted Central Catheter 10+
Arterial Line Placement	Arterial Line Placement 0	Arterial Line Placement 0-1	Arterial Line Placement 1	Arterial Line Placement 2	Arterial Line Placement 3	Arterial Line Placement 4	Arterial Line Placement 5	Arterial Line Placement 6	Arterial Line Placement 7	Arterial Line Placement 8	Arterial Line Placement 9	Arterial Line Placement 10	Arterial Line Placement 10+

Additional Comments

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* 12. Musculoskeletal/Soft Tissue

	0	0-1	1	2	3	4	5	6	7	8	9	10	10+
Cellulitis	Cellulitis 0	Cellulitis 0-1	Cellulitis 1	Cellulitis 2	Cellulitis 3	Cellulitis 4	Cellulitis 5	Cellulitis 6	Cellulitis 7	Cellulitis 8	Cellulitis 9	Cellulitis 10	Cellulitis 10+
Abscess	Abscess 0	Abscess 0-1	Abscess 1	Abscess 2	Abscess 3	Abscess 4	Abscess 5	Abscess 6	Abscess 7	Abscess 8	Abscess 9	Abscess 10	Abscess 10+
Joint effusion	Joint effusion 0	Joint effusion 0-1	Joint effusion 1	Joint effusion 2	Joint effusion 3	Joint effusion 4	Joint effusion 5	Joint effusion 6	Joint effusion 7	Joint effusion 8	Joint effusion 9	Joint effusion 10	Joint effusion 10+
Fractures	Fractures 0	Fractures 0-1	Fractures 1	Fractures 2	Fractures 3	Fractures 4	Fractures 5	Fractures 6	Fractures 7	Fractures 8	Fractures 9	Fractures 10	Fractures 10+
Foreign bodies	Foreign bodies 0	Foreign bodies 0-1	Foreign bodies 1	Foreign bodies 2	Foreign bodies 3	Foreign bodies 4	Foreign bodies 5	Foreign bodies 6	Foreign bodies 7	Foreign bodies 8	Foreign bodies 9	Foreign bodies 10	Foreign bodies 10+

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* 13. POCUS applications not listed above.

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* 14. Do you teach any other healthcare providers the use of point-of-care ultrasound?

Yes

If yes, please describe your teaching experience (including who you teach, which applications and how long you have been teaching).

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* 15. Do you hold any leadership roles in point-of-care ultrasound?

Yes

If yes, please describe those roles.