Point-of-care ultrasound (PoCUS) is a mandatory part of emergency medicine training in the UK. Under the RCEM curriculum, PoCUS sits within Specialty Learning Outcome 6, "Deliver key procedural skills", and you progress through it like any other procedure: by gathering evidence over time until a supervisor trusts you to scan without supervision.
This guide sets out what the current RCEM documents require, where most trainees lose time, and how to plan sign-off from your first ACCS placement to CCT.
Your action plan: how to get it done
These steps are Wavelength's practical advice, built on the official requirements set out in this guide. Where a step quotes a rule, the rule comes from the source documents listed at the end. Follow them in order.
Step 1. Find your PoCUS lead in your first week
Every RCEM training department should have a named consultant PoCUS lead. Ask your college tutor or rota coordinator who it is, then send a short email:
Ask the PoCUS lead three questions: which consultants and registrars are at level 4 and happy to supervise, where the machines live and how images are saved, and what the local reporting policy says for trainees.
Step 2. Get a machine induction before your first scan
Ask the PoCUS lead or a level 4 colleague for a ten-minute induction on the machine you will use: switching on, entering a patient or training reference, choosing presets, saving clips, exporting and cleaning the probe. RCEM's governance guidance lists "seeks and completes PoCUS induction before using it" as a level 1 behaviour, so record the induction in your portfolio.
Step 3. Do the e-learning for your first modality
Complete the matching RCEMLearning module before you start logging scans for a modality. Save the certificate to your e-portfolio straight away. In ACCS, start with physics and image optimisation, then vascular access and fascia iliaca block.
Step 4. Set up your logbook today
Pick one place and stick with it: the e-portfolio procedural log, a spreadsheet or an app. Set up columns for the fields in our logbook guide. Log every scan on the day. Ten minutes at the end of a shift beats a weekend rebuilding a logbook before ARCP.
Step 5. Agree a written plan with your educational supervisor
At your first educational supervisor meeting, add a PoCUS line to your personal development plan, for example: "Sign off vascular access and fascia iliaca block by February. Log one scan every two weeks. Two DOPS per modality." A written target turns good intentions into a deadline both of you see.
Step 6. Make scanning part of every shift
- At handover, tell the nurse in charge and the senior on shift: "I am working on my PoCUS sign-off. Call me for any cannula that needs ultrasound, any fascia iliaca block or any patient needing an aorta or FAST scan."
- Scan in resus whenever a level 4 colleague is there. Ask before the patient arrives: "Are you happy for me to do the eFAST with you watching?"
- Scan normal anatomy on suitable patients after consent. Normals build speed.
- Use the procedural modalities. Difficult intravenous access and hip fractures arrive every shift.
Step 7. Ask for DOPS in the moment
Do not save assessments for a quiet day. Open the DOPS form on your phone before the scan, and ask: "Could you watch this scan as a DOPS for my PoCUS sign-off? It takes two minutes to fill in afterwards." Send the e-portfolio ticket before the end of the shift while it is fresh.
We suggest at least two DOPS per modality from different assessors, plus one CbD or Mini-CEX where ultrasound changed what you did.
Step 8. Book protected scanning time
Opportunistic scanning rarely gets diagnostic modalities over the line. Ask your PoCUS lead about scanning lists, drop-in sessions or a supervised session in the acute medical unit or intensive care, and use your development time for it. For ELS and shock assessment, ask to join simulation sessions where you scan during a scenario.
Step 9. Write five reflections per modality as you go
Write a reflection the same day you meet a scan worth learning from: a missed finding, a difficult window, a scan that changed management. Use the RCEM e-portfolio ultrasound case reflection form. Five strong reflections per modality beat twenty thin ones.
Step 10. Ask for the entrustment decision
When your logbook, reflections and DOPS show consistent independent scanning, ask your supervisor for the entrustment decision: "I think I am ready for level 4 in AAA. My logbook, reflections and three DOPS are in the e-portfolio. Could you review them and record your decision?" We suggest asking at least three months before ARCP, so there is time to fill any gap.
A weekly routine that works
| When | What to do |
|---|---|
| Start of each shift | Tell the senior and nurse in charge you want ultrasound cases |
| During the shift | Scan at least once, and ask for a DOPS when a supervisor watches |
| End of the shift | Log every scan with a training reference and findings |
| Once a week | Check formal imaging results for last week's scans and add them |
| Once a month | Review saved images with a supervisor for 20 minutes |
| Every three months | Check progress against your plan with your educational supervisor |
What changed and what stayed the same
The 2021 curriculum moved PoCUS away from the old "Level 1" model of a mandatory course, fixed scan counts, triggered assessments by a regional lead and a one-off finishing school. RCEM's own FAQ confirms a mandatory course and finishing schools are no longer required, and scan numbers are now indicative, not absolute.
The curriculum also added three areas to the old core four:
- Ultrasound-guided fascia iliaca compartment block (FICB)
- Extended FAST (eFAST), adding the chest views for pneumothorax and haemothorax, and Focused Assessment for Free Fluid (FAFF), the same scan used outside trauma
- Assessment of the hypotensive or peri-arrest patient: a shock protocol combining focused echo, lung, IVC, aorta and free fluid views
Abdominal aortic aneurysm assessment, vascular access (peripheral and central), echo in life support (ELS), physics, settings, safety and ergonomics, and governance carried over unchanged.
The August 2025 update to the curriculum (version 1.5) gave more flexibility in how procedural skills in SLO6 are assessed. It did not change the PoCUS modalities, the indicative numbers or the entrustment model. If you started training before August 2025, check with your training programme director which version applies to you: trainees within six months of CCT at the implementation date stayed on the previous version.
The modalities and indicative numbers
RCEM divides PoCUS into procedural and diagnostic modalities. Procedural skills come first, in core training, because you perform them often. Diagnostic scans follow in intermediate and higher training.
| Modality | Type | Indicative scans | Reflective notes |
|---|---|---|---|
| Vascular access (peripheral and central) | Procedural | 5 | 5 |
| Fascia iliaca compartment block | Procedural | 10 | 5 |
| Abdominal aorta (AAA) | Diagnostic | 25 | 5 |
| eFAST or FAFF | Diagnostic | 25 | 5 |
| Echo in life support (ELS) | Diagnostic | 10 | 5 |
| Shock assessment | Diagnostic | 25 | 5 |
These numbers run across the whole training programme. RCEM states some trainees will need fewer and some more. If you reach the right entrustment level without meeting the indicative number, your supervisor records on the e-portfolio they are aware of this, and it should not stop your progress.
The reverse matters more. Hitting 25 scans does not earn sign-off on its own. Quality and consistency of evidence decide it.
The entrustment scale
Every modality is judged on the RCEM entrustment scale. The level describes how much supervision you need, not how many scans you have done.
| Level | What it means in practice |
|---|---|
| 1 | Direct supervision: your supervisor is with you for the scan |
| 2a | Supervisor on the shop floor, checking at regular intervals |
| 2b | Supervisor in the hospital, available for queries and prompt help |
| 3 | Supervisor on call from home, able to advise by phone and attend if needed |
| 4 | Able to scan and act on the findings with no supervisor involvement |
Level 4 is the target for every modality by CCT. RCEM's August 2022 guidance, "SLO6: Point of Care Ultrasound Competence Entrustment Scale", describes the skills and knowledge expected at each level for each scan. Read it before you start a modality. It tells you what your supervisor will look for, view by view.
Two examples from that guidance show how specific it is:
- ELS at level 4. You obtain modified views from different positions without interrupting CPR, keep the probe in place to monitor compressions, and tell a pericardial effusion from a pleural effusion and from a fat pad.
- AAA at level 2a. You identify the vertebral body, separate the IVC from the aorta, and measure outer wall to outer wall: three transverse measurements, one longitudinal and one of the iliac arteries.
The triangle of evidence
RCEM describes three sources of evidence feeding the entrustment decision.
1. Learning
- RCEMLearning PoCUS modules, starting with physics and image optimisation and moving to each modality. Each modality guidance lists the matching e-learning module as a level 1 requirement.
- Study days: introductory in ACCS, intermediate in the later ACCS years and a refresher or advanced day in higher training.
- Departmental teaching, scanning clubs, drop-in sessions and simulation.
- Optional courses and qualifications. RCEM lists FAMUS, FUSIC, FEEL, EGLS and BSE as complementary, along with postgraduate certificates.
2. Workplace-based assessment
- DOPS remains the primary assessment tool for every modality. A DOPS assesses two separate things: whether you obtain an adequate image, and whether you interpret it correctly.
- Mini-CEX, CbD, ACAT and ESLE assess how you apply ultrasound in the clinical context: the indication, the decision you made and the limits of the scan.
- Simulation counts. DOPS on simulated patients are acceptable, and simulation is the main way to see pathology you rarely meet.
In higher training, RCEM expects assessments to happen during real patient management, for example an aorta scan inside the assessment of a patient with abdominal pain, and to be built into recorded learning events.
3. Logbook and reflection
- A logbook of scans with reflections, kept from your first ACCS placement.
- A review of your images with a supervisor.
- An image library of normal anatomy, artefacts and pathology.
RCEM's preferred platform for the logbook is the RCEM e-portfolio (now risr/advance, formerly Kaizen), as it links to the curriculum and ARCP. Any other platform capturing the minimum dataset and meeting data protection rules is acceptable. Our logbook guide explains what to record.
Stage by stage: a realistic timeline
The PoCUS appendix to the curriculum sets out suggested milestones. RCEM states it should be the exception for sign-off not to be complete by the end of ST5.
| Stage | Learning | Sign-off target | Scanning rhythm |
|---|---|---|---|
| ACCS | Online modules, bedside learning, start the logbook | Vascular access and fascia iliaca block | At least one scan every two weeks |
| ST3 to ST4 | Further online learning or a course, online pathology learning | ELS, AAA and eFAST or FAFF | At least one scan a week |
| ST5 | Consolidate the logbook | Shock assessment, plus any diagnostic modality not signed off in ST4 | At least one scan a week |
| ST6 | Consider enhanced training, teach juniors, contribute to governance | Maintain level 4 in all modalities | At least one scan a week |
Supervision during ACCS placements in anaesthetics, intensive care and acute medicine counts. Trainers in those specialties can supervise and observe your scans, so use the placements: intensive care gives you vascular access and focused echo, acute medicine gives you lung and abdominal scans.
What your supervisor looks at before sign-off
Before signing you off at level 4 in a modality, expect your supervisor or departmental PoCUS lead to review:
- Your e-learning certificate for the modality.
- Your logbook for the modality, with dates, findings, supervision level and outcomes.
- At least five reflective notes, ideally including a missed or difficult scan.
- One or more DOPS on the modality, observed on a patient or in simulation.
- Workplace assessments showing you use the scan in context, not only acquire images.
- Your knowledge of the generic competences: physics, artefacts, settings, probe handling and governance. RCEM publishes separate entrustment guidance for "Physics, settings, ergonomics and safety" and for "Governance and administration", and recommends assessing both alongside every scan.
Reporting your scans before level 4
RCEM advises you to report every diagnostic scan according to local ED guidelines, even before level 4, and to state your entrustment level in the report. The report goes in the patient notes, on the machine with upload to PACS, or both.
This differs from FAMUS and FUSIC, which ask trainees not to put training scans in the clinical record until a supervisor has verified them. Follow your department's PoCUS policy. If the policy is unclear, ask your PoCUS lead before you scan, not after.
Governance your department should provide
RCEM recommends every department training in PoCUS has:
- A governance framework, with local PoCUS induction and a written code of practice
- Modern, maintained machines, preferably connected to PACS
- A consultant with at least six months of level 1 PoCUS competence holding overall responsibility for training, administration and governance
- At least 0.5 dedicated programmed activities for the PoCUS lead
If your department lacks these, raise it early with your educational supervisor and college tutor. A missing PoCUS lead is a training environment issue, not a personal failing.
Non-training doctors, ACPs and CESR applicants
The same model applies to clinicians outside the training programme. RCEM recommends the 2021 PoCUS syllabus as the blueprint for the Portfolio Pathway (formerly CESR), specialty and specialist doctors, pre-hospital clinicians, advanced clinical practitioners and physician associates. A modular approach is encouraged, so you work to level 4 in the modalities within your scope of practice.
For a Portfolio Pathway application, your evidence needs to show the same things a trainee's would: learning, a logbook with reflection, workplace assessments and an entrustment decision signed by a suitably experienced consultant.
If you are behind
Talk to your educational supervisor and PoCUS lead early, well before ARCP. Common fixes:
- Book protected scanning sessions with a supervisor rather than hoping for opportunistic scans on shift.
- Use simulation for ELS and pathology you rarely see.
- Scan normal anatomy on every suitable patient. Normals build speed and give you the reference for spotting abnormal.
- Log as you go. Reconstructing a logbook from memory in the month before ARCP rarely convinces anyone.
After sign-off
Competence fades without practice. RCEM recommends a personal development plan and continuing professional development after level 4: keep logging, keep reflecting, review scans with peers and compare your findings with formal imaging. Supervising and teaching others counts as part of maintaining competence.
Sources
Checked against these documents on 4 October 2026. Always confirm against the current RCEM version and your local guidance.
- RCEM: Ultrasound education and training, 2021 curriculum FAQ
- RCEM Point of Care Ultrasound Curriculum 2021, Appendix 3
- RCEM SLO6 PoCUS Competence Entrustment Scale: guidance for education and training (August 2022)
- RCEM Governance and Administration entrustment scale (September 2022)
- RCEM Curriculum 2021, version 1.5, updated 6 August 2025
- RCEM: Training curriculum changes (2025 update)