At a glance · Checked 4 October 2026
RCEM PoCUS sign-off
Who it is for
Emergency medicine trainees in the UK, from ACCS to CCT. RCEM recommends the same syllabus for Portfolio Pathway applicants, specialty and specialist doctors, advanced clinical practitioners and physician associates, in the modalities within their scope.
Requirements at a glance
- Sign-off is an entrustment decision at level 4 in each modality: you scan and act on the findings with no supervisor involvement.
- Evidence comes from three sources: learning, workplace-based assessment, and a logbook with reflections.
- Scan numbers are indicative, not targets. A mandatory course and finishing school are no longer required.
Modalities and indicative numbers
| Modality | Usual stage | Scans | Reflections |
|---|---|---|---|
| Vascular access | ACCS | 5 | 5 |
| Fascia iliaca block | ACCS | 10 | 5 |
| Echo in life support | ST3 to ST4 | 10 | 5 |
| Abdominal aorta (AAA) | ST3 to ST4 | 25 | 5 |
| eFAST or FAFF | ST3 to ST4 | 25 | 5 |
| Shock assessment | ST5 | 25 | 5 |
Assessments
- DOPS is the primary tool for every modality. It assesses image acquisition and interpretation separately.
- Mini-CEX, CbD, ACAT and ESLE show you use the scan in clinical context.
- DOPS on simulated patients are acceptable.
Who supervises and signs off
- Level 4 clinicians supervise your scans. Trainers in anaesthetics, intensive care and acute medicine can supervise during ACCS placements.
- Your supervisor or departmental PoCUS lead reviews your evidence and records the entrustment decision.
- Every training department should have a named consultant PoCUS lead.
Suggested sequence
- Meet your PoCUS lead and get a machine induction.
- Complete the RCEMLearning module for the modality.
- Log every scan on the day, with no patient identifiers.
- Collect DOPS from different assessors as you go.
- Write five reflections per modality.
- Ask for the entrustment decision well before ARCP.
Final sign-off
Before level 4 your supervisor reviews your e-learning certificate, logbook, at least five reflections, one or more DOPS, workplace assessments, and your grasp of physics, settings and governance. RCEM states sign-off should be complete by the end of ST5, except in rare cases.