The American College of Emergency Medicine (ACEP) issued a position paper in 1990 [
1] that supported the use of POCUS; this was followed by a similar document written by the Society for Academic Emergency Medicine in 1991 [
2]. With this early support for the use of POCUS by EM physicians, EM residency programs in the United States and Canada started to introduce ultrasonography as a standard part of training. The ACEP developed an ultrasonography working group in the 1990s who were vigorous proponents of POCUS and were responsible for establishing POCUS as a widely accepted standard within the EM community. This required resolution of conflicts with the radiology and cardiology services related to jurisdiction, economics, and scope of practice. In 2001, the ACEP developed emergency ultrasound guidelines [
3] that described the scope of practice for EM POCUS to include seven ultrasound competencies: trauma, pregnancy, abdominal aorta, cardiac, biliary, urinary tract, and procedural. These were expanded in 2009 to include thoracic, deep vein thrombosis (DVT), ocular, and soft tissue/musculoskeletal [
4]. The American College of Graduate Medical Education (ACGME) has established POCUS as a required part of EM training based upon the recommendations of the professional societies. All EM residencies accredited by the ACGME provide POCUS training guided by consensus recommendations published by the ACEP in 2009 that include a minimum 80 hours of dedicated clinical ultrasonography, 20 hours of didactic ultrasonography education, and accurate performance of 150 independently reviewed ultrasound studies [
5]. Many residencies exceed these minimum requirements; as a result, training in EM POCUS is now standard in the 190 EM training programs in the USA. There are also 95 EM ultrasonography fellowship training programs in the USA which provide an optional year of further training following standard residency training in EM for those physicians who seek special qualification in EM POCUS. The ACEP has developed guidelines for fellowship training [
6] that include the performance of a minimum of 1000 ultrasonography examinations and 20 hours per month of dedicated ultrasonography practice, education, or research. The fellowship programs have been instrumental in filling the need for qualified faculty to provide training in POCUS to EM residents. At present, there is no nationally recognized certification in EM POCUS. Although this is controversial, the present consensus is that the requirement for a specific certification for POCUS is not necessary. Completion of residency training in EM by established ACGME standards implies competence in a wide variety of skills, none of which require specific certification. Ultrasonography should be seen no differently than other aspects of EM training. This is similar to the situation regarding certification in CCUS.
The development of POCUS in Europe is more difficult to summarize, because there is no central authority such as the ACGME that determines scope of practice or training standards. The development of EM POCUS has therefore been country specific. It is apparent to North American observers that EM POCUS is used in many hospitals in Europe, and that much of the best quality research related to POCUS comes from these centers of excellence. Lacking a central control of residency training requirements, the authors cannot comment on residency or fellowship training patterns in Europe.