Table 1.

Milestones Utilized for Measuring Physician Competency

Level 1	Level 2	Level 3	Level 4	Level 5
A. Goal‐directed focused ultrasound (diagnostic/procedural)—PC12 a
Describes the indications for emergency ultrasound	Explains how to optimize ultrasound images and identifies the proper probe for each of the focused applications Performs an eFAST	Performs goal‐directed focused ultrasound examinations Correctly interprets acquired images	Performs a minimum of 150 focused ultrasound examinations	Expands ultrasonography skills to include: advanced echo, TEE, bowel, adnexal and testicular pathology, and transcranial Doppler
B. Our competency‐based self‐assessment for PEM POCUS fashioned after the ACGME milestones
Describe the indications for emergency ultrasound	Explain how to optimize ultrasound images and identify the proper probe for each of the focused ultrasound applications I also can perform a FAST/eFAST examination	Perform goal‐directed focused ultrasound examinations and correctly interpret acquired images	Perform a minimum of 150 focused ultrasound examinations	Consistently achieve scans at the technical level of an imaging professional, meaning I would feel comfortable documenting the results, making a clinical decision based on my findings, saving the images to the chart, and billing the patient for my images
C. ACGME PEM milestone for general approach to procedures—PC9 b
Identifies pertinent anatomy and physiology for a specific procedure; uses appropriate universal precautions	Performs patient assessment, obtains informed consent, and ensures monitoring equipment is in place in accordance with patient safety standards; knows indications, contraindications, anatomic landmarks, equipment, anesthetic and procedural techniques, and potential complications for common ED procedures; performs the indicated common procedure on a patient with moderate urgency who has identifiable landmarks and a low‐to‐moderate risk for complications; performs postprocedural assessment and identifies any potential complications	Determines a back‐up strategy if initial attempts to perform a procedure are unsuccessful; correctly interprets the results of a diagnostic procedure	Performs indicated procedures on any patients with challenging features (e.g., poorly identifiable landmarks, at extremes of age or with comorbid conditions; performs the indicated procedure, takes steps to avoid potential complications, and recognizes the outcome and/or complications resulting from the procedure	Teaches procedural competency and corrects mistakes
D. ACGME PEM milestone for emergency stabilization—PC5 c
Recognizes abnormal vital signs	Recognizes when a patient is unstable requiring immediate intervention; performs a primary assessment on a critically ill or injured patient; discerns relevant data to formulate a diagnostic impression and plan	Manages and prioritizes critically ill or injured patients; prioritizes critical stabilization actions in the resuscitation of a critically ill or injured patient; reassesses after implementing a stabilizing intervention; evaluates the validity of a DNAR order	Recognizes in a timely fashion when further clinical intervention is futile; integrates hospital support services into a management strategy for a problematic stabilization situation	Develops policies and protocols for the management and/or transfer of critically ill or injured patients

ACGME = Accreditation Council for Graduate Medical Education; DNAR = do not attempt resuscitation; PEM = pediatric emergency medicine; POCUS = point‐of‐care ultrasound; TEE = transesophageal echocardiography.

^aUses goal‐directed focused ultrasound for the bedside diagnostic evaluation of emergency medical conditions and diagnoses, resuscitation of the acutely ill or injured patient, and procedural guidance.

^bPerforms the indicated procedure on all appropriate patients and takes steps to avoid potential complications, and recognizes the outcome and/or complications resulting from the procedure—PC9.

^cPrioritizes critical initial stabilization action and mobilizes hospital support services in the resuscitation of a critically ill or injured patient and reassesses after stabilizing intervention—PC5.