Table 3.

Progressive plan for training in ultrasound in Primary Care.

Level of competence	Concepts and learning method	Assessment and skills
A	Basic physical principles Basic principles of ultrasound and general notions of using the ultrasound scanner. Both concepts can be studied in a theoretical framework (for example, a virtual environment). It includes management of the ultrasound apparatus, as well as basic concepts of image optimisation (definition and concept of the different ultrasound artefacts and how to interpret or minimise them), and the understanding and management of the different modes of examination (B, M, colour Doppler, pulsed Doppler). Must be accredited by theoretical examination (e.g. multiple choice answer type)	Basic physical principles of ultrasound General use of an ultrasound device, including the different modes and basic buttons
B	Normal ultrasound anatomy The support can be in the format of images or videos and face-to-face training is not necessary. It includes ultrasound indications, patient preparation, image optimisation concepts and scanning systematics, as well as the interpretation of normal anatomy images. It must be accredited by means of a theoretical examination that includes the interpretation of images or videos of normal anatomy (both anatomical schemes and ultrasound images)	Normal anatomy of the exploration area Preparation (of the patient) needed to carry out the ultrasound examination of the area
C	Normal ultrasound anatomy It requires face-to-face training through practices in healthy model or simulation model. Special emphasis on image optimisation, scanning systematics, interpretation of normal images and recording and reporting of ultrasound. It must be accredited by practical exam in healthy model or simulation (it is advisable to define and use a checklist of skills)	Perform a systematic ultrasound examination, identifying the different anatomical structures under normal conditions
D	Pathological ultrasound Support may be in image or video format. Special emphasis on the interpretation of the images, recording and documentation of the ultrasound (report with description of the findings), possible diagnostic orientation and clinical decision according to this diagnostic orientation. It must be accredited by means of a theoretical examination that includes the interpretation of pathological images or videos, or by means of a practical examination with a medical simulation mannequin that permits the pathology to be simulated	Possible pathology that affects the exploration area Description of pathological images
E	Ultrasound in conditions of real clinical practice This requires training in real patients, referred for clinical reasons, establishing a concordance between the learner and the tutor. It may be accredited by demonstrating a good agreement with the tutor (not less than 0.7) by direct practical examination or by presenting a portfolio of ultrasounds performed, in the format of clinical cases with the videos recorded and the written reports	Practical skills under conditions of routine clinical practice