Identification and Rationale for the Chosen Barrier Across Canadian medical schools, integration of point of care ultrasound (POCUS) in undergraduate medical education remains inconsistent and insufficiently standardized. A national review found that only half of undergraduate medical education programs offer formal ultrasound teaching, and typically under five hours per year [1]. Meanwhile, 76% of internal medicine trainees report using POCUS in clinical practice despite minimal training, revealing a disconnect between undergraduate preparation and clinical expectations [2]. Although the Canadian Medical Student Ultrasound Curriculum (CMSUC) outlines national competencies, few schools have implemented standardized instruction or validated assessment [3]. This gap limits competency development and prevents students from applying ultrasound diagnostically. Proposed Initiative This initiative embeds POCUS directly into system-based Clinical Skills, taught alongside traditional examination maneuvers. During the Respiratory block, students pair auscultation with lung ultrasound to identify pleural effusion and pulmonary edema—conditions with >90% sensitivity and specificity, outperforming both percussion and auscultation [4–8]. Emphasizing high-yield, high– pretest-probability conditions such as left ventricular dysfunction, pericardial effusion, and abdominal aortic aneurysm, enables learners to apply ultrasound to answer diagnostic questions and integrate imaging into bedside reasoning [4]. Competence will be evaluated using the Objective Structured Assessment of Ultrasound Skills (OSAUS)—a validated global rating scale for ultrasound performance and diagnostic integration [9–12]. Implementation Plan We will coordinate with block leads, secure ultrasound machines from institutional inventory, and train clinical skills teaching assistants (senior students/residents) as near-peer instructors. The pilot will launch in the Respiratory block, dedicating one hour per session to hands-on POCUS teaching. Feedback from students and facilitators will guide evaluation and integration into the team observed structured clinical examination (TOSCE), where students perform targeted scans to answer diagnostic questions. Findings will inform refinement and expansion to Cardiovascular and Abdominal systems. The initiative will leverage existing resources and infrastructure [14,15]. Evaluation Strategy and Scalability Within the TOSCE, OSAUS will assess diagnostic scanning and interpretation, with success defined as a mean score of ≥3.5/5, a validated competency threshold [9,13]. Pre- and post-session knowledge assessments will measure improvement, while anonymous surveys will evaluate confidence. Curriculum effectiveness will be determined by the proportion of students meeting the competency standard and inter-rater reliability (ICC > 0.8) [13,16]. Findings will guide expansion toward a sustainable, evidence-based framework for POCUS education in undergraduate medicine.
While national recommendations for point of care ultrasound (POCUS) integration in undergraduate medical education (UGME) are outlined by Canadian POCUS leaders, a critical barrier remains: the absence of standardized national objectives for POCUS teaching and evaluation. To address this gap, we propose an outcome-driven approach to learning—the entrustable professional activity (EPA). This tool evaluates a student’s competency and progression in performing clinical tasks. In Canada, EPAs are used to document key clerkship competencies, making it readily accessible. We suggest a series of POCUS-specific EPAs spanning the UGME curriculum. Establishing EPAs across the program’s entirety reinforces a longitudinal educational framework, enhancing skill retention. Our proposed EPAs include a 10-domain checklist assessing common POCUS competencies. Each EPA builds on skills developed in completed ones, creating a coherent progression that mirrors learners’ evolving clinical responsibilities. To align with national standards, EPAs will be derived from the Canadian POCUS Acute Care Core curriculum. Due to its high scalability, the ultrasound applications within this EPA-based program can be updated without modifying the assessment framework, allowing the curriculum to remain current with medical advancements. Pre-clerkship EPAs will emphasize foundational physics, knobology, anatomical landmark recognition, and supervised image acquisition. Clerkship EPAs will focus on independent image acquisition and their integration in clinical contexts. To test this method, an initial phase will be conducted in entering cohorts in Quebec’s four medical schools. Evaluation will be based on learner performance, measured through completion rates, entrustment scores, and student and faculty feedback on usability and educational value. EPAs will occur during existing practical sessions or clinical rotations, thus requiring no additional equipment nor instructor. Costs will be related to administrative and technical tasks, including EPA form incorporation into existing electronic systems. The following year, after fine-tuning, Quebec schools will extend the framework to incoming cohorts, after which the system can be expanded nation-wide. The educational impact will be assessed by comparing learner progression across Canadian cohorts and institutions. Residents and physicians will monitor POCUS preparedness of incoming clerks and residents via surveys. Stakeholders include medical students, UGME curriculum committees, and national bodies such as cPOCUS and the Medical Council of Canada. This EPA-based model offers a feasible and scalable strategy to standardize UGME POCUS education nationally, ensuring all medical graduates possess the foundational skills required for clinical practice.
Structured point of care ultrasound (POCUS) education remains limited across Canadian undergraduate medical programs, despite its growing clinical relevance. At our institution, where no formal POCUS curriculum exists, 84% of surveyed students (n = 71) rated POCUS education as "lacking" or "severely lacking," with many seeking costly, external training. To address this gap, we designed InSiGHT-US—the Interdisciplinary and Simulation-Guided Hands-on Training in Ultrasound curriculum—an evidence-informed, two-phase program introducing foundational skills and reinforcing them through spaced, simulation-based application. Phase 1, POCUS Day, launches the initiative with an interdisciplinary, full-day, multi-station workshop providing intensive, hands-on training in core applications, including diagnostic scanning (Focused Assessment with Sonography for Trauma (FAST), cardiac, lung, obstetric) and ultrasound-guided procedures (vascular access, thoracentesis, paracentesis, blocks). This phase leverages evidence-based pedagogical methods—small group learning, active learning, and near-peer teaching—delivered by interdisciplinary resident instructors to maximize skill acquisition and resource efficiency. Several months later, Phase 2, a Hybrid Simulation Session, allows learners to apply their training to realistic case scenarios. Students perform real-time scanning on standardized patients while preceptors integrate digital ultrasound clips displaying corresponding pathological findings. This innovative format bridges image acquisition with diagnostic reasoning, enabling students to practice technical skills, interpret both normal and abnormal findings, and use these insights to guide management. Integrating simulation-based learning and spaced reinforcement enhances procedural retention and knowledge consolidation. InSiGHT-US is designed for high feasibility and cost efficiency. By leveraging existing institutional infrastructure (ultrasound equipment, models, and protected teaching time for residents), expenses are largely limited to standardized patients and preceptor honoraria (~$6000 annually for a class of 200; <$30 per student). The program will be piloted with voluntary participation in Year 1 (estimated cost: $200), followed by full implementation in Year 2 upon successful evaluation. The evaluation employs a rigorous pre- and post-intervention design. It will use primary metrics of objective knowledge gain (multiple choice question assessments) and self-reported competence (Likert surveys) to ensure data-driven quality improvement and scalability. This model is highly adaptable; it can be tailored for institutions with varying resources by adjusting scanning stations, substituting virtual cases, or tailoring content to local needs. InSiGHT-US offers a robust, sustainable, and scalable model for embedding essential POCUS education into undergraduate training nationwide.
Introduction by Conference Chair On October 25, 2025, the 5th annual Séguin Canadian POCUS Education Conference (SCPEC) was held over Zoom. SCPEC is an annual student-led conference that unites Canadian medical students, residents, and staff physicians to collaborate and advance POCUS education across all medical schools. This year’s conference was the largest to date, bringing together over 150 attendees at all levels of training. We were pleased to host our inaugural case competition this year, titled “Breaking Barriers in POCUS Education – Innovate to Educate.” The case competition featured 32 teams of medical students and their creative proposals to improve POCUS training at their medical school. With the expertise of our resident and staff MD judges, the top three case competition teams were awarded the SCPEC 2025 Grant to support the implementation of their POCUS initiative at their home school. We especially thank The POCUS Journal for this partnership to publish the winning teams’ abstracts – showcasing the innovative ideas by Canadian medical students to improve POCUS education. Congratulations once again to all 150 medical students who participated in SCPEC 2025! We hope you will continue to lead change in POCUS training at your medical school. I would like to sincerely thank everyone who made SCPEC 2025 possible. To my incredible team of 21 medical student leaders across Canada: thank you for five months of hard work to re-design SCPEC to host a new and successful case competition and conference. A huge thank you to Dr. Tsoutsoulas for his outstanding supervision and mentorship with SCPEC. Many thanks to our keynote speaker, judges, and workshop leaders for their engaging sessions. Finally, thank you to our sponsors; your support makes this national collaboration happen every year. It has been my absolute privilege to chair SCPEC 2025, and I am so proud of all the medical students across the country who are changing the landscape of POCUS education. We cannot wait to hear of all your successes next year at SCPEC 2026 (https://seguincpec.wixsite.com/scpec). Sincerely, Dr. Selina Chow Conference Chair, SCPEC 2025 PGY1 Resident Physician, Family Medicine, University of Toronto
Background: Lung point of care ultrasound (POCUS) offers advantages over traditional imaging for diagnosing pulmonary conditions, with superior accuracy compared to chest X-ray and lower cost compared to computed tomography. Despite these benefits, widespread adoption is limited by operator dependency, moderate interrater reliability, and training requirements. Deep learning (DL) could potentially address these challenges, but the development of effective algorithms is hindered by the scarcity of comprehensive image repositories with proper metadata. Methods: We created an open-source dataset of lung POCUS images derived from a multi-center study involving 226 adult patients presenting to emergency departments with respiratory symptoms between March 2020 and April 2022. Images were acquired using a standardized scanning protocol (12-zone or modified 8-zone) with various POCUS devices. Three blinded researchers independently analyzed each image following consensus guidelines, with disagreements adjudicated to provide definitive interpretations. Videos were preprocessed to remove identifiers, and frames were extracted and standardized to 512×512 pixels using letterboxing to maintain aspect ratios. Results: The dataset contained 1,871 video clips comprising 324,027 frames extracted and standardized to 512×512 pixels. Half of the participants (50%) had COVID-19 pneumonia. Among all clips, 66% contained no abnormalities, 18% contained B-lines, 4.5% contained consolidations, 6.4% contained both B-lines and consolidations, and 5.2% had indeterminate findings. Pathological findings varied significantly by lung zone, with anterior zones more frequently normal and less likely to show consolidations compared to lateral and posterior zones. Discussion: This dataset represents a large, annotated lung POCUS repository and includes patients with and without COVID-19. The repository metadata and expert interpretations enhance its utility for DL applications. Despite limitations including potential device-specific characteristics and COVID-19 predominance, this repository provides a valuable resource for developing artificial intelligence tools to improve lung POCUS acquisition and interpretation.
Background: In some clinical circumstances, it may be difficult to accurately measure systolic blood pressure (SBP) using direct auscultation technique or an automated oscillometric cuff pressure device. As an alternative method, this study compared the measurement of SBP using point of care ultrasound (POCUS) with color Doppler to the measurement of SBP using an intraarterial catheter. Methods: Study subjects were 50 patients in an intensive care unit who had an intraarterial catheter placed for monitoring blood pressure. The intraarterial catheter systolic pressure was recorded and compared to the contemporaneous measurement of SBP using POCUS with color power Doppler (CPD). The operator placed the Doppler sample volume over the brachial artery with ipsilateral inflation of a prepositioned upper arm blood pressure cuff that was inflated sufficiently to ablate blood flow in the target artery. The blood pressure cuff was then deflated until there was return of CPD signal in the brachial artery. At this moment, the corresponding blood pressure was noted on a sphygmomanometer attached to the blood pressure cuff. The values of the two methods were compared using standard statistical technique. Results: The intraarterial systolic pressures and CPD systolic pressures by POCUS were well correlated with a Pearsons correlation coefficient of 0.96. Bland-Altman analysis of bias and limits of agreement indicated that the POCUS with CPD measurement was sufficiently accurate to have clinical utility. Conclusions: The use of POCUS with CPD to measure SBP may have utility in situations where direct auscultation or automated oscillometeric cuff pressure measurements may be unreliable.
In females, failure of the processus vaginalis to close properly can result in continued outpouching of the parietal peritoneum through the inguinal canal into the labia majora, forming a structure known as the Canal of Nuck. In rare cases, a Canal of Nuck hydrocoele can develop in association with the presence of a ventriculoperitoneal (VP) shunt, leading to symptoms of pain and discomfort in the inguinal region. We present the first reported case of a Canal of Nuck hydrocoele identified using POCUS in a child. This case highlights the role of POCUS as a safe, reliable, first-line imaging tool for identifying Canal of Nuck hydrocoeles in patients with VP shunts.
Background: Acute limb ischemia (ALI) is a vascular emergency associated with significant pain that can be challenging to manage, especially in opioid-tolerant patients. Case Report: A 44-year-old man with opioid use disorder presented with ALI of the right hand not amenable to surgical intervention after self-injection of fentanyl. Despite high-dose opioids, he continued to experience refractory pain. Point of care ultrasound (POCUS)-guided radial and median nerve blocks performed in the emergency department provided substantial relief. Discussion: This case illustrates the novel use of POCUS-guided upper extremity regional anesthesia by emergency physicians to manage ALI pain. POCUS-guided regional anesthesia may be a safe, effective adjunct in select patients, though patients must be closely monitored for complications.
Peer review is a fundamental element of the modern scientific publishing process. It serves an important role in evaluating the quality of research and refining submitted manuscripts into accurate and impactful contributions to the existing scientific literature. Over the last two decades, opportunities for publication have skyrocketed, and the demand for peer reviewers has grown exponentially. Although peer review offers significant benefits, the most common challenges to recruiting peer reviewers include the time commitment needed to provide meaningful reviews and the uncertainty of how to prepare a cohesive and beneficial peer review. This article offers prospective peer reviewers a structured guidance and thus a sense of confidence to perform an effective review.
Minor abdominal blunt trauma is a common pediatric emergency department presentation. Contrast-enhanced computed tomography (CECT) is the current gold standard imaging modality for identifying abdominal parenchymal injuries. Contrast-enhanced ultrasound (CEUS) has been suggested as a radiation-sparing alternative. Here we describe, for the first time, the use of pediatric emergency physician-performed CEUS in the evaluation of minor abdominal trauma in a child. The use of CEUS informed the decision-making process in this case and ultimately led to the diagnosis of an adrenal hemorrhage.
Point of care ultrasound (POCUS)-use during short-term surgical missions (STSMs) to resource-limited settings has not been well studied. We conducted a retrospective analysis of POCUS use during the perioperative course of patients undergoing definitive surgical treatment over the course of two STSMs. A total of 58 perioperative POCUS exams were performed by emergency physicians on our team. Operative findings correlated with POCUS results in 90% of cases that underwent surgery, while surgery was deferred based on POCUS findings in 33% of scans. Our findings suggest that POCUS is a portable, rapid and cost-effective modality that can be used in a focused manner in the perioperative period. Specifically, our inter-disciplinary experience and results demonstrate that POCUS-use has a positive impact on patient safety and quality, and optimizes the use of valuable resources and time.
Background: Point of care ultrasound (POCUS) is increasingly recognized as a valuable tool for mediastinal assessment in children, particularly in resource-limited settings where advanced radiological options such as computed tomography (CT) scans are often unavailable. In high-income countries, POCUS is gaining traction as a complementary imaging method, offering a safer, radiation-free alternative. Methods: To overcome the operator-dependent nature of mediastinal POCUS, a standardized protocol was developed. The protocol includes clear techniques and detailed descriptions of normal and pathological findings, aiming to enhance consistency and diagnostic accuracy. Results: The standardized protocol improved reliability in mediastinal POCUS assessments, especially in the context of paediatric pulmonary tuberculosis, a condition often marked by lymph node involvement. Given the challenges of obtaining respiratory samples in children and their typically low diagnostic yield, POCUS emerged as a particularly suitable diagnostic modality. Conclusions: Mediastinal POCUS, guided by a standardized protocol, represents a safe, affordable, point-of-care, and non-ionizing option for identifying mediastinal lymphadenopathy. Its application holds promise for improving the diagnosis of paediatric tuberculosis, especially in settings with limited access to advanced radiological imaging
A previously healthy 12-year-old boy presented to the paediatric emergency department on three occasions in the space of four days with progressive right iliac fossa pain. His presentation appeared consistent with appendicitis; however, blood tests remained normal at each presentation. Point of care ultrasound (POCUS) revealed significant inflammatory changes in the right lower quadrant along with free fluid. Due to worsening pain and advancing findings on POCUS, the patient underwent a diagnostic laparoscopy which identified a normal appendix but had features consistent with omental infarction. Omental infarction is a rare condition that can mimic appendicitis, with few recorded cases in the literature. This is the first documented case of POCUS being utilised in the evaluation of a child with omental infarction. While the patient’s diagnosis was less common than initially suspected, POCUS played a crucial role in guiding timely and effective patient care, highlighting its value in clinical decision-making However, there are indications of lower POCUS sensitivity to fluid overload with a full peritoneum.
Acute lymphadenopathy has a wide range of possible etiologies, ranging from self-limiting viral infections to life-threatening malignancy. Point of care ultrasound (POCUS) can play a crucial role in identifying lymphadenopathy and ruling out other potential causes of soft tissue swelling, such as hernias, abscesses, and malignancies. Furthermore, POCUS enables the characterization of lymphadenopathy by evaluating the size, shape, echogenicity, and vascularity of the involved lymph nodes, thereby helping to identify the presence and extent of pathology. When performed at the time of initial presentation, POCUS can narrow the differential diagnosis and guide appropriate work-up and management. We present a case of a teenage male evaluated in the pediatric emergency department for acute bilateral inguinal swelling, in which POCUS identified lymphadenopathy and guided the evaluation of a presumed infectious process, ultimately determined to be caused by cat scratch disease.
Pyonephrosis is a severe complication of hydronephrosis and can lead to the destruction of the renal parenchyma, sepsis, shock, and death. The clinical presentation is nonspecific, and 15% of patients are asymptomatic on presentation. In resource-limited settings, where Computed Tomography (CT) imaging is not available, point of care ultrasound (POCUS) plays an important role in evaluating kidney diseases in the emergency department (ED). In this case, a 36-year-old man presented to the ED with dyspnea, fever, abdominal pain, and abdominal distention in the area where an intra-abdominal tumor was reported. After ultrasound-guided aspiration, pyonephrosis was diagnosed. In the absence of other capable specialists, the emergency physician performed a percutaneous nephrostomy procedure, and eight liters of pus were removed. The patient improved significantly and was discharged from the ED with oral antibiotics and scheduled urology follow-up in the clinic.
Objective: This study aimed to investigate variations in fluid overload using point of care ultrasound (POCUS). We assessed patients undergoing peritoneal dialysis (PD) with full and drained peritoneum and their correlation with clinical parameters. Methods: POCUS examination and intra-abdominal pressure (IAP) measurements were conducted in patients undergoing PD with a full peritoneum. Subsequently, after drainage, a new POCUS and bioimpedance analysis (BIA) were performed. Results: Seventeen patients were included in the study: 70.6% male, mean age 66+/-9.5 years. Of these, 65% had fluid overload >1 L and 23% had overhydration (OH) adjusted for extracellular water (ECW) exceeding 15%, as assessed by BIA. B-lines with full peritoneum had a median of 1 (0-2.5), and with drained peritoneum 0 (0-0). This difference was not statistically significant (p=0.063). In the correlation analysis of variables, IAP and PD fluid volume per m2 of body surface did not correlate with the diameters or collapsibility of the inferior vena cava (IVC) with full or drained peritoneum. The degree of OH in liters correlated with IVC collapsibility with drained peritoneum (Spearman ρ=-0.43; p=0.08), as did the OH adjusted for ECW (Spearman ρ=-0.61; p=0.02). These correlations disappeared with full peritoneum (p>0.05). Conclusions: There were no significant differences in ultrasound volume overload parameters in patients undergoing PD with full vs. drained peritoneum. However, there are indications of lower POCUS sensitivity to fluid overload with a full peritoneum.
