Curricular Impact of Resource Investments in Point-of-Care Ultrasound Education Among Family Medicine Residency Programs: A CERA Study

Point-of-care ultrasound (POCUS) has become an increasingly valuable diagnostic tool in outpatient medicine.^1-3 Studies have reported several benefits, including changes in clinical management, reduced resource utilization, increased diagnostic confidence, and improved patient satisfaction.^4-7 Recognizing these substantial benefits, the major organizations responsible for family medicine training, certification, and education have reached consensus on the importance of POCUS. The Accreditation Council for Graduate Medical Education reinforced its role in residency education in 2023 by introducing a dedicated POCUS program requirement stating, “Residents should have experience in using point-of-care ultrasound in clinical care.”⁸ Likewise, the American Board of Family Medicine (ABFM) has announced that POCUS competency will become a requirement for board eligibility.⁹ This institutional commitment has been mirrored by family medicine residency programs nationwide, where POCUS curricula have expanded dramatically from just 2.2% of programs in 2014 to 53% in 2019.^10,11 Together, these developments demonstrate broad agreement among accrediting bodies, certifying organizations, and residency programs that POCUS is an essential component of contemporary family medicine training and practice.

Despite growing recognition of POCUS as an essential component of family medicine, significant barriers continue to limit its implementation in residency training. Common challenges include limited faculty expertise, insufficient protected time for POCUS educators, inadequate access to ultrasound equipment, and financial constraints.^10-16 High-quality POCUS education requires dedicated faculty leadership, faculty development, supervised clinical scanning, image review, assessments, and access to ultrasound technology.^17-19 As expectations for POCUS competency continue to rise, many residency programs struggle to secure the resources needed to develop and sustain comprehensive POCUS curricula.^14,15

The objective of this Council of Academic Family Medicine Educational Research Alliance (CERA) survey was to examine the relationship between institutional resources dedicated to POCUS education and the implementation of POCUS curricula in US family medicine residency programs. By identifying the resources associated with more robust curricula, this study aimed to inform and reshape the understanding of the institutional support necessary to build and sustain successful POCUS programs.

The survey was part of a larger omnibus study of US department of family medicine program directors (PDs) conducted from April 22, 2025, to May 23, 2025, with recurrent standardized demographic questions. The methodology of the CERA residency PD survey has been described previously in detail.²⁰ The American Academy of Family Physicians Institutional Review Board approved the CERA survey. The CERA steering committee evaluated questions for consistency with the overall subproject aim, readability, and existing evidence of reliability and validity. Pretesting to evaluate for clarity, readability, and feasibility of response was conducted with family medicine educators who were not included in the sampling frame.

The survey content was collaboratively developed by a multi-institutional cohort of POCUS leaders across the United States who are all members of the Society of Teachers of Family Medicine POCUS Task Force, a group working with support from the ABFM Foundation to define national curricular standards for POCUS. Questions were created in light of recurring challenges reported with POCUS program implementation warranting further investigation.^10-17 These topics were iteratively reviewed and refined by the study committee in collaboration with an assigned CERA mentor (J.H.) to ensure their relevance, clarity, and methodological rigor. The questions assessed the resources programs allocate toward POCUS, including the number of POCUS faculty, the full-time equivalents (FTEs) dedicated to POCUS education at-large (across all faculty), the training level of the family medicine residency POCUS faculty champion or lead, FTE dedicated to the POCUS champion or lead for POCUS education, money spent on additional third-party ultrasound education, and the number of ultrasound machines at the program. Of note, given the variable definition of POCUS champion or lead in the community, we excluded providing a definition and allowed interpretation by the PD. Curricular impacts surveyed were the degree of longitudinal POCUS curriculum offered, the degree of evaluation of POCUS assessments, the satisfaction of the PD regarding their POCUS education, and the percentage of residents who seek additional POCUS education outside of the core family medicine residency curriculum.

The survey was distributed to 799 residency PDs. After excluding 73 who did not meet eligibility criteria (programs had to have at least three complete residency classes), the final sample consisted of 726 directors. Of these, 321 completed surveys, yielding a response rate of 44.2%.

All data were summarized with descriptive frequencies, means, and standard deviation. We calculated the inferential comparisons with t tests and analysis of variance statistics. We analyzed the ordinal or categorical responses with χ² or Fisher exact as appropriate. We did not calculate a priori power analysis, meaning that all nonsignificant differences cannot be verified as truly nonsignificant. We ran two multinomial logistic regression models, adjusting for all variables significant in univariate analyses. The first predicted bivariate PD satisfaction (satisfied vs dissatisfied), the second predicted neutral versus dissatisfied as the bivariate outcome.

A total of 321 PDs completed some parts of the survey and 312 completed both demographic descriptors and PD satisfaction with their current POCUS curriculum. Appendix 1 contains the complete survey and a summary of participant responses. Of all respondents, 88.5% offer at least some POCUS education in their residency program (Table 1). Of the responding PDs, 58.3% were from community-based, university-affiliated programs; 25.4% from community-based or military programs; and 16.3% from university-based programs. Overall, 41.7% had less than 19 residents, 43.3% had 19 to 31 residents, and 15.1% had 32 or more residents in the program as of July 2022. Nearly half (43.4%) of the PDs had been in their current role for less than 3 years, and 17.3% for more than 10 years. PD gender was 58.3%/41.7% female/male, with the majority White (76.5%) and not underrepresented in medicine (87.1%). The demographics summary is presented in Table 1.

This study surveyed the following regarding the POCUS champion and faculty of family medicine residency programs (Table 2): the number of POCUS faculty, total protected time for all POCUS faculty, protected time for the POCUS champion or lead, and the educational training of the POCUS champion or lead. No formal definitions were provided for the roles of POCUS champion/lead or POCUS faculty. Rather, the survey allowed PDs to determine, based on their own program structure and perceptions, which faculty members fulfilled the role of a POCUS champion/lead versus any POCUS faculty.

Overall, 19.5% of programs had no POCUS faculty, and 22.8% of programs did not have a designated POCUS champion or lead. Of those programs with no POCUS champion or lead, 57.1% also lacked POCUS faculty, while the remainder all reported having at least one POCUS faculty member despite not identifying a designated POCUS champion or lead (Appendix 2A).

Protected time allocated to the POCUS champion/lead varied significantly by residency program type. Allocation of 4 or more hours per week of protected time for the POCUS champion/lead was significantly more common in university-based programs (30.0%) than in community-based university-affiliated programs (11.5%, P<0.01) and community-based military programs (9.0%, P<0.01). However, community-based university-affiliated programs were more likely to provide 2 hours per week of protected time for the POCUS champion/lead than to provide no protected time (52.3% vs 36.2%, P<0.01). Protected time allocated to POCUS faculty did not differ significantly across residency program types, with 40.1% of POCUS faculty receiving no protected time. The number of POCUS faculty compared to program-protected time is presented in Appendix 2B. Of the programs with only one POCUS faculty, a statistically greater portion of the programs had some protected time (>0.05 FTE) compared to those with none (61.5% vs 38.5%, P<0.01).

Among POCUS champions/leads, the most common training pathway was independent study (29.0%), followed by third-party educational programs (23.3%), residency training (11.5%), hospital-based fellowship programs (7.0%), and institution-sponsored fellowships (4.8%).

Table 3 describes residency program characteristics by ultrasound machine availability and annual financial investment in POCUS education. Overall, most programs (55.0%) had access to one to two ultrasound machines, and 57.9% reported some annual POCUS-related expenditures. Among programs that allocated funding for POCUS education, 34.4% (62/180) spent up to $2,500 annually, 37.8% (68/180) spent up to $5,000 annually, and 27.8% (50/180) spent more than $5,000 annually.

Programs with only one POCUS faculty member (33.9% of all programs) were significantly more likely to have access to only one or two ultrasound machines than to have access to more than two machines (63.2% vs 34.9%, P<0.01). Likewise, among programs with one POCUS faculty member, nearly half (47.2%) reported no annual financial expenditure on POCUS education, with the remainder fairly evenly distributed across levels of spending.

The survey assessed the scope of residency POCUS curricula as no curriculum, third-party online education only, or an in-house curriculum. In-house curricula were categorized by increasing comprehensiveness, progressing from didactics and hands-on workshops to the addition of bedside scanning, image review, and assessments. Table 4 examines the associations between POCUS faculty resources and curriculum scope, resident evaluation methods, and resident interest in POCUS education beyond the core residency curriculum.

Overall, 16.7% (52/312) of residency programs fully outsourced their POCUS curriculum to a third-party educational provider. Among programs offering didactics, hands-on workshops, and bedside scanning (38.0%), 93.3% had at least one POCUS faculty member. The addition of bedside scanning was associated with a significantly higher proportion of programs having two or more POCUS faculty compared with programs offering only didactics and hands-on workshops (58.8% vs 38.3%, P<0.01). As curricula expanded from bedside scanning to include image review and assessment, the proportion of programs with two or more POCUS faculty increased further (38.3% bedside scanning, 58.8% image review, and 65.0% assessment).

Offering POCUS assessment varied by both the number of POCUS faculty and the protected time allocated to them. Even with at least one POCUS faculty member, 67.2% of programs that did provide assessment had limited protected time, with only 34.5% allocating 0.1 or more FTE for POCUS education. Likewise, among programs relying on third-party POCUS curricula, 83.5% had one POCUS faculty member but also did not provide POCUS assessment (Appendix 2C).

Overall, 57 (18.3%) of PDs reported being satisfied with their residency POCUS curriculum, 96 (30.8%) were neutral, and 159 (51.0%) were dissatisfied. We used a multinomial multivariable logistic regression model to examine factors associated with PD satisfaction with the residency POCUS curriculum.

PD satisfaction differed by residency program type. Compared with community-based/military and university-based programs, PDs from community-based university-affiliated programs were significantly more likely to report dissatisfaction than satisfaction with their current POCUS curriculum (54.2% vs 16.8%, P<0.0001; and 47.4% vs 14.1%, P<0.0001, respectively). In university-based programs, satisfaction and dissatisfaction were reported in similar proportions.

Greater PD satisfaction was associated with protected time for the POCUS champion/lead and access to a higher number of ultrasound machines (Table 5). Comparing PD satisfaction with dissatisfaction, programs providing at least 0.05 FTE of protected time for the POCUS champion/lead were associated with 2.8-fold greater odds of PD satisfaction than programs with no protected time (OR 2.78, 95% CI 1.04–7.37; P = 0.04). Programs providing more than 2 hours per week of protected time had 9.3-fold greater odds of PD satisfaction (OR 9.32, 95% CI 2.92–29.76; P = 0.0002). The only other independent predictor of PD satisfaction was access to four or more ultrasound machines, which was associated with 3.4-fold greater odds of satisfaction compared with programs having fewer than four machines (OR 3.37, 95% CI 1.54–7.36; P = 0.0023).

The number of POCUS faculty and protected time allocated to the POCUS curriculum were independently associated with PDs reporting neutral rather than dissatisfied perceptions of their POCUS curriculum. Compared with programs having no POCUS faculty, programs with one POCUS faculty member had 2.54-fold greater odds of neutral satisfaction (aOR 2.54, 95% CI 1.02–6.33; P = 0.0459), while programs with two or more POCUS faculty had 4.92-fold greater odds of neutral satisfaction (aOR 4.92, 95% CI 1.93–12.56; P = 0.0009). In addition, allocating 2 hours per week of protected time for the POCUS lead was associated with 2.36-fold greater odds of neutral satisfaction compared with dissatisfaction (aOR 2.36, 95% CI 1.21–4.60; P = 0.0121).

We assessed resident engagement by the percentage of residents who pursued POCUS training beyond the core family medicine residency curriculum, such as POCUS rotations, electives, tracks, teaching opportunities, or scholarly activities. We observed no significant association between protected time for POCUS faculty and the proportion of residents pursuing additional POCUS training beyond the core residency curriculum. Among programs in which more than 30% of residents sought additional training, 52.4% provided 0.1 or more FTE of protected faculty time compared with 47.6% that provided none (P>0.05).

This study both updates previous POCUS curricular prevalence surveys and represents the first national-level assessment of resources supporting POCUS education in US family medicine residency programs. Representing an increase compared with prior national surveys, POCUS education is now offered by nearly 90% of US family medicine residency programs, reflecting the growing integration of POCUS into residency education. Despite this progress, most PDs reported dissatisfaction with their current POCUS curriculum. Our findings suggest that this dissatisfaction is driven less by whether a curriculum exists and more by the resources available to support it.

Several institutional resources were consistently associated with more comprehensive curricula and greater PD satisfaction, including the presence of a dedicated POCUS champion, the number of POCUS faculty, protected faculty time, and access to ultrasound equipment. Nearly one-quarter of programs lacked a designated POCUS champion, more than 10% had neither a champion nor POCUS faculty, and 40% of POCUS faculty received no protected time. Although community-based university-affiliated programs were more likely to provide some protected time for POCUS champions, this alone did not translate into higher PD satisfaction, suggesting that protected time must be paired with sufficient faculty, equipment, and institutional support.

An important finding of this study is the distinction between a POCUS champion/lead and POCUS faculty. Although the survey intentionally allowed PDs to define these roles within their own institutional context, the results suggest that these roles represent different educational functions. Protected time for the POCUS champion, not just the presence of POCUS faculty, was more strongly associated with comprehensive curricula and PD satisfaction. The term “POCUS champion” has crept into educational culture, and we believe that it is defined as dedicated educational leadership responsible for curriculum development, implementation, and program oversight versus general POCUS faculty who provide educational components without an overall program structure.

Our findings also highlight opportunities to strengthen competency assessment. Programs with more POCUS faculty and greater protected time were more likely to incorporate resident evaluation, whereas many programs with limited faculty resources either did not assess competency or relied on minimal evaluation methods. Because competency assessment is essential to competency-based medical education, expanding faculty capacity may be necessary to ensure that residents achieve meaningful POCUS proficiency.

As curricula became more comprehensive (from didactics and workshops to bedside scanning, image review, and competency assessment), the need for faculty resources increased substantially. While a single POCUS faculty member appeared sufficient to support introductory didactic and hands-on instruction, programs offering longitudinal bedside scanning and structured assessment typically required two or more faculty members. The robust associations of protected time for the faculty champion or lead with satisfaction and curricular outcomes suggest that 0.1 FTE may represent a practical minimum to effectively support teaching, image review, quality assurance, faculty development, and oversight of ultrasound technology. Resident enthusiasm for POCUS was encouraging, with many residents pursuing additional educational opportunities beyond the core curriculum. However, greater participation in these extracurricular activities was observed primarily in programs providing at least 0.1 FTE of protected faculty time. As national competency expectations continue to evolve and residency curricula become more comprehensive, the need for supplemental extracurricular training may diminish.

Our findings demonstrate that ultrasound equipment remains an important component of successful POCUS implementation. Access to four or more ultrasound machines was independently associated with greater PD satisfaction, supporting the importance of investing in ultrasound technology alongside faculty development. As handheld ultrasound devices become increasingly affordable and incorporate features such as asynchronous image review, expanding access to these technologies may reduce important barriers to resident education while facilitating curricular components, including image review and quality assurance, that remain underdeveloped in many programs.

This study had important limitations. The 44.2% response rate and reliance on PD responses may have introduced response and reporting bias. Additionally, PD satisfaction is a subjective measure that may not fully reflect curriculum quality or resident competency. Future studies should evaluate objective educational outcomes, such as resident POCUS competency, to better define the relationships among faculty resources, protected time, curricular design, and educational effectiveness. The CERA survey format also limited the study to 10 specific questions, preventing a more comprehensive assessment of factors such as faculty training, resident competency, and institutional barriers to POCUS implementation. However, given the extent of the CERA survey, the question limitation likely reduced survey fatigue and helped boost survey response rate.^21,22

Overall, family medicine residency programs demonstrate substantial variability in POCUS educational resources and curriculum implementation. This study emphasized the important contributions of protected faculty time and technology investments in creating successful POCUS curricula. As the ABFM introduces national POCUS competency requirements,⁹ standardized educational expectations may help promote more consistent resource allocation and ensure that residents achieve competency by graduation. This study also provided one of the first descriptions of financial investment in third-party POCUS education among family medicine residency programs. More than 40% of programs relying on outsourced curricula had already developed internal POCUS faculty, suggesting that many programs may be transitioning toward internally led education. Future studies should determine whether continued faculty development reduces reliance on third-party educational resources while improving educational quality and long-term program sustainability. Future family medicine POCUS curricular studies should work toward longer-term outcome measurement—including measured and sustained resident competency, greater real clinical utilization, enhanced patient satisfaction, and better clinical outcomes in family medicine.

Dr Patel consults with GE Healthcare’s point-of-care ultrasound team, giving input and feedback on device development and functionality specific to family medicine. Dr Patel does not have stock or equity interest in GE Healthcare. Dr Patel does not have any relevant conflicts of interest from this work in relation to this article.

An overview of this content was presented at the Society of Clinical Ultrasound Fellowships Annual meeting, October 7–9, 2025, St. Louis, MO.

We acknowledge the CERA staff who were responsible for the IRB approval, the survey dissemination, and the data transfer to our team. The team also acknowledges Jamie Smith for contributions to summary statistics.