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* 1. Please enter your name and contact information.

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* 2. How many years have you personally been using point-of-care ultrasound in your clinical practice?

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* 3. Describe your past training in point-of-care ultrasound, including courses attended (names, dates) and applications learned.

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* 4. Have you earned at least 35 hours of CME credits from live, hands-on POCUS courses, either as an attendee or faculty member?

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* 5. Please provide proof of CME credit from participation in live, hands-on POCUS training by uploading certificates here or by emailing POCUS@hospitalmedicine.org.

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During a typical 1-month period of working as a full-time clinician providing care to patients, how frequently, on average, do you perform the following point-of-care ultrasound applications?

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* 6. Cardiac

  0 0-1 1 2 3 4 5 6 7 8 9 10 10+
Left ventricular systolic function
Right ventricular systolic function
Pericardial effusion
Valve assessment
Inferior vena cava

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* 7. Pulmonary

  0 0-1 1 2 3 4 5 6 7 8 9 10 10+
Pleural Effusion
Pneumothorax
Pulmonary Edema
Pneumonia
Thoracentesis
Chest tube (any size)

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* 8. Gastroinestinal (GI)

  0 0-1 1 2 3 4 5 6 7 8 9 10 10+
Peritoneal Fluid / Ascites
Gallbladder
Paracentesis

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* 9. Urinary

  0 0-1 1 2 3 4 5 6 7 8 9 10 10+
Hydronephrosis
Bladder volume
Catheter placement/confirmation

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* 10. Gynecological

  0 0-1 1 2 3 4 5 6 7 8 9 10 10+
Intrauterine Pregnancy

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* 11. Vascular

  0 0-1 1 2 3 4 5 6 7 8 9 10 10+
Abdominal Aortic Aneurism (AAA)
Deep Vein Thrombosis (DVT)
Peripheral IV Access
Central Line Placement
Peripherally Inserted Central Catheter
Arterial Line Placement

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* 12. Musculoskeletal/Soft Tissue

  0 0-1 1 2 3 4 5 6 7 8 9 10 10+
Cellulitis
Abscess
Joint effusion
Fractures
Foreign bodies

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* 13.  POCUS applications not listed above.

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* 14. Do you teach any other healthcare providers the use of point-of-care ultrasound?

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* 15. Do you hold any leadership roles in point-of-care ultrasound?

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