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SHM -Chest POCUS COC Alternative Pathway Application
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1.
Please enter your name and contact information.
(Required.)
Name
*
Company
Address
*
Address 2
City/Town
*
State/Province
*
ZIP/Postal Code
*
Country
*
Email Address
*
*
2.
How many years have you personally been using point-of-care ultrasound in your clinical practice?
(Required.)
*
3.
Describe your past training in point-of-care ultrasound, including courses attended (names, dates) and applications learned.
(Required.)
*
4.
Have you earned at least >24 hours of CME credits from live, hands-on POCUS courses, either as an attendee or faculty member?
(Required.)
Yes
No
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
(Required.)
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Left ventricular systolic function
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Right ventricular systolic function
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Pericardial effusion
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Valve assessment
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Inferior vena cava
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Additional Comments
*
7.
Pulmonary
(Required.)
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Pleural Effusion
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Pneumothorax
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Pulmonary Edema
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Pneumonia
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Thoracentesis
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Chest tube (any size)
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Additional Comments
*
8.
Gastroinestinal (GI)
(Required.)
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Peritoneal Fluid / Ascites
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Gallbladder
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Paracentesis
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Additional Comments
*
9.
Urinary
(Required.)
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Hydronephrosis
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Bladder volume
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Catheter placement/confirmation
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Additional Comments
*
10.
Gynecological
(Required.)
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Intrauterine Pregnancy
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Additional Comments
*
11.
Vascular
(Required.)
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Abdominal Aortic Aneurism (AAA)
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Deep Vein Thrombosis (DVT)
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Peripheral IV Access
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Central Line Placement
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Peripherally Inserted Central Catheter
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Arterial Line Placement
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Additional Comments
*
12.
Musculoskeletal/Soft Tissue
(Required.)
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Cellulitis
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Abscess
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Joint effusion
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Fractures
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Foreign bodies
0
0-1
1
2
3
4
5
6
7
8
9
10
10+
Additional Comments
13.
POCUS applications not listed above.
*
14.
Do you teach any other healthcare providers the use of point-of-care ultrasound?
(Required.)
Yes
No
If yes, please describe your teaching experience (including who you teach, which applications and how long you have been teaching).
*
15.
Do you hold any leadership roles in point-of-care ultrasound?
(Required.)
Yes
No
If yes, please describe those roles.
