Establishment of Core Entrustable Professional Activities for Advanced Emergency Medicine Ultrasonography Fellowship Using a Nominal Group Technique

Abstract

Background

Advanced Emergency Medicine Ultrasonography (AEMUS) has become a recognized subspecialty within Emergency Medicine, yet no unified national curriculum or assessment framework exists for fellowship training. As competency-based medical education develops, entrustable professional activities (EPAs) offer a structured approach to defining essential tasks, guiding curriculum design, and standardizing assessment. To support high-quality, equitable AEMUS fellowship training, the Education Committee of the Society of Clinical Ultrasound Fellowships (SCUF) convened a diverse expert panel to develop core EPAs for AEMUS fellows.

Methods

We employed a modified virtual nominal group technique (vNGT) to achieve expert consensus. Eleven AEMUS education leaders participated between July 2024 and June 2025. Prior to the initial session, panelists reviewed curated literature and independently generated EPA ideas. During structured virtual meetings, participants engaged in round-robin idea sharing, clarification, and discussion, guided by existing national AEMUS standards of certification and program accreditation. Ideas were subsequently subjected to iterative voting, with ≥ 80% agreement required for acceptance. Three vNGT rounds were conducted. Accepted EPAs were further refined by assigned primary editors.

Results

The expert panel produced 15 core EPAs spanning four established domains: Administration, education, sonography skills, and scholarship. Professionalism was designated as its own domain. Panel deliberations focused on feasibility within a one-year fellowship, post-graduation scope of practice, and variability in program resources. The group endorsed a modified entrustment scale tailored to AEMUS to guide assessment across EPAs.

Conclusion

Using a structured consensus process, we developed the first EPA-based framework for AEMUS fellowship training. These EPAs provide a foundational curriculum and assessment structure intended to support program rigor, promote national consistency, and prepare fellows for independent advanced practice and leadership in clinical ultrasound.