Defining the scope of point-of-care ultrasound in internal medicine: a consensus statement by the point-of-care special interest group of the Internal Medicine Society of Australia and New Zealand.

Background: Point-of-care ultrasound (POCUS) complements physical examination to advance diagnosis and treatment in a range of clinical scenarios. However, the scope for adult internal medicine physicians is not defined in Australia and New Zealand.

Aim: To outline the clinical scope and core competencies of POCUS for internal medicine physicians in Australia and New Zealand using a consensus process.

Methods: A steering committee and expert panel utilised the Delphi method, comprising rounds of questionnaires and anonymous feedback, to define scope by determining (i) clinical scenarios in which POCUS provides benefit and (ii) core competencies in scanning. An 80% agreement cut-off was used in each round for both inclusion and exclusion of items, and items could be added depending on feedback. Synthesis of qualitative feedback was included.

Results: The expert panel endorsed the use of POCUS in eight clinical scenarios: assessment of fluid status, undifferentiated shock or hypotension, dyspnoea/respiratory failure, acute kidney injury, suspected venous thromboembolism, synovitis/joint effusion and for guiding invasive procedures and diuretic therapy in heart failure. Core competencies based on identification of organ system pathology were endorsed, incorporating abnormalities of the heart, lung, inferior vena cava, abdomen, peripheral veins, soft tissue collection and joint effusion. The consensus intended not to mandate POCUS use nor limit the scope for physicians with advanced training, but offer a structured schema.

Conclusion: We successfully established a consensus on the POCUS scope for internal medicine in our region. This provides a foundation to develop formal training and credentialing.