By WPOCUS Consulting
Access to ultrasound education has expanded considerably over the past decade. Handheld ultrasound systems have become more widely available, training opportunities have increased, and point-of-care ultrasound is now incorporated into a growing number of healthcare disciplines worldwide.
Women's point-of-care ultrasound (WPOCUS) is increasingly used by physicians, nurse practitioners, physician associates, certified nurse-midwives, certified midwives, and other clinicians to support focused bedside assessment and clinical decision-making in women's healthcare settings.
Although many practitioners cite ‘lack of training’ as a primary reason for low uptake of WPOCUS use, technical training is not the only factor. Image acquisition and interpretation are only the starting points for employing WPOCUS in practice.
Some clinicians successfully incorporate ultrasound into patient assessment and continue to expand their skills over time. Others complete training but encounter barriers that limit ongoing use. Integrating ultrasound into routine clinical care often presents practical challenges other than knowledge and skill.
The usefulness of WPOCUS is determined by the “added value” it brings to clinical decision-making. This value is determined by comparing the benefit of expedited care to the difficulties encountered in using it.
In short, long-term success depends on how easily this can be applied in everyday clinical practice. Clinical relevance, opportunities for continued use, workflow design, organizational support, and ongoing competency development all influence whether ultrasound becomes part of routine patient care.
The value of WPOCUS is determined by how effectively it helps patient assessment, clinical decision-making, triage, referral, and clinical management.
In addition to obstetric care, women’s health encompasses a large spectrum of applications in women’s health, from adolescent care to menopause. Applications that help answer clinical questions quickly are more likely to become part of routine care. Many clinicians rely on rapid AI research and rapid turnaround of diagnostic lab testing to help them make critical decisions. Similarly, POCUS imaging offers another modality for a faster assessment of a simple clinical question, rather than relying on a delayed, scheduled full diagnostic ultrasound. [2,4]
Answering critical questions at the bedside (not requiring a full diagnostic scan) includes examples of:
Early pregnancy assessment, including determining gestational age
Fetal cardiac activity, assuring fetal life and well-being
Fetal presentation, assuring a healthy labor and birth
Certain gynecologic concerns, such as assessing for pelvic pain and bleeding (the leading reasons for women’s visits to the Emergency Department)
Specific applications will vary depending on practice setting, patient population, scope of practice, and available resources. But the domains and technical skills used for WPOCUS are the same across these different settings. And the reason for providing WPOCUS is to enable rapid assessment without compromising imaging quality.
When women's point-of-care ultrasound provides information that influences patient care, opportunities for continued use occur naturally. Continued use, in turn, supports continued competency development.
Competency develops through continued practice, feedback, supervision, and clinical application rather than isolated educational experiences. [1-3]
As with any other learned clinical skill, each clinical encounter provides opportunities to strengthen image acquisition/optimization, anatomical recognition, interpretation, and clinical correlation. Repeated exposure helps clinicians develop pattern recognition while gaining experience with normal findings, technical limitations, and variations in patient presentation.
Instead of WPOCUS diminishing the need for diagnostic imaging, evidence suggests otherwise. [4] In fact, when a diagnostic scan is done after a WPOCUS assessment, it often provides feedback and confirmation for the WPOCUS provider to be validated in the initial assessment. Much like a simple screening X-ray can show a fracture, more advanced imaging (such as CT) can both confirm this and provide additional relevant information.
For WPOCUS to be adopted as a routine practice, it must be feasible. It must be easy to use, cost-effective, easy to import into the EMR, billable, and most importantly, not bog down the workflow.
Questions affecting day-to-day use include:
What kind of equipment works best for the practice, and who will use it?
Where is the equipment located?
How are images stored?
How are findings documented?
How does scanning fit within patient flow?
What quality processes are in place?
These considerations are particularly relevant in women's healthcare environments where clinicians often balance complex patient needs, significant documentation requirements, and competing clinical priorities.
In summary, WPOCUS is more likely to be sustained when the surrounding workflow supports practical use.
The notion that a quick assessment does not qualify for billing or reimbursement is false. The use of provider time and expertise, as well as specialized equipment, should be counted as billable.
Most point-of-care services are billable if the appropriate diagnosis and procedure codes are applied. This is also true for WPOCUS. Codes for diagnostic ob/gyn ultrasound have very specific parameters that must be documented in order to bill appropriately. The correct codes for WPOCUS typically fall into the category of “limited” exam, or describe the type of scanning modality used (transabdominal versus transvaginal, and obstetric versus gynecologic or non-pregnant).
So in addition to educating the provider who does the scan, support staff also needs to learn appropriate coding and billing procedures to make WPOCUS financially feasible.
Professional organizations and women’s health medical societies have embraced WPOCUS and instituted training and technical guidance for its use. In addition, several professional organizations have collaborated to reinforce these guidelines and recommend certification as a means of validating competency.
Access to mentorship, quality assurance processes, image review, continuing education, peer collaboration, and organizational support can influence whether ultrasound use is sustained over time. [1–4]
These resources support ongoing skill refinement while helping clinicians maintain confidence in appropriate ultrasound use.
Successful ultrasound integration rarely occurs all at once. Many clinicians begin by incorporating ultrasound into a limited number of clinical situations that are highly relevant to their practice.
The objective is not immediate mastery of every possible ultrasound application. As experience increases comfort level, additional applications can be added.
For example, a clinician may start using WPOCUS to assess fetal viability but, over time, may expand its use to visualize the adnexa. This progression mirrors competency development across many areas of healthcare.
Successful integration of WPOCUS depends on more than learning how to obtain an image.
Long-term success depends on creating the conditions that allow those skills to be applied consistently and meaningfully within practice.
Clinical utility, opportunities for continued use, workflow design, support structures, and ongoing competency development all influence whether ultrasound becomes part of routine practice.
As point-of-care ultrasound becomes increasingly integrated, providers are seeking educational models that support both competency and successful clinical implementation. Effective WPOCUS education extends beyond image acquisition and interpretation to include workflow integration, documentation practices, quality processes, and long-term competency maintenance.
WPOCUS Consulting was developed with recognition that successful ultrasound adoption requires both technical instruction and practical application.
It was also developed with the flexibility of a modular program, giving providers options for limited skills versus comprehensive WPOCUS education. It also presents certain domains of women’s health (gyn versus ob) and very specific skills (such as IUD assessment).
Our educational approach emphasizes:
focused clinical applications
progressive competency development
workflow integration
practical implementation
documentation considerations
and real-world women's healthcare practice
The primary goal of our curriculum is to support clinicians in integrating focused ultrasound into patient care in ways that are sustainable, clinically meaningful, and aligned with their practice environment.
Successful WPOCUS integration depends on more than initial training alone.
Clinical utility supports continued ultrasound use.
Competency develops through repeated clinical application, feedback, and ongoing practice.
Workflow considerations influence long-term sustainability.
Support structures and professional organizations help sustain learning and skill development.
Integration is often progressive and aligned with the realities of clinical practice.
What is the biggest challenge in integrating WPOCUS into clinical practice?
Integrating women's point-of-care ultrasound into clinical practice involves more than learning how to acquire images. Long-term success depends on clinical relevance, opportunities for continued use, workflow integration, documentation processes, ongoing competency development, and organizational support.
Why do some clinicians continue using ultrasound after training while others do not?
Continued use is influenced by factors such as clinical relevance, opportunities for practice, workflow integration, access to equipment, and organizational support. [1–4]
Does completing an ultrasound course guarantee competency?
Minimal or entry-level competency is established when a cilnician completes a course of knowledge and skills. Proficiency, however, is a higher level of expertise, and develops through continued clinical application, feedback, supervision, and practice over time. [5–7]
How should clinicians approach expanding their ultrasound skill set? Many clinicians begin with applications that address recurring clinical questions within their practice environment and expand as competency, experience, and opportunities for use increase.
References
[1] Solomon SD, Saldana F. Point-of-Care Ultrasound in Medical Education—Stop Listening and Look. New England Journal of Medicine. 2014;370:1083–1085.
[2] Díaz-Gómez JL, Mayo PH, Koenig SJ. Point-of-Care Ultrasonography. New England Journal of Medicine. 2021;385(17):1593–1602.
[3] Moore CL, Copel JA. Point-of-Care Ultrasonography. New England Journal of Medicine. 2011;364(8):749–757.
[4] Henz S, Yakar D, Dierckx R, Kwee T. Point-of-care ultrasonography: Downstream utilization of and diagnostic (dis)agreements with additional cross-sectional imaging, European Journal of Radiology. 2022; 152 (110344)
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