1 Haskins SC, et al. Reg Anesth Pain Med 2021;0:1–13. doi:10.1136/rapm-2021-102561 Special article American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of- care ultrasound education and training for regional anesthesiologists and pain physicians—part II: recommendations Stephen C Haskins , 1,2 Yuriy Bronshteyn, 3 Anahi Perlas , 4 Kariem El-Boghdadly , 5 Joshua Zimmerman, 6 Marcos Silva, 4 Karen Boretsky, 7 Vincent Chan, 4 Richelle Kruisselbrink, 8 Melissa Byrne, 9 Nadia Hernandez, 10 Jan Boublik, 11 William Clark Manson , 12 Rosemary Hogg, 13 Jonathan N Wilkinson, 14 Hari Kalagara, 15 Jemiel Nejim, 1,2 Davinder Ramsingh , 16 Hariharan Shankar, 17 Antoun Nader, 18 Dmitri Souza, 19 Samer Narouze 19 To cite: Haskins SC, Bronshteyn Y, Perlas A, et al. Reg Anesth Pain Med Epub ahead of print: [please include Day Month Year]. doi:10.1136/rapm-2021- 102561 For numbered affliations see end of article. Correspondence to Dr Stephen C Haskins, Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA; haskinss@hss.edu Received 29 January 2021 Accepted 4 February 2021 © American Society of Regional Anesthesia & Pain Medicine 2021. No commercial re-use. See rights and permissions. Published by BMJ. ► http://dx.doi.org/10.1136/ rapm-2021-102560 ABSTRACT Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine Society (ASRA) commissioned this narrative review to provide recommendations for POCUS. The recommendations were written by content and educational experts and were approved by the guidelines committee and the Board of Directors of the ASRA. In part II of this two-part series, learning goals and objectives were identifed and outlined for achieving competency in the use of POCUS, specifcally, airway ultrasound, lung ultrasound, gastric ultrasound, the focus assessment with sonography for trauma exam, and focused cardiac ultrasound, in the perioperative and chronic pain setting. It also discusses barriers to POCUS education and training and proposes a list of educational resources. For each POCUS section, learning goals and specifc skills were presented in the Indication, Acquisition, Interpretation, and Medical decision-making framework. INTRODUCTION As previously described in part I, 1 the American Society of Regional Anesthesia and Pain Medi- cine (ASRA) guidelines committee and leadership appointed a task force to develop recommendations for education, training and clinical indications for point-of-care ultrasound (POCUS). In this review article, the skills to be discussed are airway ultra- sound, lung ultrasound (LUS), gastric ultrasound, the focused assessment with sonography for trauma (FAST) exam, and focused cardiac ultrasound (FoCUS) for the regional anesthesiologist and pain physician. For each POCUS section, learning goals and specific skills are presented in the Indication, Acqui- sition, Interpretation, and Medical decision-making (I-AIM) framework. We also discuss barriers to POCUS education and training, as well as the educational resources currently available. Ulti- mately, these task force recommendations define education, training, competency and credentialing criteria to promote the safe and appropriate use of POCUS for the regional anesthesiologist and pain physician. Ultimately, these guidelines should not be considered standard of care but should serve as a framework for educators and learners, given each individual may require more or less POCUS training than described in the document. METHODS An expert panel was assembled for this project based on the ASRA guidelines committee and ASRA Board of Directors. The full details of the process have been previously described in part I. 1 Expert panel education and training recommendations In the past decade, multiple groups have devel- oped anesthesiologist-specific diagnostic POCUS curricula. 2–4 These curricula have included training in at least the following: ultrasound physics, image interpretation and image acquisition. Technology can also facilitate training. Interactive, computer- based modules can teach ultrasound physics and image interpretation, 5 6 and image acquisition can be enhanced with ultrasound simulators. 6 These computer-based modules and ultrasound simula- tors may decrease the operational costs of running POCUS training programs and increase learners' access and convenience. While electronic modules could potentially be used to teach the core skillset of image interpreta- tion, this Expert Group does NOT believe ultra- sound simulators can adequately teach the skillset on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from on December 7, 2021 by guest. Protected by copyright. http://rapm.bmj.com/ Reg Anesth Pain Med: first published as 10.1136/rapm-2021-102561 on 24 February 2021. Downloaded from