Consensus on core POCUS applications for Korean emergency medicine training: a Delphi study

Abstract

Background Point-of-care ultrasound (POCUS) is an essential diagnostic and procedural tool in emergency medicine, yet training content and evaluation remain inconsistent across Korean residency programs. To address this gap, the Society of Emergency and Critical Care Imaging (SECCI) sought to develop a consensus-based list of core POCUS applications tailored to the Korean clinical context. Methods A three-round modified Delphi survey (2022-2023) was conducted with 71 Korean emergency and critical care physicians, all certified POCUS instructors with >= 3 years of teaching experience. An initial list of 109 applications across 15 categories was generated from international guidelines and pre-round expert meetings. In each round, panelists rated items on a 9-point Likert scale; consensus was defined as >= 80% of ratings in the highest (7-9) or lowest (1-3) tertiles. Items meeting consensus were removed after each round, while unresolved items proceeded to subsequent rounds. Open-ended feedback in Rounds 1 and 2 informed item revisions and additions. This study was not a clinical trial; a trial registration number is therefore not applicable. Results Response rates were 73.2% (Round 1), 96.2% (Round 2), and 84.0% (Round 3). Across the three rounds, 59 applications achieved consensus: 27 in Round 1, 24 in Round 2, and 8 in Round 3. The final list encompassed resuscitative (e.g., E-FAST, pericardial tamponade, global ventricular function), diagnostic (e.g., biliary disease, femoral DVT, pulmonary edema), and procedural (e.g., vascular access, thoracentesis, pericardiocentesis) domains. Compared with international curricula, the Korean consensus emphasized advanced hemodynamic and cardiac function assessments, reflecting local priorities in resuscitation and shock management, while de-emphasizing certain diagnostic scans (e.g., obstetric, musculoskeletal) due to ready access to alternative imaging. Conclusions This nationwide Delphi process produced the first consensus-based core POCUS curriculum for emergency medicine residency training in Korea. The framework balances alignment with global best practices and responsiveness to local clinical workflows, providing a structured basis for standardization, competency assessment, and phased implementation across training programs.