Defining core and advanced point-of-care ultrasound applications for hospital-based internal medicine in Switzerland: a Delphi consensus of the Swiss Interest Group for Ultrasound in Internal Medicine (IG-USIM)

Abstract Background Point-of-care ultrasound (POCUS) has become an essential bedside tool in internal medicine; however, its expanding use is associated with substantial variability in training and scope of practice. Although several countries have developed consensus-based POCUS curricula and recommendations on relevant applications, no comparable national consensus currently exists in Switzerland, including on which applications should be prioritized for hospital-based general internal medicine (GIM) trainees. Methods We conducted a three-round modified Delphi study between March and September 2025 to establish expert consensus on relevant POCUS applications for hospital-based GIM postgraduate training in Switzerland. Thirty hospital-based GIM-certified POCUS experts participated, including representatives from all Swiss university hospitals and accredited postgraduate training centers. Experts rated the clinical relevance of POCUS applications using Likert scales, allowing their classification as core, advanced, or irrelevant for GIM practice. Consensus was defined a priori as ≥70% agreement. Results Across three Delphi rounds, 119 items were assessed. Final consensus was reached for 71 items: 24 were classified as core applications, 24 as advanced applications, and 23 as irrelevant for hospital internists. Core applications primarily included pulmonary ultrasound and ultrasound-guided procedures, along with selected focused cardiac and abdominal applications. Advanced applications reflected more context-dependent use, while obstetric/gynecologic, ocular, ear-nose-throat, and thyroid ultrasound were largely considered irrelevant. Several applications reaching core consensus are not currently included in the mandatory Swiss certification requirements. Conclusions This national Delphi study identifies a consensus-based, prioritized set of POCUS applications for hospital-based GIM training in Switzerland. Rather than issuing prescriptive recommendations, these findings provide a structured basis to inform national dialogue and subsequent curriculum development. Considerations related to cost-effectiveness, implementation resources, and long-term sustainability were beyond the scope of this study and should be addressed in future evaluations to ensure feasible and equitable integration across institutions.