Swiss Experts Agree on Which Bedside Ultrasound Skills Every Hospital Internist Needs

Point-of-care ultrasound, or POCUS, has quietly become one of the most transformative tools in modern hospital medicine. A handheld probe and a portable machine can now reveal a collapsed lung, a failing heart, a distended bladder, or a hidden abscess in seconds, at the bedside, without moving a critically ill patient. Yet as the technology has spread from radiology departments into the hands of general internists, an uncomfortable question has emerged: which ultrasound skills should every hospital-based internal medicine physician actually master, and which belong only in the hands of specialists? In Switzerland, that question had never been answered at a national level, leaving training programs to improvise and certification requirements to lag behind bedside reality.

A new study published in BMC Medical Education now provides the first structured national answer. Researchers led by Antonio Leidi, André Juillerat, Thomas Agoritsas, and Olivier Grosgurin of Geneva University Hospitals, working with a large network of co-authors drawn from every Swiss university hospital and numerous accredited training centers, conducted a three-round modified Delphi consensus study between March and September 2025. The work was carried out under the banner of the Swiss Interest Group for Ultrasound in Internal Medicine, known as IG-USIM, and involved thirty hospital-based experts certified in point-of-care ultrasound who practice general internal medicine themselves. The goal was deliberately pragmatic: not to write another textbook of ultrasound applications, but to prioritize them for the physicians who actually staff Swiss medical wards.

The Delphi method is a well-established technique for extracting reliable consensus from expert panels without the distortions of group dynamics. Instead of convening a single contentious meeting, researchers circulate structured questionnaires over successive rounds, feeding anonymized group results back to participants so that opinions can converge or diverge on their merits. In this study, the experts rated the clinical relevance of 119 distinct POCUS applications using Likert scales, which measure degrees of agreement along a fixed range. Consensus was defined a priori, before the data were examined, as at least 70 percent agreement, a threshold designed to prevent a slim majority from masquerading as expert agreement. Each application could ultimately be classified as core, advanced, or irrelevant for hospital-based general internal medicine practice.

The results, published on 12 October 2026, are striking for both their clarity and their implications. Of the 119 items assessed across the three rounds, final consensus was reached for 71. Twenty-four applications were classified as core, meaning the panel judged them essential for any hospital-based internist; another 24 were deemed advanced, appropriate for context-dependent or specialized use; and 23 were rated irrelevant to the daily work of hospital internists. The core set is dominated by pulmonary ultrasound and ultrasound-guided procedures, supplemented by selected focused cardiac and abdominal applications. In practical terms, the experts agreed that a well-trained internist should be able to detect pleural effusions, pneumothoraces, and alveolar consolidations; safely guide vascular access and drainage procedures; and perform focused assessments of the heart and abdomen at the bedside.

The advanced tier captures a different philosophy of training. These applications, which include more nuanced cardiac assessments and context-dependent abdominal and vascular evaluations, are valuable but not universally necessary. The panel’s message is that training programs should distinguish between skills every internist must command and skills that deepen expertise in particular clinical environments, such as intensive care or emergency observation units. Perhaps most tellingly, the irrelevant category drew firm boundaries around the edges of internal medicine: obstetric and gynecologic ultrasound, ocular ultrasound, ear-nose-throat applications, and thyroid imaging were largely judged to lie outside the hospital internist’s remit, remaining the province of the relevant specialties.

Buried in the consensus list is a finding with immediate regulatory consequences. Several applications that reached core consensus are not currently included in the mandatory Swiss certification requirements for internal medicine training. In other words, the formal curriculum that governs what Swiss internists must demonstrate before certification does not yet match what a national panel of experienced practitioners considers indispensable bedside competence. This gap between formal requirements and clinical consensus is precisely the kind of misalignment the study was designed to expose, and it gives Swiss postgraduate training authorities a concrete, evidence-based starting point for revision.

The technical rigor of the study deserves attention. The panel was constructed to represent the full geography and institutional diversity of Swiss hospital medicine, from the five university hospitals in Geneva, Lausanne, Bern, Basel, and Zurich to cantonal and regional centers across the German-, French-, and Italian-speaking regions. The authors followed CREDES guidance, an international standard for conducting and reporting Delphi studies, which requires transparent documentation of panel selection, response rates, and consensus criteria. The Geneva Cantonal Research Ethics Commission reviewed the protocol and determined that it fell outside the scope of the Swiss Human Research Act, requiring no additional ethics approval. The study received no external funding from public, commercial, or non-profit organizations, and the authors disclosed their professional roles in ultrasound societies and training committees in detail.

What makes this study resonate beyond Switzerland is the broader problem it addresses. POCUS has exploded globally because the hardware has become cheap, portable, and increasingly integrated into smartphones and tablet-based devices. But hardware is the easy part. Ultrasound is an operator-dependent technique: the same probe that reveals a pericardial effusion in trained hands can produce confident misdiagnoses in untrained ones. Countries including the United States, Germany, and others have developed consensus curricula to standardize training, but Switzerland, despite its dense network of high-quality hospitals, had no comparable national framework. Training therefore varied substantially between institutions, and an internist certified in one canton might possess a very different ultrasound skill set from a colleague certified elsewhere.

The authors are careful about what their findings do and do not claim. They explicitly frame the consensus list not as a prescriptive recommendation but as a structured basis to inform national dialogue and subsequent curriculum development. They also acknowledge that considerations of cost-effectiveness, implementation resources, and long-term sustainability were beyond the scope of the study. Equipping training centers with machines, training supervisors, and assessing competency all carry real costs, and any national rollout will need to ensure that smaller regional hospitals are not left behind their university-hospital counterparts. Those feasibility questions, the authors write, should be addressed in future evaluations to ensure feasible and equitable integration across institutions.

Still, the study marks a genuine milestone in the professionalization of bedside imaging. For the first time, Swiss hospital internists have a nationally agreed, expert-validated map of what point-of-care ultrasound should mean in their specialty: twenty-four core skills that define baseline competence, twenty-four advanced skills that define depth, and a clear statement of what does not belong in their hands. As handheld ultrasound devices continue to proliferate through hospital corridors worldwide, this kind of disciplined, consensus-driven prioritization offers a template for other health systems grappling with the same question. The stethoscope took decades to earn its place in the physician’s routine; the ultrasound probe is earning its place far faster, and studies like this one are helping ensure that its adoption is matched by competence rather than merely enthusiasm.

Subject of Research: Delphi consensus on point-of-care ultrasound training priorities for hospital-based general internal medicine in Switzerland

Article Title: 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)

Article References: Leidi, A., Juillerat, A., Schneider, C., Benmachiche, M., Cosma, T., Dratz, L., Esposito, F., Felser, R., Greiser, J., Hausherr, Y., Kirsch, M., Kistler, A. D., Knoblauch, C., Lambert, A.-C., Monti, M., Moret Bochatay, M., Mosimann, V., Muggetti, E. M. N., Öhrström, L., … Grosgurin, O. (2026). 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). BMC Medical Education. https://doi.org/10.1186/s12909-026-10574-3

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10574-3

Keywords: point-of-care ultrasound, POCUS, general internal medicine, Delphi study, medical education, Switzerland, curriculum development, postgraduate training, ultrasonography, competency-based education, hospital medicine, consensus