Proposing the Learning Ultrasound in Critical Care Framework for a Longitudinal Competence Program for Point-of-Care Ultrasound in Critical Care-A Modified Delphi Survey.

Point-of-care ultrasound (PoCUS) is a critical diagnostic tool in intensive care, yet training pathways remain fragmented and inconsistently implemented. This study aimed to achieve expert consensus on the design and delivery of a longitudinal PoCUS-competence program for critical care trainees, focusing on the 'basic' level defined by existing guidelines. A modified Delphi process was conducted from April to October 2025, involving critical care stakeholders from India, Sri Lanka, Vietnam and Australia. Participants included trainees, educators, and institutional leaders with PoCUS experience. The web-based questionnaire was developed using Miller's pyramid, Competency-Based Medical Education, and Experiential Learning frameworks. Consensus was defined a priori as ≥ 80% agreement. Items were refined across three rounds, incorporating thematic feedback and controlled response summaries. Of 215 invited participants, 59 (27%) completed Round 1, 34 (16%) completed Round 2, and 29 (13%) completed Round 3. Consensus was achieved for 14 of 17 items in Round 1, with the remaining items and new feedback explored in subsequent rounds. Round 2 resolved all outstanding items. Round 3 explored additional themes from Round 2 regarding trainer qualifications and 'train-the-trainer' components. All items reached consensus or were deemed sufficiently addressed. The final Learning Ultrasound in Critical Care (LUCC) framework integrates modular design, structured mentorship, protected scanning time, and standardised assessments. It reflects broad stakeholder endorsement and aligns with contemporary educational principles. The LUCC framework offers a scalable, consensus-based model for longitudinal PoCUS training in critical care. It is adaptable across diverse settings and ready for pilot implementation and validation.