Given the rapid learning curve for US guidance of CVCs, especially for the physician who is already experienced in the landmark method of CVC placement, I would suggest approximately 2 h of didactics, 2 h of laboratory training, and 5 to 10 proctored examinations. It should be pointed out that these numbers are based on the above suggestions as well our experience with a medical procedure service. Clearly, these suggestions should be prospectively validated with trials comparing a group who receives formal education/simulation training to a group educated through other means such as mentorship. Laboratory training should include exposure to a variety of ultrasound units to ensure familiarity with knobology, examination of normal vascular anatomy on healthy volunteers, as well as hands-on simulation with vascular access models. Available models range in sophistication from Jell-O (Kraft Foods; Northfield, IL)/Metamucil (Proctor & Gamble; Cincinnati, OH)/Penrose (Sherwood-Davis & Geck; St. Louis, MO) drains, to the Blue Phantom (www.bluephantom.org) [Blue Phantom LLC; Kirkland, WA] to CentralLineMan (http://www.simulab.com/CentraLineMan.htm) [Simulab Corporation; Seattle, WA]. Ideally, some of the laboratory training would include visualization of abnormal anatomy (ie, the obese patient, intraluminal thrombus, or significant overlay of the carotid artery by the IJ vein). The 5 to 10 proctored examinations should be broken down into 3 to 5 ultrasound examinations of normal anatomy/vascular access models, followed by 5 to 7 proctored procedures on vascular access models/simulators. For the physician who is already an expert at CVC placement, I recommend two proctored examinations on real patients followed by review of the next five ultrasound-guided CVCs. This would include reviewing the stored static picture/videotape as well as outcome (success, complications, number of needle passes), and discussion about factors that may have influenced the outcome. Additionally, I recommend a postinstruction assessment of the basics covered in the didactic and hands-on session. This can include static images and videotape, asking the operator to identify anatomy, as well as questions relating to the use of the ultrasound unit. These numbers are clearly subjective, as are other procedural recommendations based on number,44 and the main determinant in determining competence should be the evaluation of the proctor.