Pelvic floor ultrasound (PFUS) is increasingly used in urogynecological practice for diagnostic assessment, surgical decision-making, and risk stratification, but training during Obstetrics and Gynecology residency is not standardized. We hypothesized that a national consensus process could identify the essential competencies required for PFUS training and the key drivers of skill acquisition. The aim of this study was to define the core theoretical, technical, and interpretative competencies considered necessary for PFUS training in Obstetrics and Gynecology residents.

A national Delphi study was conducted among 62 Obstetrics and Gynecology residents from 6 Italian residency programmes, representing all 5 years of training. A 29-item questionnaire, developed and reviewed by three urogynecologists with expertise in pelvic floor imaging, explored five domains: theoretical knowledge, technical skills, image interpretation, clinical relevance, and learning-curve determinants. Statements were scored on a 9-point Likert scale, with 1–3 indicating “not important”, 4–6 “uncertain”, and 7–9 “essential”. Consensus was predefined as at least 70% of participants rating a statement as 7–9. A second Delphi round was planned only for statements not reaching consensus.

Consensus was reached for all 29 statements in the first round, demonstrating strong agreement on the need for structured PFUS training during residency. No second Delphi round was required. Five statements achieved 100% agreement: the need for a minimum number of supervised examinations; the importance of including both technical and interpretative skills in the learning process; the essential role of expert supervision; the ability to distinguish different types of pelvic organ prolapse, and the value of PFUS in identifying risk factors in urogynecological patients. Very high agreement (96.7%) was observed for recognition of key anatomical landmarks, identification of technically inadequate examinations, adoption of standardized interpretation criteria, and the relevance of PFUS for gynecologists involved in urogynecological surgery. Importantly, residents agreed that procedural volume alone does not adequately define competence, supporting a competency-based rather than numbers-based training model.

This study shows a consistent national consensus among residents that PFUS training should be formally incorporated into the Obstetrics and Gynecology residency program. The findings suggest that competence in PFUS depends not only on examination numbers but also on supervised exposure, correct image acquisition, standardized interpretation, and clinically meaningful application of findings. These data support a structured educational framework based on competency assessment rather than procedural volume alone.

A national consensus was achieved on the core competencies required for PFUS training in Obstetrics and Gynecology residents. Structured training pathways, expert supervision, and standardized competency-based assessment should be implemented to improve PFUS education during residency. These findings may support the development of future national and international training standards in urogynecological ultrasound.

Continence 19S (2026) 102800
DOI: 10.1016/j.cont.2026.102800