RIPP Program Details

Please read below about how the RIPP program would work for you to get your IP certification done locally. 

Purpose of RIPP

The Rural Independent Practitioner Program (RIPP) is for individuals seeking to obtain their CEUS certification as an Independent Practitioner residing or working in a rural hard to reach environment who are unable to travel. Depending on the number of candidates, instructors will come to your facility for four days and complete the training with volunteers as subjects for scanning.

Instructors and Machines

Two Candidates: One Master Instructor, unless other provisions have been made with CEUS, and one ultrasound machine from the host site.

Four Candidates: One Master Instructor and one Independent Practitioner instructor as well as the requirement for two machines from the host site.

Access to a backup machine in case of a machine malfunction would be advisable.

Anything over four candidates should be referred to another educational track that will fulfill your site’s needs (see below).


Training will take place over three days for six hours per day along with a fourth day for testing. The cost for this experience is $1,500 per day of trainer time. Training times are approximate and extra training time might be required. This is reimbursed at an extra $200 per hour. The hosting center is also responsible for the trainers’ lodging and transportation costs. The following cost break down includes the estimated instructors’ fees and estimated travel/lodging expenses:

Per two candidates the cost will be approximately $3,750 per candidate (total cost $7,500/instructor)

Four candidates will be approximately $3,750 per candidate (total cost $7,500/instructor)

The two and four candidate tracks are the most cost effective for the participants. We have tried to keep the program costs as low as possible while at the same time reimbursing the instructors for their time both teaching and being away from their own practices.

Single candidates may contact the chair of the RIPP program at for assistance finding a center close to them that is running a RIPP or for assistance finding another candidate to train with in a RIPP hosted at their center. Also, you can contact the RIPP chair if you have over four candidates to train at your center. The chair will then assist you to make contact with an educational program that best suit your center’s needs.

Volunteer requirements:

There will be 22 volunteers required per day of training plus any inpatient or emergency room visits for three days of scanning. The volunteer pool must be highly concentrated to females in order to obtain all the required scans. Every effort must be made to have volunteer models recruited for these day previously to the RIPP taking place. This will help ensure the proper of scans get completed by the programs end.

Since women of childbearing age can be difficult to enlist as volunteers, there may be a need for a “pelvic scanning session”. These sessions refer to bringing any female friends, family or co-workers of child bearing age together for a two-hour session to scan as many uteri as possible. These types of sessions can help develop confidence with the OB scan.

The same volunteers may be re-scanned as long as there is at least 24 hours between their scans. This may help the smaller center to fulfill their number of scans. Although, the more volunteers available the better to represent a more “real life” cross section and improve the clinician’s ability to scan a diverse group of individuals. Every effort should be made to have the most number of volunteers possible although we recognize the limitations of a small centre. The volunteers should reflect real world scans so they will not be asked to have full bladders or any other preparation that would make for a more unrealistic scan.

The volunteers obtained should reflect a wide range of body types in order to expose the learner to “the real world” of scanning. Two goals of this process are to scan safely and know when to reject substandard images as well as efficiency to learn how to get quality images in a timely fashion while recognizing when quality images may not be possible to obtain.


Verbal consent should be obtained from each volunteer with the understanding that the trainee is a local emergency clinician, the trainer is visiting from XXX to provide advanced instruction and the emergency department ultrasound has a limited scope and that if anything appears outside of the normal, they will be referred on appropriately.


All scans must be documented in the CEUS logbook (provided), with identifying information for each model (name and birthdate are sufficient). Only determinant scans will be counted towards your total. If a scan is inconclusive, for whatever reason, it cannot be counted. Although, indeterminate scans must be recorded and there is an expectation of there being a significant number of indeterminate scans.


The goal of this course is not to rush through your scans in order to reach your goal in a timely fashion. The purpose is to provide advanced training to instill good habits when scanning to ensure the integrity of scans in the future. This may result in a slower start to the sessions requiring more time for each scan when first starting. As the sessions continue, the trainee will develop better habits and become more skillful in their techniques thereby speeding up the process so trainees are encouraged not to panic if it appears to be moving relatively slow in the beginning.


The first three days will include six hours of training per day concentrated on obtaining the required scans, including a “Pelvic Scanning Session” if required. Training times are approximate and extra training may be required. The fourth day will be focused on the examination portion of the certification.


The three certification exams will be done on the fourth day of the RIPP.

The written exam can be completed by the trainee at any time on the trainee’s own time and will be corrected free of charge. The written exam is not open book.

The CEUS visual exam consist of the instructor asking a number of questions based on images appearing on a computer screen over 90-120 minutes per trainee. The images are mostly from the obstetrical area. The candidate will be told immediately if their answer was correct or not. There are a number of “lethal errors” within the visual exam that if a candidate answers even one of those answers incorrectly must redo the entire exam. Conducting the visual exam is considered paid time for the trainers.

The last hour of trainer time during your program is devoted to the practical exam. The exam takes the form of an observed structured process including a “Teach the Teacher” wherein the trainer will simulate a beginner scanner making a series of mistakes which the trainee must identify and correct. This exam will take place after the trainee has obtained 40-45 scans per area. The exam scans count towards certification. Each ED U/S Independent Practitioner should be a leader in the field as opposed to just a skilled probe manipulator.

Transportation and Lodging Requirements

Lodging (hotel) will be reserved and paid for directly by the hosting facility and is at their discretion.

Any transportation receipts including flights, rental vehicle, and gas will be submitted by the individual to the hosting site for direct reimbursement. Hosting facilities are not responsible for the trainer’s meals.


Trainers are paid $1,500 for six hours per day. These training times are approximate and extra training may be required. Any additional hours required to complete the requirements may be sought from trainers at the rate of $200 per hour.