Noelle M. Northcutt, MD; Nathaniel C. Reisinger, MD – For those that have experienced how much point of care ultrasound can positively impact patient care, the potential of an organized point of care ultrasound program is moderated by the reality of building such a program from scratch. We have watched novice and intermediate users ride the roller coaster of ambition and reality checks at each of the hands-on skills sessions across the nation.