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Background: The availability of faculty proficient in point of care ultrasound (POCUS) has emerged as a barrier to the ongoing expansion of POCUS across the field of internal medicine. We sought to examine the faculty graduates of our institutional POCUS program to identify characteristics associated with long-term proficiency to inform curricula and guide institutional support. Methods: We emailed a test and survey to the 89 faculty graduates of the annual POCUS course we have run from 2018-2023. Results: Of the 46 participants (52%) who completed the test and survey, the overall median test score was 72%. Graduates were most confident with image acquisition of the lung, and were most likely to use ultrasound to evaluate ascites and dyspnea. All 11 participants reporting completion of an image portfolio were actively teaching POCUS, whereas only 54% of non-completers were teaching. Portfolio completers scored higher on the test compared to non-completers (median 92% and 68%, respectively, p <0.01) and were more confident in image acquisition and interpretation (p<0.001). Conclusions: In this long-term, single-institutional study of faculty graduates of an annual POCUS program, those who reported completing an image portfolio scored significantly higher on a knowledge test, reported higher confidence with image acquisition and interpretation, and reported using and teaching POCUS more frequently compared to graduates who did not complete the portfolio. POCUS education programs should be designed to foster continuous scanning practice and image portfolio completion., Competing Interests: The authors declare no conflict of interest., (Copyright (c) 2024 Michael Janjigian, Anne Dembitzer, Isaac Holmes, Caroline Srisarajivakul-Klein, Khemraj Hardowar, Harald Sauthoff.)