Background <p>Point-of-care ultrasound (POCUS) is an important clinical skill in internal medicine (IM) and requires robust methods to assess competency.</p> Objective <p>The objectives of this research were to develop an entrustable professional activity (EPA) framework and instrument for POCUS competency assessment.</p> Design <p>An expert panel of seven IM POCUS educators guided the development of the EPA framework and assessment instrument. We evaluated the EPA framework and assessment instrument for validity, reliability, and feasibility of use for IM learners.</p> Participants <p>Trained raters assessed POCUS competency in IM learners at the bedside. We performed a total of 604 assessments on 48 unique learners across three US academic sites.</p> Main Measures <p>Authors analyzed the data using correlation, generalizability (G-) study, and decision (D-) study statistics to generate evidence for the validity, reliability, and feasibility of the instrument.</p> Key Results <p>The authors developed the EPA, “Assessing the acutely ill patient using POCUS,” using a structured process. The study team performed assessments on the ten clinical syndromes identified by the expert panel and single organ practice studies. The variance component attributed to learners ranged from 27.7 to 31.4%. The estimated number of observations needed to obtain a reliability index of 0.8 ranged from 11 for clinical syndromes to nine for single organ practice studies. The time to complete the supervisory scale and provide feedback to learners was 4.65&#xa0;min.</p> Conclusions <p>The authors developed an EPA and EPA-based assessment instrument for workplace-based assessments of IM POCUS learners. The analysis generated validity, reliability, and feasibility evidence that supports competency assessment of IM learners using POCUS at the bedside. Authors anticipate that this will have high utility for IM programs seeking to assess POCUS learner competence.</p>