Abstract Background: Point-of-care ultrasound (POCUS) is increasingly vital in surgical critical care, yet standardized training remains inconsistent. This study evaluates a structured POCUS curriculum for surgical critical care fellows, assessing its impact on knowledge, skills, and confidence over six months. Methods: A prospective observational study was conducted from July 2024 to January 2025 at a tertiary care center, involving 15 fellows with varying prior ICU experience (3–15 months). The curriculum included two days of didactic lectures and hands-on sessions, followed by monthly maintenance training. Competency was assessed at baseline, 3 months, and 6 months via written tests (knowledge), self-reported Likert scales (confidence), and a 25-task checklist (skills). Nonparametric statistical tests (Wilcoxon signed-rank, Friedman) analyzed changes, with correlations explored using Spearman’s rank. Results: First-year fellows showed the greatest improvement (knowledge: +7 points, skills: +9 points, p < 0.05), while all cohorts demonstrated significant gains (overall knowledge p = 0.001). Skills and knowledge were sustained at 6 months (median knowledge: 27 [26–29], skills: 33 [32–33]), with confidence rising progressively (22 [20–23]). Formal training outperformed informal methods in knowledge (27 vs. 18, p < 0.05) and skills (33 vs. 21, p < 0.05). Strong correlations linked confidence, skills, and knowledge (r = 0.76–0.79, p < 0.01). Conclusion: A structured POCUS curriculum significantly enhances fellows’ competencies, particularly for novices, with sustained benefits over six months. These findings advocate for standardized, expert-led training in critical care fellowships.