ObjectiveThis study aimed to develop a virtual reality test for abdominal point-of-care competence, to gather validity evidence for the test, and to establish a pass/fail score. MethodsThe developed test consisted of four abdominal point-of-care ultrasound cases. Medical students and doctors with varying abdominal point-of-care ultrasound experience were invited to the test and divided into three study groups: Novices, intermediates, and experienced abdominal point-of-care ultrasound operators. Data from the following items were used for item analysis and to examine internal consistency: The ability to correctly enter patient identification, orientate the ultrasound probe, and select a patient diagnosis (hydronephrosis, cholecystitis, gallbladder stones, abdominal aortic aneurysm, and/or urine retention). The contrasting groups’ standard setting method was used to establish a pass/fail score. ResultsThirty-one participants were included in the test. The item analysis included 49 items and a credible pass/fail score of 31 points was established (minimum of 0 points, maximum of 49 points). A one-way ANOVA was used to compare the mean test scores between the groups and showed significant difference between all three groups (p < 0.001). Internal consistency was high (Cronbach's alpha of 0.91), and an independent t-test showed statistically significant difference between the total scores of novices (mean = 23.7 points; SD = 8.7) and experienced operators (mean = 39.1 points; SD = 7.9), p < 0.001. ConclusionWe developed a test for abdominal point-of-care ultrasound competence assessment in virtual reality. Solid validity evidence was gathered, a credible pass/fail score was established, and the test could distinguish between novices and experienced abdominal point-of-care ultrasound operators.