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EDE Zen and the Art of POCUS Teaching

June 17, 2018

This is for all the POCUS teachers out there…

We started the EDE 2 course in February 2009. To be honest, myself and the rest of the team were still figuring out the best way to do the various scans that we taught. We were also improving our bedside teaching. As most of you know, the EDE courses place a heavy emphasis on image generation and deconstructing how that is best performed. It was sometime in 2010, over a year later, that I had the following experience. We were holding the course at a large venue. It may have been at EMU. In any case, I had to leave the stretcher that I was supervising for about 30 seconds to do something organizational. The participant that I was supervising was trying to do the A4C scan. I looked back at the participant, saw the screen, saw their hand, and I knew exactly what they needed to do to improve the image. So I said out loud to them so they could hear from a distance, “slide laterally and heel medially”. Immediately after I said that, a shiver went down my spine.

We had been trying to break the advanced cardiac scans into its component parts and probe movements and had finally figured it out about a year into the course. Being the tougher scan, A4C took a bit longer. It was at that course that everything came together to the point where our instructions could be purely verbal. Until then, we relied more heavily on holding the participant’s hand to guide them through a trouble area to help them through the scan. At first, it was because we didn’t know ourselves how exactly they should move the probe. Then, we didn’t know how to put it into words.… until that day. That shiver down my spine and the goosebumps that followed are what I call having reached the level of “EDE Zen”. By now, most EDE instructors have attained that level.

When you go from being a practitioner of POCUS to a teacher, the depth of your knowledge and skills must necessarily become more profound. This doesn’t happen overnight. Over this weekend, we held our first Nickel POCUS Bootcamp in Sudbury for the CPOCUS Resuscitation Track scans. Rob Lepage and Emily Conrad (photos below) were apprentice instructors. Rob is our ED Chief and Emily is one of our emergency medicine residents. Rob and Emily are already certified in the resuscitation track scans, but teaching is an entirely different story. When you first start teaching, it’s difficult to put into words the advice that you want to provide to a participant. And sometimes you’re not sure how they should move your hand based on what you see on the screen and the participant’s hand position. The only way to get around this as an new instructor is to place your hand on the hand of the participant and start moving the probe with them. If new instructors continue to teach POCUS, they will find the need to place their hand on the hand of the participant less and less often. One day, they may even surprise themselves with the instructions that they are able to put into words. And if you ever feel goosebumps right after you give those instructions, you have just had your first EDE Zen moment 🙂

P.S. Many thanks to Greg Hall and Julie Thorpe of Brantford for all the help and advice in getting this first Bootcamp in Sudbury off the ground. We couldn’t have done it without you!



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