NEUROMUSCULAR/EMG-EMG 2
RESIDENT EDUCATION CURRICULUM
Description of Rotation
The Neuromuscular/EMG Section of the Department of Neurology has redefined its
educational programs for Neurology residents. The following rotations are offered:
1. One-month “observer rotation” required for all Adult Neurology residents and an
elective for Pediatric Neurology residents.
2. Additional two-month rotation (total of three consecutive months in the EMG
Laboratory) for residents interested in learning to perform nerve conduction
studies and needle electromyography, and those who have a potential interest in
fellowship training in neuromuscular disease.
3. Elective in clinical neuromuscular disease. This elective requires permission
from the Neuromuscular Section head, based on specific request by the interested
resident.
Educational Purpose
1. To provide an experience that will allow the resident to increase their knowledge
of anatomy of the peripheral nervous system and the clinical presentation and
pathophysiology of neuromuscular disorders.
2. To provide an experience that will allow the resident to achieve understanding of
electrodiagnostic studies correlating it with the basic science of neurophysiology.
3. To learn the indications for ordering, diagnostic evaluation and interpretation of
EMGs and autonomic studies.
4. To provide training and supervision that allows development of skills necessary to
perform accurate electrodiagnostic studies.
Assessment Summary
The resident will work one-on-one with staff, and get immediate feedback about his/her
performance after every patient encounter/work-up. It is expected that the resident will
improve their performance based on the feedback they receive and as the rotation
progresses.
Resident performance will be assessed in the six core competencies:
1. Patient Care (PC)
2. Medical Knowledge (MK)
3. Interpersonal and Communication Skills (ICS)
4. Practice Based Learning and Improvement (PBLI)
5. Professionalism (P)
6. Systems Based Practice (SBP)
By the end of the rotation, the resident should receive and/or complete the following
assessments:
1. Verbal feedback from preceptors
2. Global written assessments (METS)
3. Procedure Logs
4. Written examination
5. Testing of residents performance through direct observation and record review
Expectations
Additional Two-Month Rotation in EMG
In addition to the curriculum in the Basic Rotation, the additional two-month
rotation is directed toward developing technical skills in NCS and needle EMG.
This two-month rotation must directly follow the Basic Rotation. Extended time
away during this rotation is discouraged. There will be more concentration on
EMG design to answer the clinical question being asked by the referring
physician. There will be more emphasis on electrodiagnostic impression writing
and interpretation of abnormal results. There will be continued EMG case
sessions with staff and fellows, as well as an EMG unknowns quiz at the end of
the rotation.
Orientation
This occurs on the first day of the rotation by the staff attending assigned to the clinic/lab.
Orientation to the EMG machine will evolve over the first month of the clinical rotation.
Supervision
Residents will actively participate in the clinics/lab supervised both by neuromuscular
staff physicians as well as neuromuscular fellows.
Mix of Diseases
 Muscular Disoders /myopathies/ muscular dystrophy
 Disorders of neuromuscular junction
 Polyneuropathy
o Axonal
o Demyelinating
o Sensory, motor, autonomic
 Mononeuritis multiplex
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Entrapment neuropathy
Plexopathy
Radiculopathy
Anterior horn cell disorders/ Motor neuron disease/SMA
Patient Characteristics
Patients will be referred to the EMG laboratory from either physicians in the outpatient
department or from the inpatient hospital services for further diagnosis of a wide variety
of neuromuscular disorders. Children and adult, of various ethnic backgrounds and
socioeconomic backgrounds with acute and chronic neurological disorders will be
encountered during the EMG rotation. Adults over the age of 18 will be encountered in
the neuromuscular clinic.
Procedural Skill Acquistion
Additional Two-Month Rotation in EMG/ Three-Month Advanced Elective in EMG
1. Normal and abnormal findings in NCS and needle EMG
2. Interpretation of NCS and EMG findings
3. NCS techniques on 10 volunteers, then on patients
4. Needle EMG techniques with staff supervision
5. Writing electrodiagnosis interpretations
Conferences
The residents should continue to attend the mandatory Neurology conferences including
Neurology Grand Rounds. In addition, the residents are required to attend the biweekly
Neuromuscular conference (1st and 3rd Thursday of the month). This conference is
located in MEB.
References:
Resources are available in the EMG Laboratory for learning skills.
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Electromyography in Clinical Practice: Clinical and Electrodiagnostic Aspects of
Neuromuscular Disease by Michael J. Aminoff. Churchill Livingstone; 1998.
Neuromuscular Function and Disease: Basic, Clinical, and Electrodiagnostic
Aspects by William F. Brown, Charles F. Bolton, Michael J. Aminoff. Saunders;
2002
Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic
Correlations by David C. Preston, Barbara E. Shapiro. Butterworth-Heinemann;
1998.
Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice
by Jun Kimura Oxford University Press, 2001
Comprehensive Clinical Neurophysiology by Kerry Levin, Hans O. Luders,
Saunders; 2000.
AAN Practice Guidelines: http://www.aan.com/professionals/practice/index.cfm
Scholarly Responsibilities: Present a lecture on artifacts found in EMG
Present one interesting case
Clinical Responsibilities: Monday-EMG clinic at Lord & Taylor
Tuesday- EMG clinic at Baptist
Wednesday- EMG clinic at Baptist
Friday-EMG clinic at Baptist
SUB-SPECIALTY: Neuromuscular Disease/EMG
ROTATION EXPERIENCE: EMG 2
PATIENT CARE
PATIENT CARE-Objectives
EMG 2
Demonstrate basic technical and procedural skills of
NCS; this will include performing NCS on 10 volunteers
prior to conducting studies on patients
Demonstrate basic technical and procedural skills of
NCS; this should include completion of at least 5 studies
on patients referred to the EMG laboratory.
Demonstrate the basic technique of needle electrode
examination with performance of 10 needle electrode
examinations of both the upper and lower extremities.
Teaching Methods
Assessment Strategy
Direct Patient Care
EMG case conference
Didactic Lectures
Staff and resident instruction and
supervision
Observed performance on volunteers
EMG case conference
Didactic Lectures
Staff and resident instruction and
supervision
Observed performance on patients with
tech supervision
EMG case conference
Didactic Lectures
Staff and resident instruction and
supervision
Review of previously recorded NEE
abnormalities
Global rating
Checklist evaluation of live performance
Record review
Case logs
Global ratings
Checklist evaluation of live performance
Record review
Case logs
Global ratings
Checklist evaluation of live performance
Record review
Case Logs
MEDICAL KNOWLEDGE
Neuromuscular/ EMG Rotation
Medical Knowledge -Objectives
Teaching Methods
Assessment Strategy
Apply knowledge of nerve conduction studies and develop a study
that accurately diagnoses the patient’s symptoms.
Didactic lecture
Clinical teaching
Characterize the main features of the needle electrode examination
as being normal or abnormal.
Analyze abnormalities seen on needle electrode exam and
determine underlying pathology (neurogenic, neuromuscular
junction defect or myopathic)
Clinical teaching
Departmental Conferences
Didactic lecture
Case conferences
Clinical teaching
Didactic lecture
Case conferences
Clinical teaching
Global ratings
Case Logs
Record review
Global ratings
In-training examination
Global ratings
In-training examination
End of course quiz
Global ratings
In-training examination
End of course quiz
EMG 2
Correlate findings on NCS with NEE and write an
electrodiagnostic impression (for 5 patients), demonstrating
comprehension of the etiology of the patient’s symptoms
INTERPERSONAL AND COMMUNICATION
Neuromuscular/ EMG Rotation Interpersonal and Communication
INTERPERSONAL AND COMMUNICATION-Objectives Teaching Methods
EMG 2
Establish excellent rapport and communication with their
Clinical practice
patients and their families
Assessment Strategy
Modeling
360 degree evaluation
Work as an integrated member of the Neuromuscular Center
and EMG Lab
Clinical practice
Global ratings
Modeling
360 degree evaluation
Present case presentations in an organized and detailed
manner
Clinical practice
Global ratings
Modeling
360 degree evaluation
Educate their patients and their families as appropriate to the
clinical situation in a manner that is geared to the patients
educational level
Direct patient care
Global rating
Modeling
Demonstrate the ability to provide consultants with a report that Clinical rounds
can be easily interpreted.
Global ratings
Modeling
Global ratings
PRACTICE BASED LEARNING AND IMPROVEMENT
Neuromuscular/ EMG Rotation Practice Based Learning and Improvement
PRACTICE BASED LEARNING & IMPROVEMENT
Teaching Methods
Assessment Strategy
Research clinical questions regarding their patient’s health
Electronic medical record
Self assessment
problems using information technology to access on-line medical
Medline/OVID searches- patient
Global ratings
information to support their own education and to improve patient
centered
care and education
Case presentations
Evaluate the clinical literature applying knowledge of
Teaching conferences
Global ratings of Journal club
epidemiology, biostatistics, and research study design
Journal Clubs
performance
Integrate the feedback they receive from Staff physicians such that
Modeling
Global ratings (METS)
Objectives:
EMG 2
their performance will improve as the rotation progresses.
PROFESSIONALISM
Neuromuscular/ EMG Rotation Professionalism
PROFESSIONALISM-Objectives
Teaching Methods
Assessment Strategy
EMG 2
Demonstrate respect, compassion, integrity, and honesty
Direct patient care
Global ratings
Modeling
Interact responsibly with patients and families taking into
consideration age, disability, culture and gender issues
Modeling
Global ratings
Demonstrate exemplary interaction with their colleagues
Modeling
Global ratings
Demonstrate appropriate use of the EMR in regards to patient Direct patient care
Global ratings
respect and confidentiality
Modeling
Self-assess their performance and the means for
improvement
Recognize mistakes that occur and take measures to learn
from them so that the do not recur
Modeling
Global ratings
Direct patient care
Global rating
Modeling
Self assessment
SYSTEM BASED PRACTICE
Neuromuscular/ EMG Rotation System Based Practice
SYSTEM BASED PRACTICE-Objective
Teaching Methods
Assessment Strategy
EMG 2
Utilize appropriate resources to better care for their patients.
Direct patient care
Global ratings
Review of evidence based medicine
Focused Record Review
and guidelines of the AAN
Departmental conferences
Identify obstacles to good patient care, engaging other
members of the health care team such as child-life and social
work, appropriately consulting other subspecialists or
generalists.
Communicate with the specialized services or laboratories in
order to obtain timely information on their patients
Direct patient care
Consider ethical, legal, and cost-effective standards of
practice
Global ratings
360 degree evaluation
Direct patient care
Global ratings
Modeling
360 degree evaluation
Role modeling
Self assessment
Clinical teaching
Focused record review
Focused record review