Resident education curriculum



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NEUROMUSCULAR/EMG-NEUROMUSCULAR
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




Clinical Neuromuscular Disease Elective


This one-month elective must be approved in advance by the Neuromuscular Section head. The resident will see patients every half day with members of the Section. Depending on the staff physician, the experience may be as an observer during staff encounters with patients. The resident may elect to observe in the multidisciplinary ALS Clinic and in the Peripheral Nerve Clinic. There is an opportunity to observe and learn skin biopsy techniques and observe nerve and muscle biopsy procedures. Attendance at biweekly Tuesday noon neuromuscular conferences is required.
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

    • Axonal

    • Demyelinating

    • Sensory, motor, autonomic

  • Mononeuritis multiplex

  • 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.
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.




  • 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 grand rounds case

Present a lecture on the topic to the other residents
Clinical Responsibilities:

Monday: Continuity Clinic and EMG clinic

Tuesday: Neuromuscular Clinic at Baptist

Wednesday: Neuromuscular Clinic

Friday: Neuromuscular Clinic at Baptist
You must attend one Pedicatic Neuromuscular Clinic this rotation. Please contact Drs. Weimer, Tilton or Wong for the dates of this clinic so you can make the appropriate arrangements.

SUB-SPECIALTY: Neuromuscular Disease/EMG

ROTATION EXPERIENCE: Clinical Neuromuscular Disease Elective
PATIENT CARE

Neuromuscular/ EMG Rotation Patient Care

O

bjectives


Clinical Neuromuscular Disease Elective


Teaching Methods

Assessment Strategy


Through direct observation and instruction, the resident will gain knowledge of advanced skills in examination of the muscular and peripheral nervous system in context of the neurological examination

Direct patient care

Recommended readings

Staff instruction


NEX examination (observation of live performance)

Global ratings



As the schedule permits, perform initial history and examination, present to precepting staff, follow through with work up and follow up during time on the neuromuscular rotation


Direct patient care

Recommended readings

Performance feedback


NEX examination (observation of live performance)

Global ratings



Perform interval history and examination on selected established patients

Direct patient care

Recommended readings

Performance Feedback



NEX examination (observation of live performance)

Global ratings


MEDICAL KNOWLEDGE



Neuromuscular/ EMG Rotation Medical Knowledge

O

bjectives


Clinical Neuromuscular Disease Elective


Teaching Methods

Assessment Strategy


Describe the pathophysiology neuromuscular disorders such as polyneuropathy , ALS, myasthenia gravis, and myopathy.


Didactic Lecture

NM Conference (Tues)

Neurology Case Conference (Thurs)

Clinical Teaching



Global ratings

In-training examination




Describe the fundamental principles of the neuromuscular examination and apply this knowledge in completing a thorough history and neurological examination


Didactic Lecture

NM Conference (Tues)

Neurology Case Conference (Thurs)

Clinical Teaching



Global ratings

In-training examination




Explain peripheral nerve and muscle anatomical concepts


Didactic Lecture

NM Conference (Tues)

Neurology Case Conference (Thurs)

Clinical Teaching



Global ratings

In-training examination




Discuss the various treatment and management options for neuromuscular disorders and apply the latest knowledge to care of patients


Didactic Lecture

NM Conference (Tues)

Neurology Case Conference (Thurs)

Clinical Teaching



Global ratings

In-training examination




Research a patient’s problem and provide a expanded neuromuscular differential diagnoses


Didactic Lecture

NM Conference (Tues)

Neurology Case Conference (Thurs)

Clinical Teaching



Global ratings

In-training examination




Compare and contrast different management strategies for patients with neuromuscular disorders


Didactic Lecture

NM Conference (Tues)

Neurology Case Conference (Thurs)

Clinical Teaching



Global ratings

In-training examination



INTERPERSONAL AND COMMUNICATION



Neuromuscular/ EMG Rotation Interpersonal and Communication

Objectives
Clinical Neuromuscular Disease Elective

Teaching Methods

Assessment Strategy

Establish excellent rapport and communication with their patients and their families


Clinical practice

Modeling


Global ratings

360 degree evaluation



Work as an integrated member of the Neuromuscular Center and EMG Lab


Clinical practice

Modeling


Global ratings

360 degree evaluation



Present case presentations in an organized and detailed manner


Clinical practice

Modeling


Global ratings

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

Modeling


Global rating


Demonstrate the ability to provide consultants with a report that can be easily interpreted.

Clinical rounds

Modeling


Global ratings


PRACTICE BASED LEARNING AND IMPROVEMENT



Neuromuscular/ EMG Rotation Practice Based Learning and Improvement

Objectives

Clinical Neuromuscular Disease Elective


Teaching Methods

Assessment Strategy

Research clinical questions regarding their patient’s health problems using information technology to access on-line medical information to support their own education and to improve patient care and education

Electronic medical record

Medline/OVID searches- patient centered

Case presentations


Self assessment

Global ratings



Evaluate the clinical literature applying knowledge of epidemiology, biostatistics, and research study design

Teaching conferences

Journal Clubs



Global ratings of Journal club performance


Integrate the feedback they receive from Staff physicians such that their performance will improve as the rotation progresses.

Modeling

Global ratings (METS)

PROFESSIONALISM



Neuromuscular/ EMG Rotation Professionalism

Objectives

Clinical Neuromuscular Disease Elective

Teaching Methods

Assessment Strategy

Demonstrate respect, compassion, integrity, and honesty

Direct patient care

Modeling


Global ratings

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 respect and confidentiality


Direct patient care

Modeling


Global ratings

Self-assess their performance and the means for improvement


Modeling

Global ratings

Recognize mistakes that occur and take measures to learn from them so that the do not recur


Direct patient care

Modeling



Global rating
Self assessment

SYSTEM BASED PRACTICE



Neuromuscular/ EMG Rotation System Based Practice

Objective

Clinical Neuromuscular Disease Elective

Teaching Methods

Assessment Strategy

Utilize appropriate resources to better care for their patients.



Direct patient care

Review of evidence based medicine and guidelines of the AAN

Departmental conferences


Global ratings

Focused Record Review




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.

Direct patient care


Global ratings

360 degree evaluation



Communicate with the specialized services or laboratories in order to obtain timely information on their patients


Direct patient care

Modeling


Global ratings

360 degree evaluation



Consider ethical, legal, and cost-effective standards of practice


Role modeling

Clinical teaching

Focused record review


Self assessment

Focused record review





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