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:
One-month “observer rotation” required for all Adult Neurology residents and an elective for Pediatric Neurology residents.
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.
Elective in clinical neuromuscular disease. This elective requires permission from the Neuromuscular Section head, based on specific request by the interested resident.
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.
To provide an experience that will allow the resident to achieve understanding of electrodiagnostic studies correlating it with the basic science of neurophysiology.
To learn the indications for ordering, diagnostic evaluation and interpretation of EMGs and autonomic studies.
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:
Patient Care (PC)
Medical Knowledge (MK)
Interpersonal and Communication Skills (ICS)
Practice Based Learning and Improvement (PBLI)
Systems Based Practice (SBP)
By the end of the rotation, the resident should receive and/or complete the following assessments:
Verbal feedback from preceptors
Global written assessments (METS)
Testing of residents performance through direct observation and record review
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.
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.
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
Sensory, motor, autonomic
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.
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
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
Work as an integrated member of the Neuromuscular Center and EMG Lab
360 degree evaluation
Present case presentations in an organized and detailed manner
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
Demonstrate the ability to provide consultants with a report that can be easily interpreted.
PRACTICE BASED LEARNING AND IMPROVEMENT
Neuromuscular/ EMG Rotation Practice Based Learning and Improvement
Clinical Neuromuscular Disease Elective
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
Evaluate the clinical literature applying knowledge of epidemiology, biostatistics, and research study design