Neuromuscular Medicine

The neuromuscular rotation includes:

• The neuromuscular clinic staffed by Drs. Gardon, Waclawik, Hansen and Fertikh
• The electromyography lab staffed by Drs. Gardon, Waclawik, Hansen and Fertikh
• The muscle and nerve pathology lab staffed by Drs. Salamat (neuropathologist) and Waclawik

Schedule

Below is an example schedule for the Neuromuscular rotation. This will be adjusted to reflect the individual resident’s existing continuity clinic schedule and clinics that are scheduled periodically, and may need alterations due to attending availability.

An individualized schedule will be generated and emailed to the Neuromuscular resident before the start of their rotation.

Residents are also expected to attend Muscle and Nerve pathology conference on Tuesday afternoons at noon. You will be excused from attending regular Tuesday afternoon lecture while on the Neuromuscular rotation.

MDA = Muscular Dystrophy Association

Work Hours

There are no call or weekend duty responsibilities beyond the normal neurology call schedule. Estimated work hours for the rotation is 40 hours per week.

Patient Care

Goals

To provide excellent training in diagnostic evaluation and management of patients with a wide spectrum of neuromuscular diseases.

Objectives

Residents will:

1. Learn the unique skills of the neuromuscular exam to accurately predict disease location and diagnosis.
2. Develop their skills in various electrodiagnostic techniques including:
3. standard motor and sensory nerve conduction studies of upper and lower extremities and cranial nerves;
4. repetitive nerve stimulation techniques;
5. basic autonomic studies;
6. standard concentric needle EMG evaluations;
7. Single Fiber EMG techniques,
8. laryngeal EMG.
9. Learn the indications and clinical utility of muscle and nerve biopsies.
10. Learn how to select the muscle biopsy site to assure the highest diagnostic yield.
11. Understand the basic principles of muscle and nerve specimen processing (histology, histochemistry, immunostaining, electron microscopy, teased fiber analysis).
12. Be able to incorporate the biopsy results into the clinical decision-making process with regard to diagnosis and management of patients with neuromuscular disorders.
13. Have an opportunity to assist in muscle and nerve biopsies (in the operating room, or in the neurology out-patient clinic for needle muscle biopsies).
14. Actively participate in the Muscle and Nerve Pathology/ Neuromuscular case conference.

Medical Knowledge

Goals

1. Provide excellent, comprehensive training in electromyography, including advanced techniques.
2. Understand the clinical utility and limitations of different electrodiagnostic tests in evaluation of patients with various neurological disorders.
3. Gradually increasing responsibility and independence in electrodiagnostic evaluation of patients in the EMG Laboratory.
4. Introduce residents to basic concepts of interpretation of muscle and nerve biopsies.
5. Introduce the residents to the technique of muscle and nerve biopsy (in the operating room, or in the neurology out-patient clinic for needle muscle biopsies).
6. Understand the clinical utility and limitations of nerve and muscle biopsies in evaluation and management of patients with neuromuscular disorders.

Objectives

Residents will:

1. Learn clinical skills necessary to diagnose neuromuscular conditions affecting different stations of the motor unit (anterior horn cell diseases, peripheral neuropathies, neuromuscular transmission disorders, myopathies).
2. Understand the principles of clinical genetics and genetic counseling applicable to patients with hereditary neuromuscular conditions.
3. Gain knowledge of laboratory and diagnostic studies and their appropriate uses.
4. Acquire the knowledge of the most current concepts in therapies applicable to neuromuscular diseases.

Practice-Based Learning and Improvement

Goals

1. Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.
2. Identify opportunities for improvement.

Objectives

Residents will:

1. Learn to critically appraise the neuromuscular literature, with emphasis on clinical trial design and outcome measures.
2. Become familiar with authoritative sources of practice guidance, such as American Association of Electrodiagnostic and Neuromuscular Medicine or American Academy of Neurology, and how to access these resources on-line.
3. Maintain a log for tracking of patients seen in clinic to ensure an adequate educational experience.
4. Learn to critically appraise the neurophysiological literature, with emphasis on critical assessment of different electrodiagnostic techniques.
5. Become familiar with authoritative sources of clinical electromyography practice guidance, such as American Association of Electrodiagnostic and Neuromuscular Medicine statements, and how to access these resources on-line.
6. Maintain a log for tracking of patients seen in EMG Lab to ensure an adequate educational experience.
7. Residents will learn to critically appraise the neuropathological literature, with emphasis on assessment of different neuropathological techniques in diagnosis of neuromuscular disorders.

Interpersonal and Communication Skills

Goals

1. Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.
2. Become skillful listeners, and develop specific proficiency in communicating with adult and pediatric neurologic patients with neuromuscular disorders through non-verbal means and with their care providers.
3. Learn to communicate rapidly and efficiently with other team members in order to ensure that proper therapies can be provided in a timely manner.
4. Learn to clearly communicate neurological assessments and plans to patients and their parents, and members of the multidisciplinary care team.

Objectives

Residents will:

1. Become skillful listeners, and develop specific proficiency in communicating and examining patients with severe disabilities.
2. Learn to communicate rapidly and efficiently with other team members in order to ensure that appropriate therapies can be provided in a timely manner.
3. Learn to clearly communicate neurological assessments and plans to patients, their families, and other health providers involved in evaluation and management of patients with neuromuscular disorders.
4. Become skillful listeners, and develop specific proficiency in communicating with patients in the EMG Laboratory.
5. Learn to prepare the EMG test reports and communicate the test results to referring physicians. Learn the terminology used in muscle and nerve pathology reports.
6. Learn to prepare the muscle or nerve biopsy reports and communicate the test results to referring physicians.

Professionalism

Goals

1. Demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.
2. Learn ethical, regulatory, and legal aspects of pediatric neurologic care, including the difference between standard and investigational treatments.
3. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ and parents’/caregivers’ medical decisions in the context of neurologic disease.
4. Demonstrate responsiveness to patient needs that supersedes self-interest.
5. Demonstrate compassion, integrity, accountability and respect in all interactions with patients from diverse backgrounds in gender, age, culture, race, religion, physical and cognitive ability and sexual orientation.
6. Adhere to ethical principles by respecting confidentiality of medical information.

Objectives

Residents will:

1. Learn ethical, regulatory, and legal aspects of care, including the difference between standard and investigational treatments.
2. Demonstrate sensitivity to the personal, cultural, and religious values that influence patients’ medical decisions in the context of the wide spectrum of neuromuscular conditions, including end-of-life issues.
3. Adhere to ethical principles by respecting confidentiality of medical information.

Systems-Based Practice

Goals

1. Provide care of uniformly high quality within fiscally constrained environment.
2. Navigate various health care delivery and financing systems to provide optimal care for patients with neuromuscular disorders.

Objectives

Residents will:

1. Demonstrate the ability to work in a multidisciplinary fashion with nurses, case managers, social workers, therapists, primary care physicians, and the various medical and surgical specialties related to neuromuscular diseases.
2. Understand the clinical utility of different laboratory/diagnostic tests and will implement them in a rational, cost efficient way to provide high quality, cost-effective care.
3. Demonstrate the ability to work in a multidisciplinary fashion with various medical and surgical specialties that refer patients for electromyographic evaluation.

Updated 9/16/2021