Overall Goals and Objectives

The overall goal of our training program is to develop superb neuromuscular clinicians ensuring that our graduates have demonstrated competency in the six core areas as designated by the ACGME. It is the goal of our program to develop life-long self-evaluation and self-improvement skill. To accomplish these goals, the fellow’s progress toward competency throughout their year of training will be evaluated both by faculty, program director, and by the fellow. At the time of each 6-month evaluation with the program director and the fellow will formulate an action plan to move towards competency and proficiency in the following areas.

Patient Care

Consistently obtain a history that includes patient reported outcomes and identifies a neuromuscular condition within a complicated medical history
Consistently perform a nuanced examination that identifies subtle findings and patterns sufficient to evaluate and narrow the diagnostic evaluation for uncommon neuromuscular disorders
Considers clinical trials for patient management
Independently adapt interventions for symptoms and complications associated with neuromuscular disorders based on patient response
Integrates recommendations for patient needs for a full range of assistive technologies based on impairments, considering barriers, contraindications, comorbidities, and input from other professionals
Performs and interprets uncommon motor and sensory nerve conduction studies, including cranial nerve testing (e.g., blink reflex, facial nerve)
Recognizes performance quality and inconsistencies of nerve conduction studies
Performs EMG of cranial nerve innervated muscles (e.g., tongue)
Proactively organizes and efficiently completes procedure to optimize diagnostic yield in challenging or high-risk patients
Interprets uncommon EMG findings and patterns of unique disorders and modifies the study accordingly
Diagnoses atypical anterior horn cell disorders, including within the context of other neurodegenerative conditions
Continuously evaluates accuracy of anterior horn cell diagnosis
Independently manages common anterior horn cell disorders and complications with the interdisciplinary team, as needed
Continuously evaluates the accuracy of the diagnosis of nerve root, plexus, and peripheral nerve disorders
Relates the results of special diagnostic testing (e.g., nerve biopsy) to the context of the clinical presentation
Independently manages common nerve root, plexus, and peripheral nerve disorders and complications with the interdisciplinary team as needed
Distinguishes worsening of neuromuscular junction disorders from complications of treatment or new disorders
Recognizes when genetic testing is indicated (e.g., congenital myasthenic syndromes)
Manages patients with refractory neuromuscular junction disorders
Distinguishes worsening of myopathies from complications of treatment or new disorders
Discusses the implications of variants of uncertain significance on genetic testing and interprets in the context of the clinical presentation
Manages patients with uncommon myopathies, including genetic counseling and goals of care for those with inherited myopathies
Uses the EHR to communicate complex care plans with patients and other providers
Uses telehealth visits for complex patient management

Medical knowledge

Efficiently and accurately localizes neuromuscular lesions, including focal and multifocal peripheral nerve lesions and generalized neuromuscular and autonomic disorders
Recognizes anatomic variants (e.g., prefixed plexus, Riche-Cannieu anastomosis)
Continuously reconsiders diagnostic possibilities in response to new clinical information
Demonstrates sophisticated and detailed knowledge of neuromuscular disorders
Continuously reconsiders diagnostic possibilities in response to new clinical information
Reconciles conflicting data from diagnostic tests and the clinical presentation; efficiently provides genetic testing suited to the clinical situation (e.g., single gene versus panel testing versus whole exome sequencing)
Recognizes uncommon pathologic findings in nerve and muscle preparations

Interpersonal and Communication Skills

Easily establishes effective patient physician relationships, with attention to the patient’s/patient’s family’s concerns and context, regardless of complexity
Uses shared decision making to align the patient’s/patient’s family’s values, goals, and preferences with treatment options
Recognizes personal biases and proactively mitigates barriers to optimize patient care
Integrates recommendations from different members of the health care team to optimize patient care
Solicits and communicates feedback to other members of the health care team
Prevents and mediates conflict and distress among interdisciplinary team members
Demonstrates concise, organized written and verbal communication, including anticipatory guidance
Provides a detailed report of common and uncommon nerve conduction findings and cranial nerve testing
Demonstrates clear, concise communication with referring providers for continuity of care

Professionalism

Intervenes to prevent professionalism lapses in oneself and others
Recognizes and uses appropriate resources for managing and resolving ethical dilemmas as needed
Recognizes situations in which one’s own behavior may impact others’ ability to complete tasks and responsibilities in a timely manner
Independently develops a strategy to optimize personal and professional well-being
Show respect, compassion, integrity and ongoing professional development
Verbalize ethical principles with adherence to confidentiality, HIPAA principles, and appropriate informed consent
Determine psychosocial issues that complicate care.
Be punctual and appropriately attired
Keep patient logs up-to-date

Practice-Based Learning and Improvement

Critically appraises and applies evidence, even in the face of uncertainty, and interprets conflicting evidence to guide care tailored to the individual patient
Seeks performance data consistently
Challenges assumptions and considers alternatives in narrowing the gap(s) between expectations and actual performance
Uses performance data to measure the effectiveness of the learning plan, and, when necessary, improves it

Systems Based Practice

Conducts analysis of patient safety events and offers error prevention strategies
Discloses patient safety events to patients and patients’ families
Demonstrates the skills required to identify, develop, implement, and analyze a quality improvement project
Role models effective coordination of patient centered care among different disciplines and specialties
Role models safe and effective transitions of care/hand-offs within and across health care delivery systems, including outpatient settings
Adapts approach to patient care to provide for the needs of specific populations
Implements social and behavioral changes for patients and patients’ families that improve health, such as exercise and diet
Leads teams to provide efficient and effective patient care by managing components of the complex health care system while advocating for systems changes that address inequities
Uses available resources to promote optimal patient care (e.g., community resources, patient assistance resources) considering each patient’s payment model
Implements changes in individual practice patterns in response to professional requirements and in preparation for practice

Clinical Training Objectives

Competence in the indications and interpretation of neurophysiology studies and their application to improve care of patients with neurological disease (Patient Care);
A rich knowledge base in both clinical and basic neuroscience, as well as the fundamentals of neuromuscular medicine (Medical Knowledge);
Competence in obtaining an appropriate medical history (including sensitive issues such as sexual history) in a professional and humane manner (Interpersonal and Communication Skills, Professionalism);
Competence in communicating diagnosis and treatment plans, and competence in communicating potentially sensitive information (Interpersonal and Communication Skills, Professionalism);
Competence in communicating succinctly and clearly with other healthcare professionals, with a proper respect for the principles of HIPAA regulations (Interpersonal and Communication Skills, Professionalism);
Skill in self-assessment and self-improvement (Practice-Based Learning and Improvement);
Skill in practice assessment, as well as both practice- and systems improvement, to enhance quality of care and improve patient safety (Practice-Based Learning and Improvement, Systems-Based Practice).

Specific Academic/Research Goals

At the end of the training program, the fellow will have developed:

A scholarly approach to the practice of neuromuscular medicine, including the incorporation of evidence-based medicine into clinical decision-making (Practice Based Learning and Improvement);
Basic knowledge of clinical trial design and statistical testing, as well as the ability to utilize this knowledge for critical interpretation of medical literature (Medical Knowledge, Practice-Based Learning and Improvement);
First-hand experience at the process of clinical research, ideally via participation in a clinical or translational research project (or even by assisting with patient enrollment into an ongoing project), or quality improvement. (Interpersonal and Communication Skills, Professionalism, Practice-Based Learning and Improvement); and
First-hand experience at the process of data presentation and peer-review, ideally via submission of one abstract or manuscript during the course of training (Interpersonal and Communication Skills, Medical Knowledge, Professionalism).