Introduction
The Neuromuscular/EMG rotation is an outpatient rotation that provides a rich clinical experience over the course of residency. Goals for PGY-2 residents include:
- Develop knowledge of peripheral nervous system anatomy and the clinical presentation and pathophysiology of neuromuscular disorders.
- Learn the indications for ordering electrodiagnostic studies and an approach to their planning and interpretation.
- Begin to develop skills in the performance of electrodiagnostic studies.
Goals for PGY-3-4 residents:
- Develop competency in planning, performing, and interpreting electrodiagnostic studies.
- Learn basic muscle and nerve pathology.
Objectives and Evaluation Matrix
As with all of the neurology rotations, the specific objectives are reflected in the entrustable professional activities and individual milestones listed below. These form the basis for the end-of-rotation evaluation. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).
| Rotation Objectives | ||
| Upon completion of the curriculum, residents will . . . | ||
| # | Description | Milestones |
| 1 | Accurately localize neuromuscular lesions to specific components of the motor unit and peripheral nervous system | PC1, PC2, MK1 |
| 2 | Select and interpret laboratory and other common neuromuscular diagnostic tests. | MK2 |
| 3 | Manage patients with immune-mediated conditions according to evidence-based practice | PC3, PC4, PL1 |
| 4 | Recognize bulbar and respiratory dysfunction and initiate appropriate interventions (eg, referral to pulmonary, speech, or swallow services) | PC1, PC2, PC3, PC4, PC6, IC3, IC4 |
| 5 | Recognize common presentations of nerve root, plexus, and peripheral nerve disorders | PC1, PC2, PC3, MK1 |
| 6 | Apply knowledge of peripheral nerve anatomy in the planning and performance of NCS and EMG | PC3, PC10, MK1, MK2 |
| 7 | Recognize common EMG findings | PC10 |
| 8 | Interpret NCS/EMG data in common disorders and apply the findings to formulation of differential diagnoses | PC3, PC10, MK1, MK2 |
| Milestones | ||
| Please grade the resident on any of the following milestones you were able to evaluate during this rotation: | ||
| PC12, SP3, SP4, PL2, PR1, PR2, PR3, IC1, IC2 | ||
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.
| Monday | Tuesday | Wednesday | Thursday | Friday | |
| AM | Neuromuscular | Neuromuscular | Neuromuscular | Neuromuscular | Neuromuscular |
| Clinic / EMG | EMG / Academic | Clinic | EMG | Clinic | |
| PM | Neuromuscular | Neuromuscular | Neuromuscular | Neuromuscular | Neuromuscular |
| Clinic / EMG | EMG / Clinic | Academic / EMG | Clinic / VA EMG | Clinic / Academic |
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.
Suggested References
Aids to the examination of the peripheral nervous system. (2010). Edinburgh: Saunders.
Preston and Shapiro. Electromyography and Neuromuscular Disorders, Clinical-Electrophysiologic Correlations. Elsevier (Can download from Ebling Library)
Katirji. Electromyography in Clinical Practice
Liveson, J. A. (2000). Peripheral neurology: case studies. Oxford: Oxford University Press.
Katirji, B., Kaminski, H. J., & Ruff, R. L. (2014). Neuromuscular disorders in clinical practice.
Daube, J. R., & Rubin, D. I. (2009). Clinical neurophysiology. Oxford; New York: Oxford University Press.
Dumitru, D., Zwarts, M., & Amato, A. A. (2002). Electrodiagnostic medicine. Philadelphia: Hanley & Belfus.
Griggs, R. C., Ciafaloni, E., Chinnery, P. F., & Griggs, R. C. (2014). Evaluation and treatment of myopathies.
Kimura, J., & Press., O. U. (2013). Electrodiagnosis in diseases of nerve and muscle : principles and practice. Oxford [etc.]: Oxford University Press.
Mendell, J. R., Kissel, J. T., & Cornblath, D. R. (2001). Diagnosis and management of peripheral nerve disorders. Oxford; New York: Oxford University Press.
“Iatrogenic Complications and Risks of Nerve Conduction Studies and Needle Electromyography.” Muscle & Nerve 27: 517-526, 2003.
Basic Concepts of Electricity and Electronics in Clinical Electromyography.” Muscle & Nerve 14: 937-946, 1991.
Latest revision: 05-14-2021
