Recommendations for Training Residents in Electrodiagnostic Medicine
Developing competency in the recognition, diagnosis, and management of neuromuscular (NM) diseases remains a critically important aspect of residency training in neurology and physical medicine and rehabilitation (PMR). With an explosion of new treatments for NM disorders, accurate diagnosis is key for allowing patients to receive appropriate treatments without delay. Electrodiagnostic (EDX) medicine studies, primarily needle electromyography (EMG) and nerve conduction studies (NCSs), are critical tools to diagnose many NM diseases. They are crucial to help differentiate between conditions that can mimic each other, and play an important role in management and prognosis.1-4 These conditions may include myopathy, motor neuron diseases, neuromuscular junction disorders, polyradiculopathy, and advanced polyneuropathies. EDX testing is frequently necessary to assess and evaluate conditions that may appear to be neurologic but are eventually found to be musculoskeletal such as shoulder and hip disease, cervical and lumbosacral pain, fibromyalgia, stretch and tendon injuries, and tendon entrapments.
In a manuscript on neurology residency training published by the American Academy of Medicine in 2002, 28% of the neurology residents reported EDX training to be the most deficient subspecialty area of education in their neurology program. 5 In a paper published by Mahajan and colleagues in 2019, only 23% of adult neurology residents had confidence about performing or interpreting EDX studies independently.6 Recently, some neurology programs have shortened exposure to EDX studies, in some cases from 3 months to 2 months, and in other instance to 2 weeks. For some neurology residencies, training in EDX is optional.
In light of these concerning trends in EDX clinical training, the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) has developed this position statement for minimum training in EDX for neurology and PMR residents. It is the position of the AANEM that neurology residents should be required to complete a minimum of 3 months training in EDX to competently perform and interpret basic studies. AANEM ideally recommends 5-6 months training (if possible) to meet the goal of performing and interpreting complex studies. It is recognized that the amount of time allocated to EDX instruction may vary depending on an institution’s clinical volume. In neurology programs EDX teaching may occur in context of a neuromuscular medicine rotation, in which EDX complements the clinical diagnosis and management of neuromuscular disorders
AANEM also recommends the following:
More details about the required training can be found in the AANEM’ Educational Guidelines for EDX Training Programs. AANEM understands the demands facing neurology and PMR training programs and their directors in coordinating the broad education of residents within a 3 year program. However, reducing the training of residents in EDX procedures will have a negative impact on patient care.
AANEM urges the ACGME to require these minimal standards and for training programs to strive to exceed those standards. AANEM believes this is in the best interest of patient care.
- Nardin RA, Rutkove SB, Raynar EM. Diagnostic accuracy of electrodiagnostic testing in the evaluation of weakness. Muscle Nerve 26: 201–205, 2002
- Haig A, Tzeng H, LeBreck D. The value of electrodiagnostic consultation for patients with upper extremity nerve complaints: a prospective comparison with the history and physical examination. Arch Phys Med Rehabil 1999;80: 1273–1281
- Kothari M, Preston D, Plotkin G, Venkatesh S, Shefner J, Logigian E. Electromyography: do the diagnostic ends justify the means? Arch Phys Med Rehabil 1995;76:947–949
- Kang PB, McMillan HJ, Kuntz NL, Lehky TJ, Alter KE, Fitzpatrick KF, El Kosseifi C, Quijano-Roy S; Professional Practice Committee of the American Association of Neuromuscular & Electrodiagnostic Medicine. Utility and practice of electrodiagnostic testing in the pediatric population: an AANEM consensus statement. Muscle Nerve. 2020 Feb;61(2):143-155.
- Corboy JR, Boudreau E, Morgenlander JC, Rudnicki S, Coyle PK. Neurology residency training at the millennium. Neurology 2002;58:1454-1460.
- Mahajan A, Cahill C, Scharf E, Gupta S, Ahrens S, Joe E, et al. Neurology residency training in 2017. Neurology 2019:92;76-83.
- https://www.acgme.org/Portals/0/PFAssets/ProgramResources/340_PMR_Minimum Procedures Announcement.pdf?ver=2015-11-06-120651-327
Reviewed and approved by the GME Committee on November 20, 2020.
Approved by the AANEM Board: December 17, 2020.
Creation of New Guidelines, Consensus Statements, or Position PapersAANEM members are encouraged to submit ideas for papers that can improve the understanding of the field. The AANEM will review nominated topics on the basis of the following criteria:
- Members’ needs
- Prevalence of condition
- Health impact of condition for the individual and others
- Socioeconomic impact
- Extent of practice variation
- Quality of available evidence
- External constraints on practice
- Urgency for evaluation of new practice technology