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Educational Objectives
Electromyography (EMG) Rotation

Medical Knowledge

1. Identify the appropriate instrument settings for needle EMG and conduction studies.
2. Define types of insertion activity, endplate activity, positive fibrillations, negative fibrillations, fasciculation potentials, myokymic discharges, and complex repetitive discharges, and recognize myotonic discharges.
3. Describe the configuration of most unit potentials in normal muscles, as well as identify neurogenic and myogenic patterns.
4. Identify appropriate instrument settings and indications for single fiber EMG.
5. Identify the settings and parameters used for stimulation of peripheral nerves.
6. Describe the electrophysiologic basis of generation and provocation of a potential in a nerve.
7. Identify measurements of duration, amplitude and area of the evoked potentials and their neurophysiologic basis.
8. Characterize the electrical alterations resulting from axonal loss and demyelation.
9. Identify the pathway and instrument settings for recording of H reflex and F wave; describe the technique of unusual conduction; i.e. blink reflex, pudendal reflex, spinal nerve stimulation.
10. Describe the 10-20 International System as applied to evoked potential studies.
11. Explain instrumentation requirements and parameters for evoked potential settings.
12. Evaluate the contribution of SEPs in diagnosis in radiculopathy, brachial plexopathy, and ulnar neuropathy.
13. Summarize the effects of temperature on nerve conduction studies.

Patient Care

1. nterpret the responses to repetitive stimulation in normal subjects and the electrophysiologic expression of abnormalities of neuromuscular transmission.
2. Diagnose the presentation of the following syndromes:
   1. Entrapment Sydromes
      1. median nerve: carpal tunnel, anterior interosseus syndrome, pronator tere syndrome
      2. ulnar nerve: Guyons canal entrapment, ulnar nerve compression at the elbow
      3. radial nerve: posterior interosseus syndroms, Saturday night palsy, radial nerve entrapment at the spiral groov
      4. femoral nerve: femoral cutaneous ulnar nerve
      5. tibial nerve: including tarsal tunnel syndrome
      6. peroneal nerve: including peroneal nerve palsy
   2. Systemic Disorders
      1. peripheral neuropathy and differentiate axonal vs. demyelating
      2. mononeuritis multiplex
      3. Guillain-Barre syndrome
      4. plexopathy, including lumbosacral plexopathy, brachial plexopathy syndrome
      5. myopathies: including myotonia dystrophica, polymyositis, and secondary myopathies, myasthenia gravis, LEMS, and botulism
3. Identify the clinical significance of upper and lower extremity evoked potentials as well as dermatomal sensory evoked potentials.
4. Analyze the data from an electrodiagnostic study on a patient with:
   1. Polyneuropathy
   2. Mononeuropathy
   3. Radiculopathy
   4. Generalized weakness and fatigue
5. Demonstrate proficiency in performing upper & lower extremity conduction studies & electromyography.
6. Demonstrate the ability to tailor studies to efficiently diagnose pathology, taking into account the patients history and physical examination findings.
7. Demonstrate the ability to alter a study in progress according to evolving findings.
8. Demonstrate the ability to minimize discomfort (both physical & emotional) to patients while undergoing electrodiagnostic evaluation.
9. Justify the use of electrodiagnostic evaluation for a managed care executive presenting with new onset of right handed weakness & numbness.
10. Contrast typical electrophysiologic findings in Bells Palsy with those in other causes of facial weakness; formulate a treatment plan for a patient with Bells Palsy.
11. Summarize the issues pertaining to reporting of results of electrodiagnostic studies to the patient and the referring physician.

Interpersonal and Communication Skills

1. Present information to patients & other care team members in an effective manner.
2. Establish trust & maintain positive rapport with patients, caregivers & family members.
3. Demonstrate effective listening skills.
4. Demonstrate effective listening skills.
5. Complete dictations and chart notes in a legible & timely manner.

Professionalism

1. Demonstrate sensitivity and responsiveness to age, culture, disability and gender of patients & colleagues.
2. Consider effects of personal, social and cultural factors in the disease process & patient management.
3. Demonstrate reliability, punctuality, integrity and honesty in all interactions with patients and colleagues.
4. Accept personal responsibility for own actions & decisions.
5. Apply sound ethical principles in practice (e.g., informed consent, confidentiality, veracity, provision or withholding of care).

Practice-Based Learning and Improvement

1. Demonstrate skill in supervising junior residents and medical students in information gathering, decision-making, and patient management.
2. Evaluate and/or modify own practice based on feedback from others.
3. Use information technology to appraise & assimilate evidence from scientific studies to enhance patient care outcomes.

Systems-Based Practice

1. Summarize the physicians role in advocating for patient care needs.
2. Summarize the physicians role in disease management across various levels of the health care system in a cost effective manner.
3. Demonstrate how to access various community resources on behalf of the patient.
4. Demonstrate integrity and responsibility in interactions with insurance and/or disability-oriented agencies.