EMG/Neuromuscular Rotation for Adult Neurology Residents
Faculty Supervisors:
Dr. Inna Kleyman, Dr. Christina Ulane, and rotating faculty
Description:
PGY-2, PGY-3, and PGY-4 residents are assigned to the electromyography (EMG) rotation for 1-2 sessions during their clinic elective week. While in the EMG lab, residents work with neurophysiology fellows and supervising faculty to observe nerve conduction studies (NCS) and EMG testing, and learn to perform NCS and EMG techniques. They learn to interpret results of NCS/EMG waveforms using reference tables and to draw conclusions appropriate to the clinical context. The EMG sessions are supplemented with didactic sessions during Monday morning study groups, Friday combined neurophysiology lectures, and Muscle Rounds conference.
Location/Time:
EMG lab, Neurological Institute 2nd Floor – Room 204
8:30am-4:30pm
Evaluation:
Residents should receive any pertinent feedback at the end of the session. They are expected to log 10 EMGs in MedHub prior to graduation (and assign a supervising faculty to each study). Procedure logging can entail observing/interpreting or performing a study.
Specific Goals and Objectives:
By the end of the rotation, residents are expected to:
Medical Knowledge:
Understand the basic underlying concepts and technical performance of common (and selected advanced) nerve conduction studies. This includes motor, sensory, and long latency reflexes. Residents should become comfortable with setting up and performing routine nerve conduction studies of the arm and leg (including median, ulnar, fibular, and tibial nerve studies and their corresponding late responses).
Understand the basic concepts, performance, and common abnormalities in needle EMG studies. This includes interpreting abnormal spontaneous activity, MUAP measurement, and recruitment. Residents should practice needle EMG of various muscles during the rotation.
Understand the typical electrodiagnostic patterns of common neuromuscular disorders, including: mononeuropathy, polyneuropathy (axonal and demyelinating), plexopathy, radiculopathy, motor neuron disease, neuromuscular junction disease, and myopathy.
Broadly understand the diagnostic role of advanced electrodiagnostic tests including repetitive nerve stimulation, blink studies, single fiber EMG and autonomic testing.
Review the normal function and anatomy of nerve roots, peripheral nerves, neuromuscular junction, and muscle.
Discuss the pathophysiology of common neuromuscular disorders.
Patient Care:
Identify by history and clinical examination the major types of neuromuscular disorders.
Choose appropriate electrophysiological studies in order to evaluate patients presenting with neuromuscular disorders.
Interpret the results of electrophysiological studies (as above) and apply them to the diagnosis and management of patients with neuromuscular disorders.
Discuss risk factors (including genetic) of common neuromuscular diseases.
Discuss the indication, goals, and possible side effects of medical treatments for common forms of neuromuscular disorders.
Interpersonal and Communication Skills:
Interview patients sent for electrodiagnostic testing to determine the specific issue to be addressed, perform relevant parts of the neurological exam, and communicate with patients throughout the electrodiagnostic examination (including counseling regarding what to expect during the procedure and queuing specific movements during the procedure).
Learn how to communicate with consulting physicians findings obtained from electrodiagnostic testing, including writing NCS/EMG reports.
Practice-Based Learning and Improvement:
Recognize common technical errors and pitfalls in performing electrodiagnostic studies.
Understand relative contraindications to electrodiagnostic studies, including risks of proximal stimulation with certain implanted electronic devices and limits of needle EMG in patients treated with anticoagulation.
Professionalism:
Demonstrate compassion and respect for patients and their families, and all team members involved in patient care.
Show responsiveness to patient needs that supersedes self-interest.
Demonstrate respect for patient privacy and autonomy.
Demonstrate respect and sensitivity for cultural beliefs and socioeconomic backgrounds.
Systems-based Practice:
Understand the appropriate indications for applications of electrodiagnostic studies.
Updated Aug 2025