Division of Neurology

McMaster Objectives: EMG 1 Block

Even though all CanMEDS roles are important, emphasised in this rotation are:

Medical Expert, Communicator, Collaborator and Manager

Goals

  • To acquire the manual skills required for performing nerve conduction studies and needle electromyographic testing
  • To acquire the knowledge of anatomy, physiology, and clinical aspects of neuromuscular disease required in order to plan an appropriate electrodiagnostic consultation
  • To learn a diagnostic approach to a range of conditions including focal neuropathies, plexopathies, radiculopathies, peripheral neuropathy, disorders of muscle, and anterior horn cell disorders.
  • To learn how to interpret electrodiagnostic findings in the context of a clinical picture and communicate the relevance of the findings to patients and other health care professionals.

Objectives

Each resident is expected to achieve the following CanMEDS competencies:

  1. Medical Expert
  2. Communicator
  3. Collaborator
  4. Manager
  5. Health Advocate
  6. Scholar
  7. Professional

1. Medical Expert

  • Comprehensive knowledge of peripheral nerve anatomy including roots, plexuses, and all clinically significant major motor and sensory nerve trunks and their branches
  • Comprehensive knowledge of the relevant physiology of myelinated axons, motor and sensory, including but not limited to:
    • Wallerian degeneration
    • Conduction block
    • Demyelination and remyelination
    • Axonal regeneration
    • Collateral sprouting
    • Neuromuscular safety margin
    • Muscle fiber membrane excitability
    • Neuromuscular junction physiology
  • Perform a history and physical examination directed at identifying evidence of nerve, muscle, and neuromuscular pathology
  • Synthesize findings in various components of the neurological examination and history in order to determine appropriate anatomical localization(s). Focus is on neuromuscular problems, but possible role of CNS pathology must also be recognized.
  • Formulate provisional as well as differential diagnosis of a patient’s symptoms based on the history and the anatomical localization.
  • Recognize the indications, advantages, and limitations of EMG testing in the context of various nerve, muscle, anterior horn cell, and neuromuscular conditions
  • Synthesize the above data into a testing protocol
  • Interpret test results so as to answer questions posed by the referring physician
  • Appreciate that the role of EMG is not only for lesion localization, but for assessment of severity, prognosis, and long term follow-up.

 


2. Communicator

  • Explain the nature of EMG testing in a comprehensible manner to patients
  • Perform the testing in a manner which will engender patient confidence
  • Demonstrate the ability to communicate to the patient and/or caregiver(s) diagnostic conclusions reached
  • Communicate the results and significance of EMG test results effectively with medical colleagues and other health care professionals in both inpatient and outpatient settings.
  • Formulate concise and clinically useful EMG reports, focusing on quality over quantity
  • Address the concerns raised by the referring physician(s) and provide guidance where appropriate.

 


3. Collaborator

  • Consult effectively with other physicians and health care professionals in achieving the best quality of patient care.
  • Contribute any special skills of his or her background to improving patient outcomes.

 


5. Manager

  • Work effectively and efficiently in a health care organization.
  • Utilize information technology to optimize patient care, lifelong learning, and other patient-related or educational activities.
  • Demonstrate skills in time management (e.g. assessing patients expeditiously in order to maintain a good patient flow in the context of a clinic environment)

 


6. Health Advocate

  • Recognize the value of EMG testing in appropriate contexts
  • Recognize the limitations of EMG testing in order to not perform the test unnecessarily, or to an unnecessary extent

 


4. Scholar

  • Demonstrate ability to use appropriate resources to research clinical and scientific/physiology questions that arise in the course of EMG assessments.
  • Critically appraise sources of medical information, and apply evidence-based and clinical practice guidelines to electrodiagnostic testing.
  • Demonstrate self-initiative in achieving one’s learning goals during the rotation.

 


7. Professional

  • Deliver highest quality care with integrity, honesty, compassion and empathy.
  • Exhibit appropriate personal and interpersonal professional behaviours.
  • Practice medicine ethically consistent with the obligations of a physician.
  • Respect the opinions of colleagues and other health care professionals.
  • Attend scheduled clinics on time; avoid keeping patients and colleagues waiting unnecessarily.

The resident should also have developed an approach to evaluating, and an understanding of the expected electrodiagnostic findings in common or important neuromuscular problems including

  • Carpal Tunnel Syndrome
  • Ulnar neuropathy
  • Facial neuropathy
  • Peroneal, sciatic and tibial neuropathies at various sites
  • Lumbar and cervical radiculopathy
  • Brachial plexopathies, traumatic and non-traumatic
  • Lumbar plexopathy, traumatic and non-traumatic
  • Peripheral neuropathies
    • Acquired vs. genetic
    • Axonal vs. demyelinating
    • Mononeuropathy multiplex
  • Muscle disorders
    • Myotonic muscle disease
    • Inflammatory myopathy
    • Muscular dystrophy
    • Metabolic muscle disease
  • Neuromuscular transmission disorders
    • Myasthenia gravis
    • LEMS
    • Botulism
  • Motor neuron disorders
    • ALS
    • Spinal muscular atrophy
    • Monomelic amyotrophy