A competent electromyographer* will be able to:

* i.e. one who is holding an FRCPC in either Neurology or PM&R and is certified by the CSCN examination.

  1. Conduct a focused and relevant consultation in the EMG lab for simple, moderate, and high complexity diagnoses:

    (e.g. Simple: entrapment neuropathy, radiculopathy;Moderate: polyneuropathy, myopathy;High: motor neuron disease, neuromuscular junction disorders, plexopathy).

    • Performs a directed history and physical examination (medical expert)
    • Accurately localizes within the nervous system, demonstrating appropriate knowledge of central and peripheral nervous system anatomy (medical expert).
    • Develops an appropriate differential diagnosis, considering the referral question and other diagnostic considerations that may change management (medical expert)
    • Demonstrates knowledge of established and evolving neuromuscular diseases and the implications for patient health care and quality of life (medical expert, health advocate)
    • Plans the appropriate electrodiagnostic studies (medical expert)
    • Communicates the plan to the patient in a compassionate, appropriate and effective manner (communicator)
    • Communicates the plan to the technologists in a professional, appropriate and effective manner (communicator)
    • Documents the consultation and results of the EMG/NCS, conveying the impression, plan, required investigations and management to the patient, family and referring physician in a timely manner (collaborator, communicator)
    • As appropriate, initiates management of neuromuscular diseases and/or ensures appropriate referral for the patient (medical expert)
    • Bills appropriately for the services requested and performed (professional).

  2. Proficiently perform and interpret basic electrophysiology studies ensuring patient comfort and safety:

    (e.g. routine motor [median, ulnar, radial, peroneal, tibial] and sensory [radial, median, ulnar, superficial peroneal, sural] of the limbs; F waves; H reflexes; needle studies; repetitive nerve stimulation)

    • Describes the normal anatomy and physiology of the peripheral nervous system, including anomalous innervation patterns. (medical expert)
    • Describes the abnormal physiology and pathology that occurs in neuromuscular disease and the effects of these processes on NCS and EMG, adjusting the plan of study accordingly (medical expert)
    • Explains the proposed testing to the patient in easy to understand language, obtains informed consent and ensures patient comfort (communicator)
    • Apply the principles of basic circuit theory, filter settings, equipment safety including the concepts of physiologic and non-physiologic electric source generations and recognition of technical considerations and potential sources of error to the practice of electrodiagnostic medicine (scholar, advocate)
    • Troubleshoot expected technical issues arising in the conduct of electrophysiological studies (scholar, advocate)
    • Maintain appropriate infection control practices and universal precautions as outlined in occupational health and safety institutional policies and procedures (leader, professional).

  3. Proficiently perform and interpret complex electrophysiology studies ensuring patient comfort and safety:

    (e.g. proximal limb motor [axillary, musculocutaneous, femoral, facial, phrenic, etc] and sensory [medial antebrachial cutaneous, lateral antebrachial cutaneous, dorsal ulnar cutaneous, lateral femoral cutaneous, saphenous, etc]; blink reflexes.)

    • Describes the normal anatomy and physiology of the peripheral nervous system (medical expert)
    • Describes the abnormal physiology and pathology that occurs in neuromuscular disease and the effects of these processes on NCS and EMG, adjusting the plan of study accordingly (medical expert)
    • Explains the proposed testing to the patient in easy to understand language, answers questions and ensures patient comfort (communicator).
    • Apply the principles of basic circuit theory, filter settings, equipment safety including the concepts of physiologic and non-physiologic electric source generations and recognition of technical considerations and potential sources of error to the practice of electrodiagnostic medicine (scholar, advocate)
    • Troubleshoot expected technical issues arising in the conduct of electrophysiological studies (scholar, advocate)
    • Maintain appropriate infection control practices and universal precautions as outlined in occupational health and safety institutional policies and procedures (leader, professional).

  4. Perform and interpret needle EMG:

    • Identifies and utilizes appropriate surface anatomic landmarks for needle examination of muscles of the bulbar, cervical, thoracic and lumbosacral segments (medical expert)
    • Samples applicable muscles of the craniobulbar, cervical, thoracic and/or lumbosacral segments for the referral question (medical expert)
    • Identifies and accurately interprets normal and abnormal spontaneous activity and motor unit morphology including recruitment and firing patterns (medical expert)
    • Recognizes absolute and relative contraindications to studies, modifying study plan accordingly (medical expert)
    • Explains the proposed testing to the patient in easy to understand language, obtains informed consent and ensures patient comfort (communicator)

  5. Effectively manage an electrophysiology lab/practice:

    • Supervise trainees and technologists as appropriate in the electrophysiology lab (leader).
    • Participates in life-long learning through continuing professional development and maintenance of competence opportunities (leader, professional)
    • Participates in and systematically assesses their practice using quality improvement methods, incorporating change as necessary to ensure high quality electrophysiology studies (leader, professional).
    • Practices electrodiagnostic medicine in an ethical and cost-effective manner for the benefit of society and containing health care costs (health advocate, professional)