Clinical Neurophysiology Fellowship—EMG Track
The standard clinical neurophysiology fellowship is our combined electroencephalography (EEG)–electromyography (EMG) one-year program.
Fellows who wish to focus on EMG participate in the EMG track and rotate through two sites during the first year: three months at NYU Langone's Tisch Hospital and nine months at our EMG location at NYU Langone Ambulatory Care Center East 38th Street. One month of vacation time is provided, typically taken in four separate one-week blocks throughout the year.
By the time the first year of EMG-track training is complete, fellows are skilled in the setup, performance, and interpretation of EMGs, nerve conduction studies (NCSs), and evoked potential (EP) studies. You will be able to identify the most appropriate tests for a given clinical situation, and provide expert documentation of your findings, thus providing valuable consultative and diagnostic services for referring physicians. You also develop clinical competency in adult and pediatric EMG and video EMG interpretation—all of which makes for a very capable clinical neurophysiologist.
The EMG-track clinical neurophysiology fellow also spends two months rotating on intraoperative monitoring (IOM). IOM involves monitoring evoked potentials, such as somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and brainstem auditory evoked responses (BAERs), during various surgeries including, but not limited to, cardiothoracic surgeries, spine surgeries, cranial and brainstem surgeries, and orthopedic surgeries. There is significant clinical overlap between the worlds of EMG and IOM, and an EMG fellow might choose to pursue separate dedicated training in IOM if interests are piqued. Our EMG fellows spend two months at Tisch Hospital rotating with our IOM faculty. During this time they are under the attending physicians’ supervision in the operating room (OR). They learn how IOM studies are set up specific to each surgery, and how to interpret them. This is also an ideal rotation for the fellow to review basic principles of electrical safety and other instrumentation information through tutorials and self-study. During this rotation, EMG fellows continue to rotate at their outpatient continuity clinic one half-day a week.
EMG-track fellows also spend one month rotating at Tisch Hospital on the Epilepsy Services as part of their EEG experience. During this month, EMGs fellow are exposed to both adult and pediatric routine EEG recordings. Routine EEG exposure is often the best way for new electroencephalographers to be introduced to the art of EEG interpretation. The diversity of patients at NYU Langone’s Comprehensive Epilepsy Center afford fellows an opportunity to interpret both normal and abnormal routine adult and pediatric studies. During this rotation the fellows are also exposed to ambulatory EEG studies. Inpatient time on the Epilepsy Consult Service introduces fellows to more complex and more acute EEG recordings on patients in the ICUs. It is here the fellow will encounter metabolic encephalopathies, coma, seizures, and status epilepticus. EMG fellows assist in seeing new consults, interpreting video EEG studies and routine EEG studies being performed on inpatients, and round with the epilepsy consult team. As your primary role will be that of an active learner, this rotation will provide an experience focused on developing a sound knowledge base in preparation for the clinical neurophysiology board examination. EMG-track fellows do not have a formal rotation on the epilepsy surgery service, also known as special procedures service. However, if you are interested in obtaining experience with intracranial monitoring, cortical mapping, and intracarotid amobarbital procedures, you are encouraged to discuss your interest with the attending on service or the program director, and every effort is made to accommodate your interests. Time to observe and participate in the special procedures service can usually be arranged.
EMG/Nerve Conduction Study/Evoked Potential Experience
The EMG rotations feature an EMG and EP rotation, daily participation in the administration of NCSs and EMGs, and experience with somatosensory, visual, and auditory EP studies. The main site location is at NYU Langone Ambulatory Care Center East 38th Street.
EMG/Nerve Conduction Study Laboratory Rotation
All fellows learn proper techniques for performing and interpreting NCSs and EMGs under the supervision of both the attending physicians and a senior registered technician before performing studies themselves. Testing of both routinely and less frequently tested nerves and muscles is reviewed, and discussion of the appropriate indications for the procedures is an integral part of training—when to choose a single- or multiple-limb study or how to choose the muscles for needle examination, for example.
Similarly, exposure to the setup, testing, and interpretation skills necessary to conduct EP studies is provided so that all trainees have a fundamental understanding of the underlying neurophysiology, as well as technical expertise required to both perform and interpret studies. Additional exposure to specialized testing, including single-fiber EMG, quantitative sensory testing, and IOM procedures, is also available.
NYU Langone’s EMG/NCS Lab serves an outpatient population referred from colleagues in both orthopedics and neurology, providing a broad array of entrapment and neuromuscular cases. In addition, Mary-Lynn Y. Chu, MD provides the opportunity to participate in pediatric cases and address the additional challenges of peripheral neurophysiology testing in younger patients.
All EMG-track fellows participate in a weekly half-day clinic where a wide array of neurologic diseases is encountered. Fellows see all patients accompanied by an attending physician, and discuss appropriate referrals for further diagnostic testing, evaluation, and treatment. Patients referred for EMG, NCS, or EP studies typically have their study performed by the same fellow, both to ensure continuity of care and to enhance the fellow’s learning experience.
EMG-track fellows are not included in the Tisch Hospital call schedule.
EMG Journal Club
Our EMG Journal Club meets monthly, immediately after the last case of the scheduled day, typically a Monday. Each fellow prepares and reviews an article, and the group then critically reviews the articles, identifies key teaching points, and practices improvement methods based upon the review. Fellows are encouraged to choose articles related to clinical questions or problems that arise in the EMG/NCS laboratory.