Electrodiagnostic medicine skills competency in physical medicine and rehabilitation residents: a method for development and assessment.

This project sought to create an educational module including evaluation methodology to instruct physical medicine and rehabilitation (PM&R) residents in electrodiagnostic evaluation of patients with neuromuscular problems, and to verify acquired competencies in those electrodiagnostic skills through objective evaluation methodology. Sixteen residents were trained by board-certified neuromuscular and electrodiagnostic medicine physicians through technical training, lectures, and review of self-assessment examination (SAE) concepts from the American Academy of Physical Medicine & Rehabilitation syllabus provided in the Archives of Physical Medicine and Rehabilitation. After delivery of the educational module, knowledge acquisition and skill attainment were measured in (1) clinical skill in diagnostic procedures via a procedure checklist, (2) diagnosis and ability to design a patient-care management plan via chart simulated recall (CSR) exams, (3) physician/patient interaction via patient surveys, (4) physician/staff interaction via 360-degree global ratings, and (5) ability to write a comprehensive patient-care report and to document a patient-care management plan in accordance with Medicare guidelines via written patient reports. Assessment tools developed for this program address the basic competencies outlined by the Accreditation Council for Graduate Medical Education (ACGME). To test the success of the standardized educational module, data were collected on an ongoing basis. Objective measures compared resident SAE scores in electrodiagnostics (EDX) before and after institution of the comprehensive EDX competency module in a PM&R residency program. Fifteen of 16 residents (94%) successfully demonstrated proficiency in every segment of the evaluation element of the educational module by the end of their PGY-4 electrodiagnostic rotation. The resident who did not initially pass underwent remedial coursework and passed on the second attempt. Furthermore, the residents' proficiency as demonstrated by the evaluation after implementation of the standardized educational module positively correlated to an increase in resident SAE scores in EDX compared with resident scores before implementation of the educational module. Resident proficiency in EDX medicine skills and knowledge was objectively verified after completion of the standardized educational module. Validation of the assessment tools is evidenced by collected data correlating with significantly improved SAE scores and American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) exam scores, as outlined in the result section. In addition, the clinical development tool (procedure checklist) was validated by residents being individually observed performing skills and deemed competent by an AANEM-certified physician. The standardized educational module and evaluation methodology provide a potential framework for the definition of baseline competency in the clinical skill area of EDX.