i was hoping someone on this forum could help me, because my emg attending certainly isnt trying to... and please forgive me because i might blow off some steam also...
i am a pgy2 and am doing my ncs/emg rotation but i am having trouble with writing my reports because whenever i interpret the numbers that are recorded on the cadwell machine, i have a written a report that my attending provides me with this and only this as my feedback... and its getting pretty tiring..."this doesnt mean anything to me..." "this wont help anyone" thats pretty much all he says..
i asked him if there are any sources that would help me with my reports (granted i have a preston and shapiro book that i try to use, but its kinda big and lenghty) and he replies, i assume you are joking, when you do these enough, you'll realize how dumb that question is...
so, is there anything you guys used to help you with your ncs/emg reports? or a source i can turn to that will give me the info i cant get from my "teaching" attending...
thanks in advance
Sorry to hear you're having that experience. I'm currently an R2 right now and I have to say my first electrodiagnostic studies as a resident were pretty hectic- there just seemed to be information flooding in from every direction. I hope I can provide a little helpful feedback based on my very limited experiences.
As far as reports go, one thing that I found to be somewhat useful was having a list of reference ranges used by your department. Granted, it's slow before you get used to knowing what the normal ranges are, but at least it's something you can always look back at. This allows me to identify what accumuldated data is normal or abnormal.
I then systematically go through each of the individual studies and basically translate that into words. I find that attendings vary on how structured they like these parts of their reports. For example, do they want something like...
1. Normal left median motor nerve conduction study.
or
2. Normal latency with normal amplitude and conduction velocity of left median motor nerve conduction study... (everything spelled out)
(Certainly, for abnormal findings, it helps to lay everything out.)
After this, I go to the impression part and basically try to summarize all the findings using the proper terminology. Again, a really systematic approach seems to help and I think this takes a lot of practice and repetition to get used to. (One thing that seems to help the quality of my reports is the thought process that starts before and during my studies- try to figure out exactly what the referring physician wants to get out of the examination. In addition, I try to make up a mental list of differentials and what studies I will need to perform to satisfy the referrer's questions and narrow down my differential. I try to answer his/her question towards the top of my impression section since that is the whole reason for the exam.)
Adding the "clinical correlations" into the impression section can be quite helpful, especially depending on the scope of practice for the referring physician. We have a copy of various tables with "electrodiagnostic classificactions" from Dumitru tacked on our lab wall that helps me at times. I also find variety in how much attendings want to include in these reports to help guide the referring physician given the electrodiagnostic findings... but that is another discussion.
In the end, I think ease of writing reports matters hugely on your attending/senior, otherwise you could just be left sitting there puzzling and pulling your hair out. Try asking your attending when you have a moment before the electrodx exam (i.e. while patient is changing) to go over a list of differentials based on the brief history and physical. While learning all the technical/mechanical aspects of performing these studies is important and sometimes overwhelming during the PGY2 year, I really welcomed discussion about "the big picture" for every case I saw.
Easy EMG (as mentioned by drvlad) was really helpful for initial information to get me going and I found Preston and Shapiro to be a relatively nice stepping stone for more in-depth detail of theory and practical application after I got some of the basics down. The yellow Manual of NCS and Surface Anatomy for EMG by Lee and Delisa has some issues with typos and its index, but it's a handy reference for placements and measurements. Perotto's anatomical guide for the electromyographer is a useful reference for needle placement with its descriptions and cross-sectional anatomy diagrams. Funny thing.. I was initially referred to the chapter on electrodiagnostics in Delisa and well, I'm still trying to go through it even now. (Personally didn't feel it was great beginner material)
See if any attendings or residents at your program have access to monographs put out by the AANEM. Some of your seniors will probably have made their own little reference cards of brachial plexus, innervation levels, etc. Whenever you see patients in other clinics or hospital settings that have electrodiagnostic reports or possible need for a study, try to discuss this and understand its role in the management of a patient.
Don't forget there are tons of residents poring through this just like you are. Hang in there! (and see if your attending can provide more helpful guidance)
