European neuromuscular fellowship core curriculum
Neuromuscular disorders include abnormalities of the anterior horn cell, nerve root, peripheral nerve, neuromuscular junction and the skeletal muscle. These disorders occur at any age. Although these disorders are individually rare, there are hundreds of different types which makes evaluation cumbersome. It is of utmost importance to establish an accurate diagnosis. A significant proportion of neuromuscular disorders are hereditary and a correct diagnosis is required for genetic counselling and prognostication. A small proportion of patients suffer from treatable neuromuscular diseases (e.g. immune-mediated disorders) which need to be recognised in a timely manner.Evaluation and management of neuromuscular disorders require specific competencies. In most university hospitals there are neurologists and paediatricians/paediatric neurologists who have specialised in neuromuscular disorders. However, this is usually not the case in community / district hospitals. Given the prevalence of neuromuscular disorders medical specialists working in these hospitals will be faced with patients with neuromuscular signs and symptoms and therefore, specialised neuromuscular training in addition to the regular residency program should become available.
2. Goals and objectives
The goal of the neuromuscular fellowship is to provide training on the pathophysiology, pathology, diagnosis and management of patients with neuromuscular diseases with the purpose to enhance the quality of care for these patients.
After completion of the training:-
- the fellow has sufficient knowledge and skills to evaluate patients with a variety of neuromuscular disorders
- the fellow has specific expertise in the diagnosis and management of these disorders
- the fellow has become acquainted with the three crucial areas of neuromuscular disorders i.e. genetics, neuro-immunology and rehabilitation medicine.
3. Requirements for the training
A. Prerequisites for the trainee
The neuromuscular fellow should have completed at least three years of his/her neurological or paediatric training.
B. Timetable for the training
The fellowship is for at least 1 year full-time or part time equivalent
Content of the training programme
- the fellow must acquire expertise in evaluating and managing patients with a variety of neuromuscular disorders including knowledge of the appropriate laboratory investigations (electrodiagnostic studies, including electromyography and nerve conduction studies, interpretation of muscle and nerve biopsies, muscle / nerve imaging (computerised tomography, magnetic resonance imaging), interpreting genetic and immunological results).
- the fellow must attend lectures and teaching courses dealing with neuromuscular disorders.
- the fellow is encouraged to devote some of the training period to active participation in a research project.
- the fellow is encouraged to take an active role in the teaching and training of residents.
4. Evaluation of the trainee
The Program director shall evaluate the knowledge, skills and professional growth of the fellow on a regular basis. This evaluation should be discussed with the fellow.At the end of the training the Program Director shall provide a written final evaluation.
5. Qualifications of the trainer
The Program Director must have at least five years of experience with the evaluation and management of a variety of neuromuscular disorders. The Program Director should have a past performance in research on neuromuscular disorders.At least one other faculty member with ample experience in the evaluation and management of a variety of neuromuscular disorders should be available.
a. Set-up for the training
The Program Director is responsible for the overall coordination of the program.
b. Facilities for the training
The neuromuscular fellowship must be within a university hospital with a neuromuscular centre to which annually at least 200 patients with a variety of neuromuscular disorders are referred.The training site should include, or have a collaboration with:-
- a neuropathologist with expertise in the evaluation of muscle and nerve biopsies
- a clinical neurophysiologist with expertise in electromyography and nerve conduction studies focused on a wide variety of neuromuscular disorders
- a department of genetics in which there is expertise with counselling of patients with neuromuscular disorders.
- a department of rehabilitation medicine in which there is expertise with management of neuromuscular disorders.
- a department of child neurology in which there is expertise with evaluation and management of neuromuscular disorders in children if the fellowship is to include paediatrics
- a major medical library and access to an on-site collection of appropriate texts and journals.
c. Subspeciality fellowships
It is recognised that not all fellows will want to do a general neuromuscular fellowship. Some fellows may want to do a specialised area e.g. neuropathies or a specialised patient group e.g paediatrics or area of investigation e.g neurophysiology. Fellowships can be individually designed with this in mind but must be approved in advance. The awarding of these subspeciality fellowships will be just in the particular subspeciality e.g Inherited neuropathy fellowship and they will not be called neuromuscular fellowships. Fellows may chose to do a general neuromuscular fellowship at first and then a subspeciality one for a further period of time. The minimal period of time for a fellowship in a specialised area is suggested to be one year.