Resident Accuracy of Electromyography Needle Electrode Placement Using Ultrasound Verification

Background Electromyography (EMG) and musculoskeletal (MSK) ultrasound (US) are core learning objectives during physical medicine and rehabilitation (PM&R) training. However, there have been no prior studies using MSK US to assess the acquisition of EMG procedural skills during residency training. This study aims to demonstrate the differences in skillful needle placement between junior and senior physiatry residents. The integration of both EMG and MSK US may have tremendous potential for additional learning opportunities related to electrodiagnostic education. Objective To determine the accuracy of anatomic landmark–guided EMG needle electrode placement in commonly used muscles by PM&R resident physicians. Design Cross-sectional study. Setting An academic PM&R residency program. Participants Twelve (5 postgraduate year [PGY] –3 and 7 PGY-4) PM&R resident physicians participating in a MSK US training course. Methods Twelve PM&R residents in the eighth month of their third and fourth years of postgraduate training performed anatomic landmark–guided needle placement to the extensor indicis proprius (EIP), pronator teres (PT), peroneus longus (PL), and soleus muscles of live subjects. Once the needle electrode was satisfactorily placed, needle localization was verified with US. Main Outcome Measures Accuracy of EMG needle electrode placement. Results The overall accuracy of needle electrode placement for all resident participants was 68.8%. The mean accuracy of the 4 selected muscles was 50% by PGY-3 residents and 82.1% for PGY-4 residents (P = .01). EIP was the most commonly missed muscle, with correct placement performed by 20% of PGY-3 and 42.9% of PGY-4 residents. PGY-3 residents demonstrated 60% accuracy with localizing the PT, PL, and soleus muscles. PGY-4 residents demonstrated 85.7% accuracy for PT, and 100% accuracy for both PL and soleus muscles. Conclusions Senior residents demonstrated greater accuracy of landmark-guided needle placement than junior residents. EMG procedural skills are important milestones in PM&R training, and MSK US may be a useful tool to enhance resident learning.