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Board of Registration of EMG Technologists of Canada

Saturday, June 12, 2010 ( practical portion only)

Sunday, June 13, 2010 (written portion only)

Examination deadline is February 28, 2010.
Contact Jodi Beswick at jodi.beswick@sjhc.london.on.ca for further details.

Prepared by Helen Brooks

Who? When?
The Board of Registration of EMG Technologists of Canada was officially formed in June of 1995 with the financial support of two parent associations, the AETC and the CSCN (EMG Section). The founding members of the board were two Registered EMG technologists appointed by the AETC and two physicians, a physiatrist and a neurologist, appointed by the CSCN (EMG section).

What?
The Board was formed to serve as the certifying body for EMG Technologists in Canada with the following objectives:

* To maintain and enforce the national standards of knowledge and proficiency in electromyography technology.
* To administer and conduct appropriate examinations to assess the knowledge and proficiency of electromyography technologists
* To keep a register of all technologists who have successfully passed the registration examination
* To issue certificates of recognition to those who have successfully passed the registration examination and to permit them to use the designation, Registered Electromyography Technologist, R.T. (EMG).
* To assist in the educational process for electromyography technologists as the Board deems necessary.

Why?
For several years members of the AETC Examination and Education Committee had been dissatisfied with the limited input the AETC has in the examination that scrutinized its members. Since 1979 the AETC had also borne the financial burden of rental fees for rooms in which the examination was conducted, any costs related to certificates and supplies, and also paid an honorarium to the physicians examiners.

What to look forward to?

Shared costs with relatively equal financial backing of the two parent associations, as has been the case for the EEG Registration Board. Positive separation of duties and focus; education (AETC to serve as primary education) and examination (autonomous BRETC). At least 50% technologist input to contents and examiners. Annual review of written and practical examination questions. Appropriate balance of physiology, anatomy, technical, electrical questions. Ranking of questions according to degree of difficulty.

The Registration Examination

A registration examination for EMG technologists is offered by the Board of Registration for Electromyography Technologist of Canada (BRETC). This board is comprised of physician members of the Canadian Society of Clinical Neurophysiologists (CSCN) EMG Section and registered technologist members of the Association of Electromyography Technologists of Canada (AETC). The purpose of the examination is to assess the competence of the individual to effectively carry out the technical task in an EMG laboratory. Candidates technical skill, insight, adaptability and theoretical knowledge is evaluated during a two part examination.

Eligibility & Training

In order to participate in the examination an individual must be a member of the AETC and must have completed a variety of unassisted nerve conduction studies on at least one thousand patients.

Registration certificates can be revoked at any time if a candidate has misrepresented his/her credentials and made a fraudulent application to take the examination.

Technologist trainees must strive to achieve a level of competency that enables them to perform nerve conduction studies on patients without contributions from another technologist or supervising electromyographer. The minimum one thousand patient requirement is to be fulfilled after this level of competency is achieved. Examination candidates are expected to be able to work independently and demonstrate the ability to correct their own errors, adjust techniques according to anatomical dissimilarities and manipulate the machine according to specific needs. The document "Requirements for Registration Examination Candidates" has been accepted as the basis for the written and practical portions of the registration examination and serves as a training or study guide. The pursuit of post-secondary education course e.g. anatomy, physiology, kinesiology, biomechanics etc. is not essential but is considered beneficial to a candidate's study and preparation for the registration examination.

AETC Basic Workshop

A Basic Workshop in nerve conduction testing will be conducted by the A.E.T.C. Education Committee prior to the registration examination. This informal session usually includes a review of equipment, basic physiology and anatomy, specific nerve conductions, patient considerations and hazards of EMG. The B.R.E.T.C. highly recommends your participation in it.

This is not specifically a pre-examination workshop and is not organized by the B.R.E.T.C. The volunteer technologists from the A.E.T.C. teaching the workshop are not aware of the content of the examination, nor the rules or policies of the examination.

Written Examination

A four hour written examination will evaluate a candidate's knowledge about nerve and muscle anatomy, clinical physiology of nerve and muscle, instrumentation, technical aspects of nerve conduction studies and technical, physical, anatomical and physiological factors which may affect results. The format is one of approximately 100-130 multiple choice questions including some oscilloscope tracings and display from patients with abnormal findings. Candidates may be required to perform some simple mathematical calculation, to recognize obvious and classic pathological features observed in nerve conduction studies and to distinguish pathophysiological abnormalities from artefact.

Practical Examination

The practical portion of the examination involves a one hour (minimum) assessment of a candidate's ability to set up and carry out conventional nerve conduction studies on a subject. Patient handling, selection of instrument settings, application of electrode, stimulation, management of artefact, practice of electrical safety, display of traes and manual reading and calculation of results will be evaluated. There will be no question relating to needle examination or interpretation of normal or abnormal EMG recordings. However, knowledge aboth the type, handling and care of needle electrodes is essential. Candidates will not be expected to operate unfamiliar EMG equipment, but must be able to specify desired settings.

Candidates are welcome to bring their own electrodes and accessories for use during the practical portion, but it is possible that they are not compatible.

The candidates will not be advised about the polarity of stimulating and recording electrodes and must not assume that the equipment they are using for the exam is equipped with signal isolation.

Candidates may perform nerve conduction studies, employing the techniques used in their labs. Candidates must be aware of alternate methods of testing the same nerves; the pros and cons of each technique; and must be familiar with the normative data for the techniques utilized.

B.R.E.T.C. examiners may request the use of stimulus pulse widths of less than 0.2ms in order to fairly assess the candidate's knowledge of anatomy and accurate employment of technique. You will not be penalized for stating that you normally use longer stimulus durations. Candidates will be penalized for what is observed as indiscriminate use of voltage and/or stimulus lead.

Examination Administration

Information and study packages are available upon request from:

Jodi Beswick
EMG Laboratory
Parkwood Hospital
801 Commissioners Road East
London, ON  N6C 5J1

Decision Making
The ultimate responsibility for all aspects of the EMG laboratory examination rests with the electromyographer. However, candidates for the BRETC registration examination are expected to be able to function independently in all phases of nerve conduction studies. For the purpose of the examination candidates will be given common neuromuscular disorder case(s) and decisions about appropriate techniques and which nerves should be tested must be made by the technologist, give the patient's history and clinical findings.

Anatomy and Physiology
All candidates are expected to know: Neuroanatomy and functional anatomy of the limbs, head, neck and lower back as it related to EMG technology. Basic nerve and muscle physiology as it pertains to excitation and propagation of action potentials in peripheral nerves, neuromuscular junction transmission and the electrochemical/mechanical coupling in skeletal muscle. The type of nerve(s) and their connections responsible for phenomena observed in EMG technology, e.g.: explain the pathways needed to evoke an H reflex. The essential nature of common neuromuscular problems tested in the EMG laboratory.

Electronic and Machine Considerations
Essential knowledge and understanding (to include how altering the machine parameters affects waveforms) about:

* Gain (sensitivity)
* Sweep speed
* Filters (high and low pass)
* Averaging
* Calibrations
* Stimulating electrode and stimulating parameters
* Recording electrodes
* Impedance
* Shock artefact 60 Hz artefact
* Grounding (current limiters and signal isolation)
* Electrical safety
* Ohm's law
* Leakage current

Patient Considerations:

* Good beside manner and patient handling skills
* Appropriate history taking
* Proper skin preparation
* Consideration of patient comfort during testing
* Management of limb temperature and its effect on nerve conductions
* Management of muscle artifact
* Ability to deal with limb edema, intravenous sites, etc.
* Understanding the effect of age
* Adequate infection control techniques regarding cleaning, disinfection and sterilization of lab equipment

Nerve Conduction Studies Candidates will be evaluated on points previously stated and in addition:

* General knowledge of normal electrophysiological values and therefore recognition of abnormal values
* Recording electrode placement
* Stimulation
* Quality of traces
* Accuracy of latency, amplitude, distance and velocity measurement (manual measurements may be asked for)
* Electrode handling and preparation
* Stimulus spread
* Manual conduction velocity calculations

Needle EMG Consideration Candidates must have knowledge about:

* Machine set up for Electromyography
* Types and properties of needle electrodes
* Infection control techniques: sterilization, handling, storage and disposal of needle electrodes and indications for wearing gloves, masks, gowns

Motor Nerves
Be prepared to perform nerve conduction studies on: Median, ulnar, radial, musculocutaneous, peroneal, femoral, facial, anomalies (Questions on the written examination will not be restricted to these motor nerves - see Anatomy section)

Sensory Nerves
Be prepared to perform nerve conduction studies on: Median, ulnar radial, musculocutaneous, sural, superficial peroneal, medial and lateral plantars, saphenous (Questions on the written examination will not be restricted to these sensory nerves - see Anatomy section)

Additional Techniques
Know: Myasthenia and Myasthenic Syndrome studies (proximal and distal techniques), F responses, Axon reflexes, H reflexes, Blink reflexes