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To the Editor:
Burns et al. reviewed clinical neurophysiology (CNP) training in the United States.1 Since the approval of CNP as an added qualification examination and the establishment of CNP fellowships, EMG and EEG training have changed. We agree that there is limited exposure to CNP during residency and that additional training is often required. However, as currently structured, we believe CNP training has become too diluted, creating CNP generalists rather than focused experts, as was the case formerly. Burns et al. acknowledge that CNP training is not designed to make experts in each CNP area, but rather provides greater knowledge and skill than obtained during residency. One might ask where future EMG and EEG experts will come from, if not from CNP fellowships. The majority of residents pursuing fellowship training still do so in preparation for an academic career.2 It would appear unlikely that many candidates will opt for training beyond one additional fellowship year. We have had the opportunity to train fellows in 6-month, 12-month, and 2-year programs devoted solely to EMG/neuromuscular disorders. The largest growth in expertise occurs between 6 and 12 months, when fellows consolidate their knowledge, increase their confidence and procedural skills, and solve difficult problems independently. As currently structured, EMG training is particularly handicapped in CNP fellowships, because the equivalent of 12 months EMG training cannot …
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