Validity and Feasibility of the EMG Direct Observation Tool (EMG-DOT)

Neurology. 2016 Apr 26;86(17):1627-34. doi: 10.1212/WNL.0000000000002609. Epub 2016 Mar 30.


Objective: To develop a new workplace-based EMG direct observation tool (EMG-DOT) and gather validity evidence supporting its use for assessing electrodiagnostic skills among postgraduate medical trainees.

Methods: The EMG-DOT was developed by experts using an iterative process. Validity evidence from content, response process, internal structure, relations to other variables, and consequences of testing was collected during the 2013-2014 academic year.

Results: Of 3,412 studies performed by trainees during the study period, 299 (9%) were assessed using the EMG-DOT. Of these, 203 (68%) involved a physician rater and 96 (32%) involved a technician rater. The 14-item EMG-DOT had excellent internal-consistency reliability (Cronbach α 0.94). Correlations between individual items and criterion-referenced global ratings of performance ranged from 0.36 to 0.72 (all p < 0.001). Mean total scores increased from 70% to 80% over 4 months of the EMG rotation (p < 0.001) despite a corresponding significant increase in case complexity (0.21-0.74 on a 3-point rating scale; p < 0.001). Trainees reported that the observational assessment exercise improved their knowledge or skills in 82% of encounters (188/230) and that feedback generated by the EMG-DOT improved the quality of care provided to patients in 58% (133/230). Trainees were "satisfied" or "very satisfied" with the observational assessment exercise in 96% of encounters (234/243).

Conclusions: This study provides validity evidence supporting the use of EMG-DOT scores to assess electrodiagnostic skills of residents and fellows. The EMG-DOT can be used to inform milestone-based assessments of trainee performance in neurology, child neurology, physical medicine and rehabilitation, neuromuscular, and clinical neurophysiology training programs.

Publication types

  • Validation Study

MeSH terms

  • Clinical Competence*
  • Education, Medical, Graduate*
  • Educational Measurement / methods*
  • Electromyography*
  • Feasibility Studies
  • Feedback
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Internship and Residency*
  • Learning
  • Neurology / education
  • Neurology / methods
  • Physical and Rehabilitation Medicine / education
  • Quality of Health Care
  • Reproducibility of Results