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Neuromuscular Disorders Editorial Improving Education in Neuromuscular Medicine—The Essential Ingredients Dianna Quan, MD Neuromuscular Medicine Fellowship, University of Colorado Denver, Aurora, Colorado, US Abstract Neuromuscular medicine fellowship training, like neurology training, is undergoing important changes. The widespread effort to standardize educational practices and assessment methods across programs is exemplified by the Next Accreditation System. The lasting effects of this framework are largely unknown and will require study. In order truly to meet the goals of improving patient and population outcomes and improving the educational experience for trainees, more changes will likely be needed. Keywords Neuromuscular medicine fellowship training, education, assessment, Next Accreditation System Disclosure: Dianna Quan has nothing to declare in relation to this article. No funding was received for the publication of this article. This article is a short opinion piece and has not been submitted to external peer reviewers. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: January 17, 2016 Published: February 26, 2016 Citation: US Neurology, 2016;12(1):27–8 Correspondence: Dianna Quan, MD, University of Colorado Denver, 12631 East 17th Avenue, Mail Stop B-185, Aurora, CO 80045, US. E: dianna.quan@ucdenver.edu In my avocation as a home cook, I found interesting a passage in Fuchsia Dunlop’s Shark’s Fins and Sichuan Pepper, a memoir of the author’s culinary journey in China. 1 She describes an elderly gourmet’s lament for the rising dominance of culinary school education over traditional chefs’ apprenticeships. He was dismayed by the substitution of mass-produced cooks, armed with standardized repertoires and knowledge, for highly skilled chefs with both a solid foundation in traditional techniques and the ability to innovate with new methods. experiences, supervisory requirements, duty hour restrictions, and alertness management/fatigue mitigation training requirements, among other matters. This effort to standardize the knowledge base, educational process, and skills of neuromuscular practitioners has necessitated the tandem development of assessment methods and tracking measures to ensure that programs and physicians are up to par. The latest iteration prescribed by the Next Accreditation System (NAS) includes 17 pages of milestones and two faculty meetings per year to review the status of trainees. 4,5 ACGME accreditation specifies the minimum level This evolution in the educational system of professional chefs in China echoes the changes we have seen in numerous American professions in the last several decades, including medicine, neurology, and neuromuscular medicine. Some of the most visionary physicians in neuromuscular medicine today are graduates of an apprenticeship system, and learned at the side of masters who defined our field. As recently as 10 years ago, most neuromuscular physicians trained in such unregulated programs, many with decades-long traditions of educational excellence. Some still do. The system worked but produced trainees with variable levels of competence, and no yardstick existed to compare graduates across programs. of infrastructure and support required for educational programs, and subspecialty certification endorses that graduates of such programs have achieved competency by passing a detailed written examination. A decade ago, the Accreditation Council for Graduate Medical Education (ACGME)—whose mission is to “improve health care and population health by assessing and advancing the quality of resident physicians’ education through accreditation”—put forth a set of requirements for neuromuscular medicine that mirrored the existing framework for neurology and physical medicine and rehabilitation residencies. 2,3 The fundamental skills expected of a neuromuscular specialist were detailed in these program requirements, accompanied by mandated didactic topics and clinical Mastery of a common body of knowledge is essential and provides the vocabulary and foundation for future practice. Gauging this is the main utility of a certification examination. Do all trainees require formal didactic lessons to acquire this knowledge? For programs with one or two fellows, is the annual repetition of formal, didactic lessons an efficient use of teaching resources? If mastery over a core curriculum is the desired outcome, then there should be a standardized core curriculum, using written syllabi, electronic resources, and virtual classrooms to teach it. Those who TOU CH MED ICA L MEDIA Do reducing variability in educational practices across programs, tracking program and trainee adherence to guidelines, and frequent assessments enhance physician competency, improve patient outcomes, and reduce costs through efficient use of resources? Do these measures improve individual health and population health? The answers are by no means clear, and more research is needed to address these questions. 27