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We read with interest the recent article “Revisions to Accreditation Council for Graduate Medical Education's Program Requirements for Physical Medicine & Rehabilitation: Input from the Tri-Organizational Graduate Medical Education Committee” by David W. Pruitt and colleagues,1 and have significant concerns regarding the proposed revisions to the Accreditation Council for Graduate Medical Education (ACGME) requirements for physical medicine and rehabilitation (PM&R) residency training. Although we appreciate the efforts of the committee to modernize PM&R training, we think the proposed reduction in electromyography (EMG) requirements undermines the competency-based training model that ACGME strives to uphold and is detrimental to trainees, patients, and the health care system. EMG competency is dose dependent, and training provides foundational experiential learning to promote mastery in the peripheral nervous and musculoskeletal systems. This is not only relevant to PM&R physicians who choose to practice electrodiagnostic (EDX) or neuromuscular medicine, but across all subspecialties. Spine, sports, pain, cancer, neurological, and pediatric rehabilitation, among other subspecialties, all integrate EMG learning to distinguish normal from pathological findings and to serve as the base from which interventional treatments can be taught, including peripheral and axial injections and chemodenervation. These areas rely on a deep understanding of peripheral neuroanatomy, which is best developed through extensive EMG practice. Recent evidence demonstrates performance on the EDX SAE correlates to number of EMGs performed by trainees, with peak effect at 300–400 studies.2 In addition to these adverse short-term effects, this proposed change may have unintended impact on future job prospects for trainees in the intermediate term and may have devastating effects on the workforce in the long term. In a recent survey to practicing physiatrists, 30% of respondents selected EMGs as an area of focus in their current practice.3 As opposed to other interventional training opportunities, physiatry-based EMG and neuromuscular fellowships are rare. Therefore if this change is enacted, physiatrists wishing to pursue EDX will have limited opportunities to do so. Reducing EMG requirements may therefore lead to the withdrawal of physiatry as the leading specialty in EDX medicine. Physicians also often discover the need for EMG skills later in their careers, regardless of their initial focus during residency. If the foundational training in EMG is insufficient, they may be unprepared for the demands of their employer. In neurology, the lack of strict EMG requirements has decreased training over time,4 resulting in the majority of graduates endorsing poor confidence in interpreting EMG studies.5 Experience with EMGs sharpens a resident's ability to interpret and integrate clinical history, physical exam, and diagnostic information, improving overall diagnostic accuracy, interprofessional care, and patient management. Finally, although there is a great deal of overlap in medical specialties offering other interventional procedures in PM&R, there are few alternatives for physician-based specialties performing and interpreting EMG outside of PM&R and neurology. Should physiatry withdraw focus from EMG, nonphysicians with less rigorous formal training are likely to fill the void. Fraud and abuse are already a concern in EDX medicine. Lessening EMG training undermines current efforts to protect patients and could lead to even more misdiagnoses and inappropriate treatments. The landscape of neuromuscular disease treatment is evolving dramatically with the advent of new therapeutic options. Timely and accurate diagnosis is paramount to ensure patients receive these disease modifying therapies and supportive interventions in a timely manner. The current requirement for 200 EMGs during residency is essential for gaining exposure and developing the competency to diagnose and manage rare and devastating neuromuscular diseases. The proposal to reduce core EMG training threatens to impose new barriers to accessing care for some of the most disabled patient populations we serve. In conclusion, as the aim to evolve PM&R training to incorporate a competency-based approach is the objective espoused by the committee, it is imperative that the essential training components that have proven to be foundational for effective clinical practice are preserved. Although this proposed reduction in the 200 EMG study requirement is intended to provide more flexibility to training programs, that flexibility will have a clear cost on competence as evidenced by studies cited here. It would therefore seem important to consider alternative changes that may have less impact on the quality of education, such as inpatient and outpatient time requirements. Any changes to the number of EMGs required should be backed by solid evidence demonstrating that resident education and patient care will not be compromised. We urge ACGME not to remove the EMG requirements and maintain the high standards of training that have long benefited both practitioners and patients alike.