The Annual Meeting of the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) is typically a gathering that provides an excellent opportunity to hear about the latest clinical updates in the evaluation and management of neuromuscular disorders and the latest research field of electrodiagnostic and neuromuscular medicine from some of the top experts in the field. The 2023 meeting was held in Phoenix, Arizona, under the leadership of AANEM President Robert Irwin, MD, whose chosen meeting theme was Disability and NMDs: The Whole Enchilada, which did not disappoint. Here are our reflections as physicians who attended the AANEM Annual Meeting 2023.
Dr. Thiru Annaswamy’s reflections:
Harnessing the Power of AI: Exploring AI Resources by Dr. John Moren
This session was a discussion of large language model (LLM) programs, aka ChatGPT and similar programs, which dominated the conference not only as a theme of multiple sessions but also among the minds of most of the attendees.
Dr. Morren discussed the huge potential of AI to benefit electrodiagnosticians and neuromuscular specialists and their patients by primarily improving the quality of health care delivery. AI can help enhance diagnostic accuracy, and improve patient outcomes by helping clinicians more efficiently and consistently find evidence-based effective treatments for their disorders. AI can help clinicians improve timeliness of care, enhance patient experience by improving workflow, and allow clinicians to have more face time with patients rather than the computer screen. AI can assist clinicians to be better prognosticators and decrease health care costs by reducing unnecessary utilization.
Dr. Morren took several questions and patiently answered them with appropriate detail. A short workshop session where session attendees could create accounts and test drive a clinical question on several common LLM platforms was a great way to test drive your newly acquired knowledge.
Before this presentation, I had never fully comprehended the breadth of LLM programs and their application in the day to day life of a physician. After this session, I not only have a great idea of what’s currently available, how to use them, what their benefits and pitfalls are, but also what potentially lies ahead. I was able to envision a vividly portrayed future scenario of how a clinician potentially evolves from their current role of data gathering and data assimilation resulting in formulation of clinical assessment and treatment plan to more of a clinician being an expert interpreter of AI-assisted (in this scenario, an AI-enabled ambient scribe embedded in your EMR is doing the data gathering and assimilation) assessment and using their “human” clinical judgment to make treatment decisions. It was an exquisite, vivid, elaborate, comprehensive, journey into the AI of now and tomorrow. I left the session feeling inspired and energized. There is a near 100% likelihood that I will continue to familiarize myself with LLM platforms, talk about its utility with my peers in informal and formal presentations, including discussions about the concerns that AI-enabled health care poses including concerns about its reliability and accuracy; patient privacy and security; lack of regulatory oversight; potential for exacerbating inequities and under-representation, dehumanizing, and possibility of threat to the very existence of the medical doctor. It is clear that AI is here to stay, and attending this session gave me (and other attendees) a clear road map on how to adapt and use it to our advantage.
Disability in Medical Education: Where is it? by Dr. Margaret (Peggy) A. Turk, MD,
In this plenary session, Dr. Turk discussed the mismatch of disability prevalence in the population with the inadequacies of required learning in medical education. She highlighted the areas of general physician knowledge and skills that need to improve so that patient care for disabled persons, including those with neuromuscular disease, improves. The Liaison Committee on Medical Education only names disability within the context of one of its competencies, which is insufficient for future physicians to develop sufficient competency to treat persons with disability.
Dr. Turk provided several examples of how inadequately trained physicians may provide incomplete medical attention to persons with disability. Despite lack of sufficient clarity on what best practices are in disability education in medical school, Dr. Turk suggested some potential curricular modifications that would better integrate knowledge/skills about disability conditions, so future clinical providers’ disability competencies are enhanced.
My takeaways from this session are that every practicing physician, especially those who work in an academic setting, has responsibility to be an advocate for persons with disability and such advocacy must include championing inclusion of better training in disability competencies so that future physicians provide compassionate and comprehensive care for persons with disability.
Dr. Nandita Keole's reflections
This meeting included a lot of content on the use of neuromuscular ultrasound in the diagnoses and management of nerve and muscle disorders. This modality is a good complement to the traditional electrodiagnostic examination. It enables visualization of the nerves and the ability to provide dynamic testing of the area. At this meeting they also demonstrated the utility of high frequency ultrasound which enables a clearer visualization of superficial smaller structures. While the use of neuromuscular ultrasound is not new, there have been several advances in the technology allowing for superior image quality and diagnoses. While this imaging modality is clinically useful, there are some concerns about what the implications of finding these anatomic abnormalities entails in management. There are some findings unrelated to presenting complaint. Would this lead to more patients being considered for procedures including surgeries? These are some facets being discussed and researched. The incorporation of diagnostic ultrasound, specifically neuromuscular ultrasound, is still not uniform in all institutions. There are not enough clinicians who are sufficiently trained in this to be comfortable including it in their practice. That will possibly change over the next few years. This is a modality I plan to incorporate in my practice after sufficient training through workshops and self-study.
Overall, the 2023 AANEM conference was a very rewarding experience that expanded our knowledge, strengthened our advocacy muscle, and provided us with diverse and patient-centered perspectives that will allow us to return to our institutions and implement them into our daily practice.
Drs. Keole and Annaswamy report no conflicts of interest.
Illustration by April Brust