Subspecialization in clinical neurophysiology: Development and current status

To describe the development and current status of training and certification in clinical neurophysiology (CNP); to explore the impact of the newer subspecialties in sleep medicine, neuromuscular medicine, and epilepsy; and to obtain information about aspects of practice in the subspecialty.

Information about training programs and certification was obtained from the records of the Accreditation Council for Graduate Medical Education and the American Board of Psychiatry and Neurology, and diplomates were surveyed about their CNP practice activities and attitudes toward certification/recertification.

In the years since the first examination was administered, a robust number of CNP training programs developed, but recently, there has been a decrease in the number of programs and fellows, although the number of programs and fellows in the subspecialties of epilepsy, neuromuscular medicine, and sleep medicine has increased. A diplomate survey indicated that most respondents devoted significant practice time to CNP procedures, especially to EEGs and EMGs. Although more diplomates performed EEGs than EMGs, a substantial portion performed both. Most diplomates were planning to or had maintained certification in CNP.

Over 3,000 neurologists, child neurologists, and psychiatrists have obtained certification in CNP, and the majority are participating in recertification. Although the newer and overlapping subspecialties of epilepsy, neuromuscular medicine, and sleep medicine may be having a negative impact on CNP, it continues to have a relatively large number of programs and attracts a relatively large number of fellows.