Table 1.

Competency Table for Transcranial Magnetic Stimulation (TMS).

	Competency	Clinician	Scientist	Technician
CORE KNOWLEDGE	1. Basic Mechanisms of TMS Including:  - Physics  - Orientation  - Electromagnetic Coupling  - Head Shape  - Skull Defects  - Pharmacological Mechanisms	+	+	+
	2. Fundamentals in design of TMS devices	+	+	+
	3. Neuroanatomy and Physiology	+	+	+
	4. Fundamentals of Clinical Neurophysiology  - Compound action potential  - M Wave  - 10–20 System  - D Waves and I Waves	+	+	+
	5. Safety and Risk	+	+	+
	6. Regulatory Landscape	+	+	(+)
	7. Fundamentals of FDA Approved Conditions  - Mood Disorders  - Cortical Mapping  - Migraine  - Obsessive Compulsive Disorder	+	(+)
	8. Knowledge of the Literature  - IFCN Recommendations  - Top Cited Papers	+	+	(+)
SAFETY AND ETHICS	9. Adverse effects of TMS	+	+	+
	10. Screening Risk and Stratification	+	+	(+)
	11. Diagnosis and Management of Seizure and Syncope	+	+	+
	12. Hearing Protection	+	+	+
	13. Recognizing and Addressing Needs of Special Populations  - Pregnant Women  - Children/Adolescents  - Elderly  - Non-autonomous persons (prisoners, wards of the state)  - Patients with seizures	+	+
	14. Recognizing and Addressing Disease-specific Conditions and Complications.Conditions Include:  - Sensory Hypersensitivity  - Cortical Hypo-/hyper-excitabilityComplications include:  - Suicidality  - Hypomania  - Pain Exacerbation	+	(+)	(+)
TECHNICAL APPLICATIONS AND HANDS-ON TRAINING *	15. Device Operation (including Troubleshooting)	+	+	+
	16. Scalp Measurements	+	+	+
	17. Basic Neurophysiology Methods and Techniques  - Recording surface EMG  - EMG vs. visible twitch	+	+	+
	18. Setting up and Recording Concurrent TMS-EEG		(+)
	19. Targeting TMS  - Scalp based landmarks  - Coil location, orientation, angulation  - Neuronavigation	(+)	+	+
	20. Basic Applications of TMS  - Finding motor hotspot  - Assessing resting motor threshold  - Assessing active motor threshold	+	+	+
	21. Assessing Non-motor Cortical Function  - Phosphenes  - Speech Arrest		+
	22. Assessing the Input/Output (I/O) Curve		+
	23. Assessing Central Motor Conduction Time (CMCT)		+
	24. Paired-pulse TMS to One Brain Region  - Short Interval Intracortical Inhibition (SICI)  - Long interval Intracortical Inhibition (LICI)  - Intracortical Facilitation		+
	25. Paired-pulse TMS to Two Brain Regions  - Inter-Hemispheric Inhibition  - Cerebellar Inhibition		(+)
	26. Paired Associative Stimulation (PAS) and Spinal Associative Stimulation (SAS)		(+)
	27. Conventional rTMS	+	+	+
	28. Theta-burst Stimulation	(+)	+	(+)
	29. Quadripulse stimulation	(+)	(+)
	30. Apply and Assess SHAM TMS	(+)	+	(+)

Required competencies are marked with “+”. Suggested competencies (or those that may be required under certain circumstances) are marked with “(+)”.

^*Assessment of the technical application/hands-on training will be done using the see 5, do 5, and test 1 where trainees will observe 5 sessions on different subjects, do 5 sessions with supervision, and then be tested on 1. This assessment should be completed for each individual device a user will have access to.