Curriculum

Mayo Clinic's Adult Neurology Residency Program is divided into two parts: an initial year (PGY-1) of graduate medical education in internal medicine followed by three years of adult neurology residency training (PGY-2 through PGY-4).

Clinical Training First Year
Before you begin your residency training, you need one year (PGY-1) of clinical training. The American Board of Psychiatry and Neurology (ABPN) requires that you spend one year in an accredited internal medicine program in the United States or Canada, or in a transitional program, which has been approved by the Accreditation Council for Graduate Medical Education (ACGME) and that includes at least six months in internal medicine. No neurology residency credit will be given for time spent in a residency program for another medical specialty. The requirements for that PGY1 year can be found on the ABPN Web site: http://www.abpn.com/.

This initial year of training may be taken at another medical center with an ACGME-approved program or you may complete it at Mayo Clinic in Rochester . No separate application or interview is required if you are interested in completing your initial year of training in Rochester . There are a limited number of first-year internal medicine training slots available, so applicants who successfully match with Mayo Neurology should always have an alternative. A separate interview is necessary if you are interested in Mayo Clinic in Scottsdale , Mayo Clinic in Jacksonville , or a non-Mayo Clinic medical facility.

Clinical Training Years 2-4
You will begin your adult neurology residency (PGY-2) with hospital and outpatient experiences. You will have a month early in your training of outpatient neurology during which you work very closely with staff consultants in the Neurology Education Section, refining your examination, history taking, presentation and differential diagnosis skills. Hospital-based rotations include General Neurology and Stroke/Cerebrovascular inpatient rotations, Epilepsy Monitoring Unit and Emergency Neurology. The first two (of three) months of Child Neurology are completed during the PGY2 year. You will also have one month of psychiatry as is required of all neurology residents. Elective time is available for residents during each year of training. Most of your PGY-3 year will be spent in clinical neurophysiology, neuropathology, elective rotations, and outpatient subspecialty rotations in four different areas. You will also have one month of neurologic intensive care unit and one month of hospital consult service. In the PGY-4 year, you will serve as a senior resident at the hospital and outpatient clinic with greater responsibility in all clinical settings. You will also have additional elective time.

During hospital assignments, you will supervise and teach junior residents and medical students, see and manage routine and emergency admissions, and provide consultations for other services. As a senior resident on clinical assignments, you will be the primary physician for several new neurology patients each day.

Throughout your residency, you will receive regular didactic and clinical instruction in neuroradiology. You can gain additional experience by using elective time to interpret imaging studies with a neuroradiologist or observe neuroradiologic procedures such as:

• Arteriography
• Computerized tomography of the head and spine, CT angiography, and spinal CT
• Endovascular interventional procedures
• Magnetic resonance imaging, magnetic resonance angiography, magnetic resonance venography, and functional MRI
• Myelography

As your experience increases during your residency, you will be given greater responsibility for patient management. Our residents have found the mix of clinical responsibilities, staff supervision and teaching to be ideal.

The schedule for the adult neurology residency includes the following rotations.

Adult Neurology Inpatient Services
During your inpatient assignments, you will learn to evaluate and treat neurological emergencies in the Saint Marys Hospital Emergency Department. You also will evaluate a wide variety of neurological disorders in the inpatient setting, including the intensive care unit. You will participate in teaching rounds each day in the hospital.

The Neurology Critical Care Team has admitting privileges to the Neurological/Neurosurgical Intensive Care Unit. Any patient with an acute neurological disorder is admitted by this service and managed primarily by a team of residents and an attending neurologist.

The Stroke and Cerebrovascular Disease Service manages patients with stroke, TIA, intracranial hemorrhage and other cerebrovascular disorders. The General Neurology Service evaluates and manages a wide range of neurologic disorders requiring inpatient care.

Adult Neurology Outpatient Services
While on outpatient rotations at the clinic, you will evaluate patients with common and unusual neurological conditions. You will participate in daily teaching case discussions and have outpatient education opportunities on special outpatient services. For one month during each of the PGY-2 and PGY-4 years, residents work in the outpatient setting with staff consultants in the Neurology Education Section. Members of this section were specifically chosen because of their expertise in neurological education.

Continuity Clinic
You will attend an outpatient continuity clinic for one-half day per week for all three years. You will develop experience in following patients requiring ongoing care for common and uncommon neurologic disorders.

Subspecialty Clinics
There are several outpatient clinics within the Department of Neurology focusing on subspecialty areas of neurology. All residents have required rotations the Movement Disorders, Cerebrovascular, Epilepsy and Neuromuscular clinics. Additional time may be spent in these clinics and electives are available in other subspecialty clinics.

Child and Adolescent Neurology
Your child and adolescent neurology assignments will be divided between hospital and clinic services for two months during the PGY-2 year and one month during the PGY-4 year. You will gain experience in dealing with acute and outpatient pediatric problems. You will learn the appropriate evaluation of neonatal, infant, child and adolescent patients with neurological problems.

Core Clinical Neurophysiology (CNP)
During the PGY-3 year, you will spend two months of required training in a clinical neurophysiology rotation. This assignment includes didactic instruction and practical experience in the basics of:

• Autonomic function testing
• Electroencephalography (EEG)
• Electromyography (EMG)
• Electronystagmography
• Evoked potentials
• Nerve conduction studies (NCS)
• Polysomnography

After completing this rotation, you can spend another four elective months in EMG, or one to four months in EEG or sleep medicine.

Neuropathology
You will spend two months training in neuropathology during PGY-3. This rotation will give you direct experience with autopsy material under the direction of a full-time neuro-pathologist. Your training also will include case reviews, brain cutting and the study of microscopic materials.

Electives
You will have nine months of elective rotations to use throughout your residency. In addition to further training in adult or child and adolescent neurology, your elective options include the following related clinical and laboratory specialty areas.

Behavioral Neurology (1-2 months)
During this elective you will:

• Evaluate the mental status of patients with neurological, psychiatric and medical   disorders in the Behavioral Neurology Clinic.
• Learn the anatomical and pharmacological foundations of various cognitive   disorders.
• Study a wide variety of guided reading assignments.
• Gain experience in research and in interpreting neuropsychological tests.

Cerebrovascular Disease (1-2 months)
During this elective you will:

• Work in the Cerebrovascular Clinic, gaining experience treating a wide variety of hemorrhagic and ischemic cerebrovascular disorders.
• Learn the procedures and applications of noninvasive cerebrovascular tools, including oculoplethysmography (OPG), transcranial Doppler (TCD) and carotid ultrasound.
• Participate in clinical and epidemiological research.

Clinical Epilepsy (1-2 months)
During this elective you will:

• Provide subspecialty consultations in the Epilepsy Clinic.
• Evaluate patients before and after epilepsy surgery.
• See patients referred to the supervising epileptologist.
• Assist with epilepsy drug investigational studies.
• Participate in the epilepsy subspecialty conference.

Clinical Neurophysiology
During this elective, which is taken after the core clinical neurophysiology two-month rotation, you will choose one or more rotations in these areas:

• Electroencephalography (EEG)
  During the initial two-month CNP rotation, you will read a wide range of normal and abnormal records. After this, you may choose to:
  
  - Work full-time in the EEG laboratory for another one to four months.
  
  - Take a part-time rotation reading EEGs during the PGY-4 year or a
    post-residency extension.

To be eligible for additional CNP certification by the American Board of Psychiatry and Neurology, you must have one year of fellowship in clinical neurophysiology.

• Electromyography(EMG)
  During the initial two-month CNP rotation, you will perform several nerve conduction studies and EMGs. After this you may choose to work full-time in the EMG laboratory for another four months. During the four-month rotation, you will:
  
  - Evaluate patients with a wide range of neuromuscular disorders.
  
  - Gain initial experience with evoked potentials, surgical monitoring, and single-fiber EMG.

After a total of six months of training, which includes the two-month required clinical neurophysiology course, you will be eligible for certification by the American Board of Electrodiagnostic Medicine. To receive board certification by the ABPN, one year of fellowship training is required.

Headache (2-4 weeks)
During this elective, you will:

• Work with members of the headache subspecialty group seeing patients in the Headache Clinic.
• Learn the approaches to the evaluation and management of headache disorders.

Movement Disorders (1-2 months)
During this elective you will:

• Care for patients with common and unusual movement disorders, learning clinical evaluation and treatment approaches in the Movement Disorders Clinic.
• Review cases from a reading list and a videotape library of movement disorders.
• Perform clinical research.

Neuroimmunology (1-2 months)
During this elective you will:

• See patients with immune-mediated disorders of the nervous system in the MS Clinic.
• Learn to evaluate and treat ailments such as multiple sclerosis, myasthenia gravis, myasthenic syndrome, stiffman syndrome and immune-mediated peripheral neuropathies.

Neuro-Oncology (2-4 weeks)
During this elective you will:

• Care for patients with common and unusual neuro-oncology disorders, learning clinical evaluation and treatment approaches in the Neuro-Oncology Clinic.
• Learn to evaluate and manage patients with primary and secondary brain and spinal tumors and paraneoplastic disorders. 

Neuro-ophthalmology (1-2 months)
During this elective you will:

• Gain experience in ophthalmology as it relates to general medical and neurological problems.
• Train in the Saint Marys Hospital neuro-ophthalmology service.
• Evaluate patients who are referred from the medical and neurological sections of the clinic.

Neurosurgery (1-2 months)
During this elective you will:

• Be assigned to staff neurosurgeons and senior residents, seeing acute neurosurgical emergencies and a wide range of neurosurgical problems.
• Participate in initial evaluations, surgical procedures and postoperative care.

Pain Clinic (1 month)
During this elective you will:

• Assess and treat intractable pain problems.
• Become familiar with both medical and invasive approaches to pain.

Peripheral Nerve Disease (1 month)
During this elective you will:

• Assist in the clinical assessment of patients with all forms of peripheral nerve disease.
• Participate in regular peripheral nerve conferences.
• Learn the appropriate use of electromyography, computerized automated sensory testing, autonomic function testing, and nerve biopsies in the diagnosis of peripheral nerve disorders.

Physical Medicine (1-2 months)
During this elective you will:

• Work with patients on the Saint Marys Hospital inpatient physical medicine rehabilitation unit.
• Gain outpatient experience in evaluating and treating disorders, including stroke, spinal cord injury, traumatic brain injury, and neck and back pain.

Psychiatry (1-2 months)
During this elective you will:

• Help with the diagnosis and care of patients in a hospital psychiatry unit.
• Learn about operant deconditioning procedures to manage chronic pain problems.

Research (1-6 months)
You can commit your elective time to research and pursue a variety of research options.

Sleep Disorders (1-2 months)
After completing the two-month introductory clinical neurophysiology course, you can take this rotation during which you will:

• Work full-time in the sleep disorders center.
• Learn to read and interpret polysomnograms and multiple sleep latency recordings.
• Consult on a wide variety of sleep disorders.

Other Electives
You also can choose to spend your elective time in speech pathology, psychology, neuro-otology and other areas related to neurology. Your faculty adviser and program director can review these additional options with you.

Rotations at Other Mayo Clinic Sites
As part of your adult neurology training, you may spend two to four months on rotations at Mayo Clinic in Scottsdale and/or Mayo Clinic in Jacksonville . These rotations offer a unique opportunity to work in a small group practice that integrates clinical neurology, neurophysiology, imaging and a variety of neurological subspecialties. Your training will emphasize outpatient activities and your call responsibilities will be limited.

Mayo Clinic funds the authorized additional costs of travel, housing, car rental and licensure fees, as well as travel expenses and lodging for you and your family. Our residents consistently rate these rotations very highly.

You also have an option to spend one month of your child neurology training at the Nemours Clinic in Jacksonville , Florida.

Didactic Training
There are many didactic opportunities associated with this residency program.

Clinical conferences, seminars, small discussion groups, journal clubs, didactic courses and one-on-one instruction are an integral part of Mayo Clinic's Adult Neurology Residency Program.

Course Work
Formal didactic courses are required during your residency. You will take basic clinical neurology, neuroanatomy and neuroradiology courses during the PGY-2 year. An advanced clinical neurology course is taken early in the PGY-3 year. Although you can schedule the clinical neurosciences course at any time, most residents take it during the PGY-3 year. There is also a neuro-ethics course.

Conferences
Throughout your residency you will participate or make presentations in weekly teaching conferences. There are scheduled departmental conferences on Mondays, Wednesdays, and Fridays. Neurology grand rounds occur on Mondays. This conference focuses on the pathophysiology, diagnosis, and management of neurological disorders. Research presentations are given by either Mayo or visiting faculty and by neurology residents. Clinical pathological conferences are held several times a year. On Wednesdays, clinical neurology hospital conferences are held at Saint Marys Hospital ; they alternate between the adult, the child and adolescent hospital services, neurosurgery and neuro-ophthalmology. Subspecialty conferences are presented on Fridays by all divisions of the neurology department.

In addition to the regularly scheduled departmental conferences, there are resident conferences on Tuesdays. Residents participate in an evidence-based medicine journal club. Visiting professors have small group discussions with the residents. Other topics covered include child and adult neurology vignettes, and neuroethics.

Teaching Opportunities
You will have the opportunity to teach Mayo Medical School students and visiting students from other medical schools through bedside instruction and formal didactic lectures. As a senior resident, you will have a key role in the education of junior neurology and non-neurology residents, and medical students.

Research Training
Your research opportunities at Mayo Clinic are outstanding. You are encouraged to participate in research projects with the consulting staff. This includes opportunities for clinical studies and laboratory-based projects. During your Adult Neurology residency or during research experiences during fellowships or specific research extensions, you can focus on:

• Behavioral neurology
• Cerebrovascular disease
• Critical care neurology
• Electroencephalography
• Electromyography
• Headache
• Movement disorders
• Muscle disease
• Neurochemistry and neuropharmacology
• Neuroepidemiology
• Neuroimmunology/multiple sclerosis
• Neuromuscular junction diseases
• Neuro-oncology
• Neuropharmacology
• Neurosurgery
• Neurovirology
• Peripheral nerve disease
• Psychopharmacology
• Sleep disorders

Basic research is performed in the following areas, as well as some of the clinical research areas listed above.

• Cellular metabolism
• Developmental neurobiology
• Evaluating neuronal-glial interactions
• Mechanisms of autoimmunity
• Membrane excitation
• Nervous system regeneration
• Neurotoxicology
• Regulation of protein and lipid biosynthesis

To fulfill this requirement and offer additional research opportunities, Mayo Clinic has short- and long-term research projects, one-year research positions, a doctoral degree in biomedical sciences, and a Clinician-Investigator Training Program.

Short-Term Research Projects
Short-term projects require a several month commitment and do not take time away from your residency responsibilities. You will have ample opportunity to pursue projects such as patient-generated case reports and chart reviews.

Long-Term Research Projects
Long-term research projects (typically longer than six months) may require time away from your residency responsibilities. You can apply for a long-term project any time during your residency. You must first obtain permission from the Neurology Research Committee and identify a staff research mentor.

One-Year Research Positions
Each year Mayo Clinic offers funded research positions for those who wish to extend their residency training. Under this option, you will learn the procedures used to identify important research questions, formulate hypotheses and critically test them. You will work with an experienced investigator, using appropriate research and statistical methods, in one of the research laboratories. Similar opportunities are available in the Neurology Department's clinical laboratories. You must have the support of a faculty member before you apply at the PGY-4 level for a formal one-year research position.

Ph.D. Program
Mayo Graduate School offers a Ph.D. in Biomedical Sciences with specialization in several tracks. Though these Ph.D. program tracks emphasize research, they also include a core curriculum for a strong foundation in the basic sciences and neuroscience. You do not need to declare an interest in this option when you first apply to the Adult Neurology Residency Program.

See also:

• Mayo Graduate School

Clinician-Investigator Training Program
The Clinician-Investigator Training Program (CITP) at Mayo Clinic offers personalized training for selected individuals who wish to pursue careers as clinician-investigators. The CITP includes a core curriculum of seminars and graduate course work, along with protocol development and two years of uninterrupted research time, incorporated into a graduate medical education residency and/or fellowship training program. The program is designed to prepare you to serve as a leader in academic medicine, and includes formal training in clinical and basic research in preparation for conducting independent research. A combination of clinical specialty or subspecialty training and research experience is offered, leading to clinical specialty or subspecialty certification. Trainees can pursue a master's degree in biomedical science or clinical research. If you would like to apply for a position in the CITP, please indicate your interest when you apply for the Adult Neurology Residency Program.

See also:

• Clinician-Investigator Training Program