Curriculum

The Adult Neurology Residency Program provides comprehensive training that will prepare you for a career in private practice, research or academic medicine. The program features:

• A formal course in evidence-based medicine
• Specialized inpatient services, including a full-time multidisciplinary stroke program
• A active epilepsy monitoring unit and epilepsy surgical practice
• Deep brain stimulation programs for complex movement disorders
• Nationally certified multidisciplinary clinics in ALS and multiple sclerosis
• NIH-funded research programs in aging and dementia.
• Parkinson's disease and related movement disorders programs
• A renowned clinical neurophysiology program.
• Ample opportunities for clinical research in all of the subspecialty areas
• Ample elective time to pursue individual areas of interest
• Opportunity to pursue elective rotations at Mayo Clinic practices in Rochester, Minn., and
  Jacksonville, Fla.

Clinical Training (PGY-1 through PGY-4)
The Adult Neurology Residency emphasizes the clinical essentials necessary to become skilled in the practice of neurology, and instills in its residents an interest and enthusiasm for patient care, education and research.

Features include:

• A unique integrated electronic medical records system
• Rotations in neuropathology, neurosurgery, neuroradiology, physical medicine and rehabilitation and psychiatry
• An extensive outpatient experience
• Seven months of elective time
• Elective rotations offered in every subspecialty of neurology
• A humanistic approach to patient care

You will begin your adult neurology residency (PGY-1) in the Transitional Year Residency program.  

•  See  http://www.mayo.edu/msgme/transyr-sct.html

Your PGY-2 year in the Adult neurology residency program will begin with hospital and outpatient experiences.

On clinical assignments, you will be the primary physician seeing several new neurology patients each day. During hospital assignments, you will supervise and teach junior neurology residents, medical residents and medical students. You will evaluate and manage both routine and emergency admissions, and provide consultations for other services.

As your experiences increase during your residency, you will be given greater responsibility in both patient management and resident education. Throughout your residency, you will receive regular didactic and clinical instruction in neurology, neuroradiology, physiatry and psychiatry.

Typical Rotation Schedule

Rotation Descriptions

Adult Neurology Outpatient Services
While on outpatient rotations at the clinic, you will evaluate patients with both common and unusual neurological conditions. You will participate in daily teaching, case discussions and have numerous outpatient educational opportunities.

Adult Neurology Inpatient Services
During your inpatient rotations, you will learn to evaluate and treat neurological emergencies in the Mayo Clinic Hospital emergency room. 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.

Electives
To further your training in adult or child and adolescent neurology, you will have seven months of elective rotations, which include:

• Behavioral neurology
• Cerebrovascular disease
• Clinical epilepsy
• Clinical neurophysiology
• Headache
• Movement disorders
• Multiple sclerosis/Demyelinating disease
• Neuro-oncology (Mayo Clinic in Rochester)
• Neuromuscular diseases
• Research
• Sleep disorders
• Neurointensive care (Mayo Clinic in Rochester)

You can also choose to spend elective time in Psychology and Behavioral Medicine and Neuro-otology.

Pediatric Neurology
During PGY-2 (two months) and PGY-4 (one month), your pediatric neurology assignments will be divided between hospital and outpatient clinic services. Your pediatric neurology experience will take place at St Joseph 's Hospital in Phoenix , Ariz. This is an approximately 25 minute drive from Mayo Clinic. You will not have outpatient or inpatient responsibilities at Mayo Clinic during this rotation. You will gain experience in dealing with acute and outpatient pediatric neurological disorders. You will learn the appropriate evaluation of neonatal, infant, child and adolescent patients with neurological disorders.

Neuropathology
You will spend two months rotating in neuropathology during PGY-3. This rotation will give you direct experience with the evaluation of autopsy material at St. Joseph 's Hospital in Phoenix , Ariz. Your training also will include case reviews, brain cutting and the study of microscopic materials. You will not have outpatient or inpatient responsibilities at Mayo Clinic during this rotation.

Psychiatry
During PGY-4, your psychiatry assignment will be divided between hospital and outpatient clinical services. During this rotation, you will participate directly in the evaluation and decision-making for patients referred to psychiatry. You will learn the psychological aspects of the patient/physician relationship and importance of personal, social, and cultural factors in disease processes. You will learn the principles of psychopathology, psychiatric diagnosis and therapy, and the indications for and complications of drugs used in psychiatry.

Neuroradiology
During PGY-4, your neuroradiology assignment will be divided between hospital and outpatient clinic services. You will gain additional experience during this rotation, interpreting imaging studies with a neuroradiologist and observing neuroradiologic procedures. Radiological procedures reviewed in this rotation include:

• Computerized tomography of the head and spine, CT angiography, and spiral CT
• Magnetic resonance imaging and magnetic resonance angiography
• Conventional cerebral angiography
• Endovascular interventional procedures
• Myelography

Neurosurgery
During PGY-4, your neurosurgical assignment will be divided between hospital and outpatient clinic services. You will participate directly in the evaluation of and decision-making for patients referred to the service. You will gain experience evaluating acute neurologic emergencies and neurosurgical problems.

Core Clinical Neurophysiology
During PGY-3, you will spend at least two months in a clinical neurophysiology rotation. This assignment includes didactic instruction and practical experience in the basics of:

• Electromyography (EMG)
• Nerve Conduction Studies (NCS)
• Electroencephalography (EEG)
• Evoked Potentials
• Autonomic Function Testing
• Polysomnography

Continuity Clinic
You will attend a continuity clinic for one-half day per week throughout years two, three and four. In this clinic, you will develop experience with consistent follow-up of patients requiring ongoing care for a variety of neurological disorders.

Off-site Rotations (Optional)
You will have the opportunity to do elective rotations at Mayo Clinic in Rochester or Mayo Clinic in Jacksonville in a subspecialty area of your choice during your training.

Opportunities exist for neuro-oncology and neuro-intensive care rotations at Mayo Clinic in Rochester .

Mayo 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. 

Didactic Training
Clinical conferences, seminars, small discussion groups, journal clubs, 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. The curriculum involves an introduction to clinical neurology, cardinal symptoms, and neurological emergencies in the PGY-2 year. Clinical neurophysiology and basic neuroscience course are mandatory during the PGY-3 year. Advanced subspecialty course is required during the PGY-4 year.

The Merit Center
The MERIT Center (Mayo Clinic in Arizona Evidence-Based Clinical Practice, Research, Informatics and Training Center ) provides formal education in evidence-based medicine (EBM) principles to Mayo Clinic trainees and faculty and to foster research in evidence-based practice that will ultimately impact patient care.

The center facilitates a multi-departmental, evidence-based, clinical practice curriculum, for trainees and consultants at Mayo Clinic in Arizona. This multidisciplinary program, which is a mandatory conference for trainees, began with the departments of Family Medicine, Internal Medicine and General Surgery and now includes the Neurology department at all three Mayo Clinic practices.

The EBM curriculum is the educational cornerstone of the MERIT Center. EBM conference goals include fostering life-long learning and provision of skills to allow clinicians to continually update their knowledge base and refine critical appraisal and decision-making skills. The Evidence-Based Neurological Practice (EBNP) curriculum meets the requirements of new ACGME core competencies, specifically those of medical knowledge and practice-based learning and improvement.

The specific goals of the EBNP curriculum include:

• Instruction of core EBM principles:
  - Rationale for and limitations of EBM
  - Basic principles of EBM in clinical practice
• Skill development in assembling clinically-appraised topics (CATs):
  - Recognizing knowledge gaps and constructing answerable clinical questions

  within the general categories of diagnosis, therapy, prognosis, and causation/harm
  - Searching and appraising the literature
  - Drawing evidence-based conclusions with application to clinical practice

The EBNP curriculum structure includes introductory didactic presentations that review the principles of EBM and the skills required for literature searching, quantitative evidence appraisal, and application to practice.  The core program are MERIT Neurology conferences that are integrated into Neuroscience Grand Rounds every two months.  During that session, a trainee, a MERIT faculty member, and a clinical content expert lead a structured patient-based presentation and discussion that takes participants through all aspects of the EBM process, including formulation of the clinical question, the literature search strategy and results, article appraisal and statistical review, and summary of the evidence.  “Clinical bottom lines” are derived from the resident’s pre-conference work and discussions with MERIT faculty combined with input from the conference participants and perspective from the clinical content expert.  The work is summarized in a 2-page written CAT which is then peer-reviewed and published on the Arizona practice intranet site.  This appraised evidence is then available to all Mayo clinicians.  Once per quarter,  this program structure is applied in a 3-site satellite videoconference with participants from the training programs in Rochester, MN, Jacksonville, Fl, and Scottsdale, AZ.  This program structure was designed to foster an environment of scholarly resident-faculty interaction that includes continuous self-directed learning and ongoing evaluation of EBM skills and provides numerous opportunities for resident research and educational projects.

Research Training
Adult neurology residents must conduct scholarly activity during their residency. You may develop a chart review, case report or original investigation.

You will be required to present the results of your research project during your PGY-4 year during a grand rounds presentation. You will be encouraged to submit an abstract on your research for presentation at a national neurology meeting such as the American Academy of Neurology or American Neurological Association meeting.

Support services are available from the clinical studies unit. A list of faculty mentors and areas of interest will be provided. During your residency, you may focus on:

• Behavioral neurology
• Cerebrovascular disease
• Electroencephalography
• Electromyography
• Headache
• Movement disorders
• Muscle disease
• Neuromuscular junction diseases
• Neuro-oncology
• Neurosurgery
• Peripheral nerve disease
• Psychopharmacology

Teaching Opportunities
You will have the opportunity to teach internal medicine and family medicine residents, as well as Mayo Medical School students and visiting students from other medical schools through bedside instruction and formal/informal didactic lectures.

Throughout your residency, you will participate in the weekly teaching conferences. Seminars and lectures are presented throughout the year on the principles of neurochemistry, neuropharmacology, neuroimmunology and diseases related to these disciplines. Additional subspecialty conferences are presented regularly by all divisions of the Neurology Department.

Call Frequency
Residents are on call every fourth night on most in-patient services. You will have one 36-hour period free of hospital/clinic duties each weekend. The 80-hour work week rule, mandated by the National Residency Review Council, is adhered to rigidly. The Adult Neurology Residency Program has adopted the Mayo Institutional Duty Hours Policy and requirements for all residents and fellows.

Committee Assignments
You will gain administrative experience by participating in committees involved in the administration of education programs and clinical practice at Mayo Clinic.

Case Studies
During the neurology training program, you will prepare case study presentations. You will present the pertinent information of an interesting case, conduct an in-depth discussion of that case, and learn to systematically search and interpret the medical and scientific literature.

Evaluation
Performance is monitored carefully throughout the Adult Neurology Residency Program to ensure that you acquire the knowledge to develop appropriate technical skills. The skill with which each resident acquires competence in the six core-competency domains defined and mandated by the American Council for Graduate Medical Education will be carefully measured.

There will be an ongoing and comprehensive evaluation of resident performance that will include clinical examinations, objective structured clinical and competency examinations, and mock board examinations. Semi-annual chart audits and 360 degree evaluations of residents performed by patients and allied health staff will also be conducted.

You will be assigned a personal faculty advisor to provide constructive feedback and guidance on a regular basis. In addition, you will evaluate faculty in each rotation to ensure that your educational needs are met.

Career Development
Periodically, you will meet with the program director, associate program director and faculty to discuss your career goals. Mayo Clinic recruits many of its staff physicians from its training programs. Thus, when you successfully complete the adult neurology residency, new opportunities may be available at one of Mayo's group practices.