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During the neurosurgery residency, you will receive advanced training
in all aspects of neuroscience in both outpatient and hospital settings.
You will participate in the care and surgery of all neurosurgery
patients as an integral member of the neurosurgical team. Progressive
responsibility and surgical experience under the direction of the
neurosurgical faculty is assured throughout the residency.
The seven-year program includes one year in general surgery and
six years in neurosurgical training. For some residents, the duration
of neurosurgery training may be extended beyond six years in order
to fulfill special educational or research goals. Opportunities
for enhanced training in a subspecialty area can be enfolded within
the six year curriculum.
Clinical Training
The typical rotation for the residency program is:
G-1 Level
The G-1 or preliminary year is required by the American Board of Neurological Surgery. This year may be done at an accredited institution other than Mayo Clinic, although residents are encouraged to spend the year at Mayo Clinic in Rochester. If you match to the Mayo Clinic Neurologic Surgery Residency and you wish to complete your G-1 year at Mayo Clinic, you need not apply separately to match to the Mayo General Surgery Residency. However, it is necessary to register with the National Resident Matching Program. See Application Process for more information.
PGY-1 neurosurgery residents spend three months on the medical neurology service, including the Neurology and Neurosurgery ICU. Additionally, the resident will complete nine months of surgical and critical care rotations which include: three months on the trauma and critical care general surgery service, two months on surgical critical care, one month on vascular surgery, six weeks on orthopedics and six weeks on neurosurgery with the Chairman.
G-2 or NS-1 Level
During this year, the neurosurgery resident will spend an additional three months on the medical neurology service with advanced responsibility in the care of adult and pediatric patients. Participation on the neurosurgery chief resident services makes up the remainder of this demanding year in which the resident is intimately involved with the care of both elective and complex trauma patients. During this time, you also will have the opportunity to work with staff surgeons as a first assistant in the operating room.
NS-2 and NS-3 Levels
During these years, neurosurgery residents are assigned to quarterly rotations on the clinical neurosurgery services of the various consultants as well as "basic science" electives. The clinical assignment system is unique in that you work one-on-one with each staff neurosurgeon for three-month intervals before rotating. This allows the evolution of a strong teaching relationship.
Six months will be spent doing neuropathology, clinical neuro-physiology and neuroradiology. Residents are required to participate in supervised courses on microsurgical technique and skull base dissection during these elective rotations, and are encouraged to begin planning for research projects in either basic or clinical sciences.
In addition, a didactic neuroscience course in January through April is mandatory. Three months may be spent on an elective rotation, and an advanced rotation in critical care medicine is encouraged. Occasionally neurosurgery residents choose an elective rotation to the neurology and/or neurosurgery services at Mayo Clinic in Jacksonville, Florida or Mayo Clinic Arizona. A three-month rotation to Jacksonville for focused neurology/neurosurgery training in management of movement disorders has been especially rewarding and popular among our neurosurgery residents.
NS-4 Level
This is a research year during which the resident is expected to perform basic or clinical research. Writing of a NREF training grant is highly encouraged. If basic research is chosen, it is developed based on interest and initiatives developed over the previous years. Clinical projects may also be chosen. The emphasis during this research year is towards the development of critical scientific methodology and production of meaningful contributions to basic science or clinical knowledge. For those residents selected through competitive applications for special training in the Clinician Investigator or Clinical Research Training Programs, that curriculum is intended to be accomplished during the NS-4 and NS-5 years.
NS-5 Level
This year is to complete clinical neurosurgery requirements and can be tailored towards a specific career path in neurosurgery. The flexibility of this year allows the resident to enfold some level of focused subspecialty or "fellowship" training into the residency.
NS-6 Level (Chief Resident Year)
During the final twelve months of the neurosurgery residency, the chief resident has responsibility for managing his/her own clinical service and operating room. This is unique among training programs.
Another unique strength of this program is the fact that the chief resident in effect works as the junior faculty member with a starting operating room in which he/she is the primary surgeon with their own roster of complex elective cases.
During this time the chief resident alternates emergency call, elective surgery and outpatient consultation on a daily basis with a chief resident partner, a schedule similar to that of the full-time faculty. Chief residents are also given the opportunity to rotate on one of the senior faculty services with shared primary responsibility for patients to acquire extra expertise in areas of subspecialty training such as spine, cerebrovascular, skull base, tumor, stereotactic surgery or radiosurgery.
Didactic Training
Clinical conferences, seminars, small discussion groups, journal clubs and one-on-one instruction are all an integral part of the Mayo neurosurgery resident educational experience.
There are five one-hour conferences each week at Saint Marys Hospital. You are required to attend when on clinical services.These include:
Neurosurgery Grand Rounds - Monday
This conference is organized by the administrative chief resident. There is an alternating form, which includes case presentations and discussion, a monthly morbidity and mortality conference dedicated to discussion of complications and quality assurance issues, and a cerebrovascular conference. There are also didactic lectures and presentations by visitors and Mayo staff that compliment this forum. . All faculty and residents attend this conference.
Chairman’s Conference – Tuesday
Complex cases are presented by the Chair in which preoperative diagnosis, surgical approaches, technical pearls, and postoperative complications are discussed. When the Chairman is not available, other staff neurosurgeons participate, discussing their areas of expertise. This conference also alternates with a board review course that includes didactic lectures from neuroradiology and neuropathology.
Joint Neurology/Neurosurgery Conference – Wednesday
This is a combined neurology and neurosurgery conference which is organized in rotation by the various hospital neurology and neurosurgery services. An interesting case is presented and discussed by the attending neurologists, neurosurgeons, neuroradiologists, and other subspecialty expertise.
Journal Club/Spine Trauma Conference – Thursday
This conference alternates between journal club and discussion of complex spine trauma cases. The journal club focuses on a critical review of current neurosurgical and neuroscience literature with discussion being held by residents and faculty. The Spine Trauma Conference is organized by the staff neurosurgeons with a subspecialty interest in complex spine.
Neuro-Oncology Conference – Friday
This is a multi-specialty combined conference in which 4 interesting brain tumor cases are presented and discussed. The faculty from all the neuroscience specialties including neurology, medical oncology, neuropathology, and neuroradiology are in attendance. The format of this conference is that the case presentation, pertinent radiology, surgical approach, pathology, and adjunctive treatment program are analyzed.
Additional Conferences
There are multiple subspecialty conferences held daily throughout the Mayo Clinic which are open to neurosurgical residents. These include a neuroradiology conference which is available to all neurosurgery residents and faculty and is mandatory for residents during their neuroradiology rotation and a weekly Surgical Epilepsy conference.
Research Training
Neurosurgery residents are expected to engage in scholarly pursuits including clinical research projects and during the elective research year, dedicated study and basic laboratory investigation under the direction of a research mentor. Members of the Mayo Clinic Department of Neurosurgery and other established investigators within the Mayo Clinic Department of Research serve as mentors and also assist the resident in developing the research proposal well in advance of the research year.
It is required that all residents will submit or publish one manuscript per year. When these are accepted for presentation, there is a policy which allows residents to present their work at national meetings.
Neurosurgery Molecular Biology Laboratories for Brain Tumor Research
These laboratories have facilities for performing standard and complex molecular biology procedures. There are a vast number of basic science laboratories available to neurosurgery residents across the Mayo Foundation which study gene therapy for malignant brain tumors using retroviral vectors and toxin genes, identification and significance of growth factor and growth factor receptor expression in gliomas and medulloblastomas, and the molecular biology of pediatric brain tumors with an emphasis on medulloblastoma. There is also an expert proteinomics laboratory that is available for neurosurgical participation.
Neurosurgery Regenerative Laboratory
This group engages in advanced research in regenerative neuroscience from the molecular to cell biological and integrative levels. Specific topics under investigation include: molecular analysis of receptors and signal transduction mechanisms; axon guidance, target recognition and regeneration; formation and plasticity of synapses; control of neural cell fate; development of neural networks; regulation of glioma cell motility; and mechanisms controlling vascular development and regeneration. The lab offers an integrated approach to training in modern neurobiology, utilizing molecular, biochemical and cell biological techniques as well as advanced optical imaging. Members of the lab have the opportunity to work closely with the Spinal Cord Injury Research team at Mayo.
Deep Brain Stimulation Laboratory
High-frequency deep brain stimulation (DBS) is an effective treatment for Parkinson’s disease, tremor, epilepsy, dystonia, and depression. However, the precise mechanisms of action for the therapeutic effects of DBS is unknown. Since both DBS and lesionectomy target similar brain regions, it has been thought that electrical stimulation works through neuronal inhibition. However, our lab has found that DBS results in excitation of neuronal and glial elements, suggesting that electrically excited neurotransmitter release may be the mechanism of action of DBS. Accordingly, our lab is studying how DBS effects changes in neuronal action potential firing and modifies neural network activities. To study the mechanism of action of DBS, we perform fluorescent microscopy along with intra-cellular and extra-cellular electrophysiologic recordings. In addition, our lab also utilizes electrochemical techniques of constant potential amperometry to measure neurotransmitter levels both in the in vivo and in vitro setting. Through this research, our lab hopes to combine sophisticated electrophysiological recordings with miniaturized analytical elements (micropressors) to augment and repair disrupted brain functions. Thus, we are actively involved with biomedical engineers to develop the next generation of deep brain stimulation devices.
Multidisciplinary Neural Regeneration Laboratory
This laboratory effort focuses on developing synthetic polymeric scaffolds and controlled delivery of bioactive molecules for peripheral nerve and spinal cord repair and regeneration. This NIH funded research endeavor combines strong collaborative efforts of neurosurgeons, neuroscientists, orthopedists, tissue engineers and cellular neurobiologists, and polymer chemists. The goal of this project is to introduce and commercialize biodegradable conduits for clinical use.
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