Curriculum

Mayo Clinic's Physical Medicine & Rehabilitation (PM&R) Residency features 34 months of required rotations in six broad areas and approximately three months of electives. To further enhance your training experience, you will rotate to Mayo Clinic in Jacksonville and/or Mayo Clinic in Scottsdale for up to three months during this residency.

Your training will include a continuity clinic during the last two years. During all three years, you may also choose to serve as a "team physician" for a local sports team.

Clinical Training
The following is a typical rotation schedule for the PM&R Residency at Mayo Clinic in Rochester :

*Other inpatient and outpatient elective rotations are available to meet your career goals.

Rotations

Inpatient Rehabilitation Services
During your inpatient rehabilitation rotations, you will serve as the primary care physician for rehabilitation patients, conduct patient care conferences with the rehabilitation team, and lead clinical discussion groups. A typical patient load includes eight to 10 patients. Residents assume an increasing level of practice independence as their experience and abilities dictate. There are no consulting staff "private" patients. The residents work side by side with the PM&R staff to care for patients. There are three services in Mayo Clinic's 47-bed rehabilitation unit:

• One spinal cord rehabilitation service
• One brain rehabilitation service
• One pediatric rehabilitation service

The spinal cord injury and brain rehab services each will have three residents and one staff physiatrist. While you are assigned to an adult rehabilitation service, you will be responsible for approximately seven to 10 patients. The Rehab Unit admits more than 1,000 patients per year. Trained allied health personnel will perform most ancillary procedures, such as starting intravenous fluids (including blood), performing venipunctures and electrocardiograms, and drawing blood gases.

Pediatric Rehabilitation Services
Your residency will include two months of pediatric rehabilitation services, consisting of inpatient care, consult service and outpatient care. You will learn to assess and manage children with developmental disabilities, cerebral palsy, muscular dystrophy, spina bifida, and acquired disorders such as trauma to the brain and spinal cord injuries. You will also participate in special pediatric clinics such as the Pediatric Pain Clinic and Spina Bifida/CP Clinics and community outreach programs for children.

Hospital Inpatient Consultation Services
While assigned to hospital inpatient consultation services, you will work with staff physiatrists to provide consultation services and regular follow-up for inpatients.

The consulting services at Rochester Methodist Hospital and Saint Marys Hospital differ considerably because of the varying needs of their patients. Each hospital has a caseload of patients with orthopedic and neurological disorders. However, Rochester Methodist Hospital also has cancer rehabilitation and organ transplant rehabilitation programs; Saint Marys Hospital has programs for neurosurgery, trauma, pediatrics and peripheral vascular disease.

Clinic Outpatient Consultation Services
While on outpatient rotations, you will see a wide variety of conditions. You will gain experience in arthritis, amputee, spine center and sports rehabilitation. You will learn to diagnose and manage occupational arm and hand injuries and will work closely with hand specialists in physical medicine and rehabilitation, orthopedic surgeons, physical therapists and occupational therapists. You will gain musculoskeletal examination skills and learn to diagnose and treat musculoskeletal injuries of all types.

Neurology
The neurology rotation includes outpatient and inpatient training. You will learn to diagnose and treat cerebrovascular and seizure disorders, movement disorders, and inherited or acquired central and peripheral nervous system disorders.

Electromyography Laboratory
You will gain extensive experience in electromyography during this unique six-month rotation in the Electromyography Laboratory. You will perform enough electromyographic studies to qualify for certification by the American Board of Physical Medicine and Rehabilitation.

Cardiovascular/Pulmonary Rehabilitation
You will learn important techniques and indications of cardiopulmonary exercise testing. You will use this information to prescribe exercise for patients and to design specific programs for patients with heart and lung disorders especially those with musculoskeletal disorders.

Electives
Most residents spend their elective time in the Pain Rehabilitation Center (PRC), Wound Care Center, Pain Clinic, and some therapy observation.

Other inpatient and outpatient elective rotations will be available to meet your interests and career goals. Your options include electives in the Department of Physical Medicine and Rehabilitation or in other areas, including the Psychiatry Pain Rehabilitation Center .

Didactic Training
Clinical conferences, seminars, small discussion groups, journal clubs and one-on-one instruction are integral parts of Mayo Clinic's PM&R Residency Program.

Your didactic training will include:

• Clinical conference and case presentations presented by physical medicine and rehabilitation consultants, residents, or guest faculty.  Attendance is required.
• Weekly conferences in sports and inpatient rehabilitation services. Attendance will be required while you are on these specific rotations; otherwise attendance will be optional.
• Journal club meets once a month. You will be assigned to approximately one article per year, but journal club attendance is required.
• A comprehensive introductory curriculum and a research training curriculum.
• A comprehensive anatomy course with prosected cadavers paired with a musculoskeletal exam course providing hands-on training and observation of joint and spine examination skills.
• Resident didactic sessions that focus on the biomechanics; pathophysiological basis of tissue healing and repair; the use of different modalities; and disorders of bones, joints, nerves and muscles.
• A two-month clinical neurophysiology course integrated into the EMG rotation.
• Course work in the related specialty fields of neurology, psychiatry, orthopedics and rheumatology.
• A week-long prosthetic/orthotic course.

Research Training
The research training program, includes planning a research project that you will complete during your residency. Projects frequently involve joint biomechanical analysis, epidemiology of specific disorders or new rehabilitation interventions. This experience improves your ability to think analytically and to critically review literature. Research funding is available for approved projects.

During the residency you will prepare two seminar presentations that represent the introduction and results of your research project.

Clinician Investigator Program
A Clinician Investigator program also is available as part of the PM&R residency. This opportunity would extend your training approximately 18 to 24 months. The CI program at Mayo Clinic is an excellent choice if you are planning a career that would emphasize research in an academic center.

Master's Degree Program
Through the PM&R Residency, you may also obtain a Master's Degree in Clinical Research.

Practice Board Exams
To prepare for board examinations, you will participate in the yearly written Self-Assessment prepared by the American Academy of Physical Medicine and Rehabilitation. You also will complete mock oral exams twice each year. Conducted by Mayo Clinic's consulting staff, these oral exams will prepare you for the second part of the physical medicine and rehabilitation boards.

Teaching Opportunities
You will have the opportunity to teach Mayo Medical School students, physical therapy students and visiting students from other medical schools through bedside instruction and formal didactic lectures.  In addition, residents and fellows from other Mayo Clinic departments will occasionally rotate through PM&R.

Regular Conferences & Seminars
Residents present clinical case conferences to the department once per year during their PGY-3 year. An annual Resident Seminar Day provides a forum for presentation of senior residents' research.

Education Conference
PM&R consulting staff present case presentations, covering topics in all subspecialty areas within physical medicine and rehabilitation.

Call Frequency
Your call schedule will vary by individual rotation. Mayo Clinic follows recommendations of the Accreditation Council for Graduate Medical Education. Generally, you will be on call every fourth night and every third weekend while you are assigned to an inpatient rehabilitation service. During the remaining months of your residency, you will cover a weekend consult service approximately once a semester.

Committee Assignments
We feel committee participation is an effective way to promote professional development. Residents may participate on committees both at Mayo Clinic and within national organizations.

Off-site Rotations
You may complete rotations at Mayo Clinic in Jacksonville and Mayo Clinic in Scottsdale during your PM&R Residency. These practices offer acute and subacute, primary care experiences in a community-based practice.

Mayo Clinic funds your authorized additional costs of travel, housing, automobile rental and licensure fees. Our residents consistently rate these rotations very high.

Moonlighting Policy
Moonlighting is permitted for licensed residents beyond the PGY-1 level. Moonlighting activities may be scheduled during those times when you are assigned to consultative or outpatient rotations as long as it does not interfere with your clinical or research-related duties. No moonlighting is allowed while you are assigned to inpatient rotations.

Program & Graduate Outcomes
Residents have many career opportunities upon graduation. It is typical for 30 to 50 percent of our graduates to go on for fellowship training in EMG, Sports Medicine, Spine, Pain Management and others. Ten to 15 percent of graduates choose careers in academic medicine. The remaining 30 to 40 percent select private practice opportunities for their career.

Board Passage Rates & Average Scores
Graduates of our program have a 100 percent pass rate for the American Board of PM&R certifying exam. This is higher than the national pass rate of 86 percent.

Number of Residents in Program
Eight residents complete Mayo Clinic's PM&R residency each year.

Evaluation
The Mayo Clinic PM&R Residency Program is committed to following the guiding principles as put forth by the ACGME Outcome Project. Residents should expect to be evaluated for progress towards achieving competency in the following areas:

• Medical knowledge
• Patient care
• Professionalism
• Practice-based learning and improvement
• Communication skills
• System-based practice

Career Development
You will meet periodically with various faculty members, administrators and the program director to discuss your career goals. Graduates of the Mayo PM&R Residency Program are typically very competitive for entering fellowships or the job market.

Additional Training
At the conclusion of your PM&R Residency, you may wish to continue your medical training at Mayo School of Graduate Medical Education .

Clinical Fellowships
At Mayo Clinic, clinical fellowships are available in EMG (Jacksonville, Rochester or Scottsdale), Pain (Jacksonville, Rochester or Scottsdale), Musculoskeletal Rehabilitation (Scottsdale), Pediatric Rehabilitation Medicine (Rochester) or Sports Medicine (Rochester).

Research Fellowships

The National Center for Medical Rehabilitation Research funds four, two-year research fellowship positions each year.

This optional feature of the PM&R Residency includes a two-year training period with an option for a third-year extension, in which you can focus on research. Highlights of this option include:

• Choice of research focus or tracks - neuroepidemiology, pain or biomechanics. The pain track includes both basic science and behavioral research components. All three tracks include didactic courses in statistics and epidemiology.
• Mentors from Departments of Neurology, Orthopedic Surgery, Anesthesiology, Psychiatry, Physical Medicine and Rehabilitation.
• Didactic learning through Mayo Graduate School - statistics, epidemiology, research ethics, clinical research design, animal research experimental surgery and methodology, clinical trial design, computer methods, questionnaire and survey research design.

Those eligible are physicians with training in PM&R, neurology, orthopedics, anesthesiology, geriatrics, psychiatry or related specialties and Ph.D.s or those with equivalent training in rehabilitation-related fields, such as biomechanical engineering, psychology, speech pathology, physical and occupational therapy and social work.

Advanced Degrees
If you would like to pursue an advanced degree (M.S. or Ph.D.) in the biomedical sciences, Mayo Clinic has a number of programs available that can be customized to your career needs.

Scholarly Activities
PM&R residents are encouraged to submit their research work for presentation at national meetings. If accepted, the department will pay the costs for attendance at those meetings. In addition, each resident is offered one trip to attend a meeting of their choice as an educational and networking opportunity.