During the seven year neurosurgery residency training program you will receive advanced education in all aspects of neurosurgery including outpatient and hospital settings. Included in this is a full six months of ICU rotations. 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. Each clinical rotation has their own specific competencies, goals and learning objectives. The department also has specific academic requirements.
Opportunities for enhanced training in a subspecialty area can be enfolded within the seven year curriculum such as complex spine, endovascular, and peripheral nerve training.
Each resident is required to spend a minimum of 42 months of clinical neurosurgery training spread out through seven years. A unique feature of the Mayo neurosurgery training program is the assignment of residents to dedicated clinical rotations on services of one or two faculty member(s) for three month periods. This provides close interaction between the resident and the faculty member(s) and a continuity for patient care on service. A one year research block is set aside to allow each resident to explore an area of neuroscience in detail and to make a contribution in the field. This period may be expanded to two years or, if necessary, longer to allow the resident to obtain a Ph.D. in Neurosciences through the Mayo Graduate School.
The typical rotation sequence for the residency program is:
PGY-1 neurosurgery residents spend four months on the medical neurology service, which includes two months in the Neurology/Neurosurgery Intensive Care Unit. Additionally, the resident will spend two months on the critical care service, three months with the chair of the department and three months on the neurosurgery chief residents' trauma service. During the three months with the chair, the resident will be able to participate in a robust outpatient and inpatient surgical experience.
By the end of this first year, the PGY-1 resident will have a basic understanding of neurological disease and be competent to perform a neurological history and examination. The resident will also have a strong knowledge base for evaluating and caring for the critically ill trauma patient in the intensive care unit. The resident will also have performed basic neurosurgical procedures including ICP monitor placement, external ventricular drain, laminectomy exposures, and basic craniotomies. This first year is expected to lay the foundation for the knowledge and remedial skills required for a stellar career in neurosurgery.
During this year, the neurosurgery resident will spend an additional three months on the medical neurology service with two months in the neurosciences intensive care unit. Hence by the time the resident completes the second year of training, the resident will have had a full six months of ICU education. The resident will spend six months as the first assistant on the chief resident services learning care of acutely ill neurosurgical and trauma patients as well as performing basic neurosurgical procedures. During this time the resident will also have ample opportunity to work one‑on‑one with staff neurosurgeons as first assistant in the operating room.
During the PGY-2 or PGY-3 year, residents will have an opportunity to attend the Research Update in Neuroscience for Neurosurgeons (RUNN) Course held at the Marine Biological Laboratory in Woods Hole, Massachusetts, to develop basic science interests and explore research opportunities.
During this year the resident is assigned to quarterly rotations on the clinical neurosurgery services of the various consultants. 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 mentorship.
During this PGY-3 year, the resident's surgical skills significantly advance. It is expected that during this time, depending on the resident's skill set, he/she will be performing critical parts of an operation with the staff surgeon serving as an assistant. Therefore, the resident's surgical skills improve dramatically during this year. It is expected that the resident better refines their clinical interest and starts to seriously consider career goals.
During the PGY-4 year, the resident will spend three months on neuropathology and three months on neuroradiology. All residents are required to participate in supervised courses on microsurgical technique and skull base dissection during these 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 available. All of this is to prepare the resident for taking and passing with high scores the ABNS written examination. It is expected that the resident will achieve a passing score greater than the 70th percentile. The remainder of the PGY-4 year will be spent rotating with a staff neurosurgeon for three months and doing a three month endovascular rotation with the interventional neurosurgeon.
PGY-5 and PGY-6 Levels
This two-year block is a time in which the resident can choose whether to pursue basic science or clinical research including obtaining higher degrees or obtain subspecialty expertise in surgery such as complex spine or endovascular surgery. For residents who are pursuing a one or two year research block, application for a NREF training grant is highly encouraged. If basic research is chosen, a research plan should have been developed the preceding year with a mentor identified. Clinical research projects may also be chosen which allows the resident to pursue a Clinician Investigator Training Program or a Master Degree.
The emphasis during the research year is towards the development of critical scientific methodology and production of meaningful contributions to basic science or clinical knowledge. For those pursuing additional clinical neurosurgery training, the goal is to develop advanced surgical training in a subspecialty area of interest. Within these two years, both research and advanced clinical training can be combined. Furthermore, each resident is strongly encouraged to rotate to Mayo Clinic in Florida or Mayo Clinic in Arizona for advanced clinical training, notably in endovascular surgery, complex adult spine surgery, or minimally invasive spine surgery. The resident can also spend up to nine months working with the orthopedic spine surgeons at Mayo Clinic in Rochester during this time.
PGY-7 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 for three to six months with one or two of the senior faculty services serving as their primary resident to acquire extra expertise in areas of subspecialty training such as spine, cerebrovascular, endovascular, skull base, tumor, epilepsy, peripheral nerve, stereotactic surgery or radiosurgery.
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 held each week at Saint Marys Hospital which residents are required to attend. 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.
Chair’s Clinical 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.
Core Curriculum in Neurological Surgery – Wednesday
This is a didactic weekly conference centered around a core curriculum in neurosurgery. Each week an expert on a selected topic gives a 50-minute didactic lecture, followed by a question-and-answer session. The course faculty is drawn from the consulting staffs in neurosurgery, neurology, neuroradiology, neuropathology, and other allied specialties. The course aims to cover a core curriculum in our specialty over the course of three years. In addition, there are periodic written examinations to assess performance.
Spinal Neurosurgery – Thursday
This is a rotating conference focusing on spinal disorders. The conference rotates between a spine journal club, a spine trauma case conference, a non-trauma case conference, and a didactic lecture on successive weeks. The course is taught by joint faculty from orthopedic surgery and neurological surgery. The case conferences are resident-driven; the didactic lecture is consultant-driven.
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.
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.
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.
Neurosurgical Oncology Laboratory
This laboratory focuses on the cellular and immunological characteristics of malignant brain tumors. Particular areas of interest include immunotherapy, brain tumor stem cells, and mouse models of malignant gliomas. Our laboratory has demonstrated that an interrelated cellular network mediates immunosuppression in malignant glioma patients including glioma cells (differentiated and stem cell phenotypes), tumor-infiltrating monocytes/microglia, circulating myeloid-derived suppressor cells, and regulatory T cells. Multiple molecular mechanisms contribute to these cells' effects, but evidence from our lab has implicated a central role for the immunosuppressive T cell costimulatory molecule homologue B7-H1. Much of our work is aimed at disrupting this network to facilitate immunotherapies and develop appropriate murine models of glioma-mediated immunosuppression to allow pre-clinical testing. A major aim of our work is to translate discoveries to the clinic through glioma vaccine clinical trials, an effort that is facilitated by the presence of a GMP ("Good Manufacturing Practices") laboratory for generating clinical grade cellular therapy reagents at the Mayo Clinic. We also work closely with other members of the Mayo Clinic Brain SPORE (Specialized Program of Research Excellence). SPORE programs are highly competitive group grants awarded by the National Cancer Institute for translational cancer research programs. Only three "Brain" SPORE's have been awarded nationwide, underscoring the Mayo Clinic's exceptional capacity to perform translational research in neuro-oncology.
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.
Neural Engineering 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.