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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/.

We offer both categorical and advanced programs, with 6 categorical slots and 3 advanced slots. In general, no separate interview with the Department of Internal Medicine is required for those interested in the categorical program, with some exceptions. Because we have six categorical slots and nine residents per year, we cannot guarantee a categorical position for all nine trainees. If Mayo Clinic in Rochester is high on your list, it is best to list both the categorical and advanced programs, and have a back-up PGY-1 year planned. A separate interview is necessary if you are interested in Mayo Clinic in Arizona, Mayo Clinic in Florida, 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, as well as 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 two months of neuroscience 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.

Rotation Months
Inpatient and Outpatient Adult Neurology 19 months
Child and Adolescent Neurology 3 months
Core Clinical Neurophysiology 2 months
Psychiatry 1 month
Neuropathology 2 months
Electives 9 months

Adult Neurology Inpatient Services

During your inpatient assignments, you will learn to evaluate and treat neurological emergencies in the emergency department at Mayo Clinic Hospital, Saint Marys Campus. 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, Multiple Sclerosis, 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. You will learn from experienced child epileptologists in the pediatric epilepsy monitoring unit.

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 2-4 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 neuropathologist. 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.

Autoimmune Neurology (1-2 months)

  • See patients with autoimmune neurological disorders in the Autoimmune Neurology Clinic.
  • Learn to evaluate and treat disorders such as neuromyelitis optica, autoimmune CNS disorders with or without associated neoplasm, Lambert-Eaton myasthenic syndrome, myasthenia gravis, and autoimmune peripheral nerve disorders with or without associated neoplasm.

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.

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 2-4 months. During the 2-4month 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.

Multiple Sclerosis (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 neuro-ophthalmology service at Mayo Clinic Hospital, Saint Marys Campus.
  • 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 inpatient physical medicine rehabilitation unit at Mayo Clinic Hospital, Saint Marys Campus.
  • 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 extensive elective time to research and pursue a variety of research options. These research months are funded by the Department of Neurology.

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 Arizona and/or Mayo Clinic in Florida. 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.

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.

Mayo International Health Program

Many of our trainees take advantage of the Mayo International Health Program, which helps Mayo residents and fellows pursue elective rotations and provide medical care to underserved international populations in well-planned and mentored settings.

The program provides selected participants up to $2000 in financial support to help defray travel and basic living expenses. In recent years we have had neurology residents train in Botswana, Ecuador, Malaysia, and Kenya among others.

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,neuroradiology, neurology ICU, and quality improvement courses during the PGY-2 year. All residents complete a quality improvement project. An advanced clinical neurology course is taken early in the PGY-3 year. The clinical neurosciences course is taken 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 Mayo Clinic Hospital, Saint Marys Campus; 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. Morbidity and Morality Conference is presented three times per year during the Friday conference.

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. All resident complete a teaching skills course in the PGY-2 year so that they have the necessary skills to educate others.

Research Training

Your research opportunities at Mayo Clinic are outstanding. The Mayo Clinic Neurosciences Program encompasses 3 campuses (Mayo Clinic in Rochester, MN; Mayo Clinic in Arizona; Mayo Clinic in Florida), with over 400 MDs and PhDs, 16 departments and divisions, over 200 Federal grants, and 18 NIH Center grants and Program projects.

All residents complete at least one research project with the consulting staff. These projects range from clinical studies to laboratory-based projects. Neurology residents often utilize our Center for Translational Science Activities (CTSA). The CTSA provides consultative services for patient-oriented research, and educates residents to design, conduct, and analyze their own research. The large majority of our residents present their research at national or international meetings, and after presentation publish their research. Mayo Clinic has a liberal trip policy, with excellent financial support for trainee presentation and attendance trips.

See also:

During your Adult Neurology residency, you can focus on:

  • Autoimmune neurology
  • Autonomic neurology
  • Behavioral neurology
  • Cerebrovascular disease
  • Clinical neurophysiology
  • Critical care neurology
  • Deep Brain Stimulation
  • Electroencephalography
  • Electromyography
  • Epilepsy
  • Headache
  • Movement disorders
  • Muscle disease
  • Neurochemistry and neuropharmacology
  • Neuroepidemiology
  • Multiple sclerosis
  • Neurology education
  • 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

Post-Residency Research Training Options

Post-residency training options in research include the Ph.D. Program and the Clinician-Investigator Training Program.

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:

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.

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