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Curriculum

Mayo's two-year Pediatric Rehabilitation Medicine Fellowship Training Program is designed to prepare individuals for a full-time academic career in Pediatric Rehabilitation Medicine. Graduates of this program will be able to function independently as program directors, teachers, or laboratory investigators in university medical schools or medical centers.

Rotations

A typical rotation schedule includes:

Rotation Length
Inpatient Pediatrics PM&R 7 months
Outpatient Pediatrics PM&R 6 months
Dedicated Research 2 months

Pediatric Subspecialty Rotations

(Neurology, Rheumatology, Orthopedic Surgery, Genetics, Developmental Pediatrics, NICU, PICU, General Pediatrics, Radiology)

7 months
Electives 2 months

Rotation Descriptions

General Outpatient Pediatric Rehabilitation Rotations

The goals during this rotation are that you will:

  • Understand, select, apply and interpret PRM assessment tools including development attainment measures, general functional measures and specific outcome measures (e.g., Peabody, Bruininks, GMFM, Preschool Language Scale, etc.) in order to promote effective intervention.
  • Identify and manage common rehabilitation medical conditions and complications such as:
    • Nutrition, swallowing and feeding disorders
    • Neurogenic bowel and bladder
    • Osteoporosis
    • Gastroesophageal reflux
    • Pressure sores
    • Pulmonary hygiene and protection
    • Motor and sensory impairments
    • Sleep disorders
    • Lymphedema
    • Spasticity
    • Contractures
  • Identify strategies to promote health and wellness and prevent complications such as those mentioned above in various medical conditions
  • Learn principles of interventions related to therapeutic management of various disabilities in order to improve function and quality of life (early intervention, various therapy strategies, use of modalities, etc.)
  • Evaluate, prescribe and follow up on age-appropriate assistive devices and technology such as orthotics, prosthetics, seating systems, adaptive equipment, gait aids, augmentative communication and environmental accessibility aids in order to improve independent function
  • Manage rehabilitation conditions including:
    • Cerebral palsy
    • Spina bifida
    • Muscular dystrophies
    • Hereditary peripheral neuropathies and peripheral nerve injuries
    • Musculoskeletal disorders and sports injuries
    • Inflammatory joint disease and other rheumatologic disorders
    • Chronic pain
    • Limb deficiency and amputation
    • Plagiocephaly and torticollis
    • Developmental delays due to hereditary and acquired disease
  • Request appropriate medical and surgical consultations from other medical and surgical specialists
  • Understand, integrate and perform pediatric rehabilitation procedures such as Botox and phenol injections, baclofen pump refills and programming
  • Advocate for care needs within the systems of care including educational, vocational, transition and home care systems

General Inpatient Rehabilitation Rotations

The goals during this rotation will be:

  • Identify and manage common medical conditions associated with childhood onset disorders such as:
    • DVT prophylaxis
    • Nutrition management
    • Skin protection
    • Respiratory hygiene
    • Sleep hygiene
    • Neurogenic bowel and bladder
    • Acute pain
    • Spine precautions
    • Seizure management
  • Manage rehabilitation conditions including:
    • Brain injury
    • Spinal cord injury
    • Multi-trauma
    • Stroke
    • Tumors/cancer
    • Burns
  • Outline the clinical course of and functional prognosis for these conditions
  • Provide consultation to physiatrists, pediatricians and other clinicians regarding pediatric rehabilitation medicine issues
  • Understand, integrate and perform diagnostic procedures such as EMG
  • Understand, order and interpret various diagnostic studies such as videofluoroscopic swallow evaluations, ultrasounds, EMG, laboratory studies, etc.
  • Develop skills and lead the rehabilitation team in order to enhance efficiency and efficacy of patient care
  • Plan, facilitate and coordinate transitions within and dismissal from the hospital along the continuum of care

General Pediatric Hospital Rotation

During this rotation, you will:

  • Develop understanding of pre-hospital decision-making and care of children who are subsequently hospitalized (phone, outpatient clinic, emergency department)
  • Gain proficiency in the evaluation and management of inpatient children with general pediatric problems and/or subspecialty concerns
  • Develop skills in planning, implementing, and completing the evidence-based management and care of hospitalized children including the use of medical information systems
  • Learn to appropriately order and interpret laboratory tests and radiological evaluations
  • Learn to work with nurses and other staff members to monitor and follow patients
  • Learn about family, social, cultural, economic, and medical issues in the inpatient care of children
    • Learn to coordinate ongoing post-hospitalization care and effectively transition patients through discharge
    • Gain experience in accurately documenting and completing the medical record
    • Learn skills of effective communication of medical information to patients
    • Develop skills as an educator of medical students and allied health staff

NICU

In the Neonatal Intensive Care Unit (NICU), you will:

  • Recognize high-risk factors in the care of pre-term and term newborns
  • Apply knowledge of respiratory physiology to neonates with lung disease
  • Recognize common newborn medical problems
  • List the differential diagnoses for common newborn signs and symptoms

PICU

In the Pediatric Intensive Care Unit (PICU), you will learn:

  • The pathophysiology and initial management of shock including the appropriate use of fluids, inotropes and vasoactive medications
  • The pathophysiology and initial management of respiratory failure, including principles and methods or artificial ventilation
  • The principles guiding the initial management of coma, status epilepticus, and raised intracranial pressure
  • The principles, including pain management, of postoperative care
  • The pathophysiology and management of acute renal failure including indications of dialysis
  • The role of nutrition and fluid management in the critically ill
  • The initial management of multiple traumas with and without head injury
  • The principles, techniques and limitations of invasive and non invasive cardiorespiratory monitoring
  • The impact of critical illness and death on the child and family
  • The determination of brain death and principles of organ donation
  • The pathophysiology and management of cardiorespiratory arrest\
  • Management of the child with special needs including technology dependency

Pediatric Neurology

On this rotation, you will:

  • Be able to obtain an adequate clinical history and perform a neurological examination on newborns, infants, toddlers, preadolescents and adolescents
  • Become well-versed in the management of neurological emergencies:
    • Status epilepticus
    • Bacterial meningitis
    • Acute viral meningoencephalitis
    • Acute or subacute progressive, generalized weakness
    • Brain herniation syndromes
    • Acute ataxia
    • Acute intoxications
  • Become well-versed in assessing and managing:
    • Developmental delay
    • Developmental regression
    • Subacute or chronic progressive weakness
    • Subacute or chronic progressive ataxia
    • Seizure disorders, including febrile seizures
    • Communication disorders in pre-school age children
    • Tourette syndrome
    • Attention deficit hyperactivity disorder
    • Indications for common neuro-diagnostic tests

Pediatric Rheumatology

During this rotation, you will:

  • Be familiar with key elements of the history and physical examination of children with musculoskeletal complaints or potential rheumatic disease
  • Have an understanding of the important and potentially serious diagnoses encountered in the differential diagnosis of children with rheumatic complaint
  • Understand appropriate use of the laboratory studies and imaging studies as they apply to children with potential rheumatic disease
  • Have an understanding of the expectations and potential problems with treatment modalities in children with rheumatic conditions, including non-medical therapies
  • Learn about conditions that are given special emphasis including:
    • Juvenile rheumatoid arthritis (JRA)
    • Systemic lupus erythematosus (SLE)
    • Henoch-Schonlein purpura (HSP)
    • Kawasaki disease (KD)
    • Seronegative spondyloarthropathies
    • Juvenile dermatomyositis (JDMS)
    • Non-inflammatory causes of joint pain ("growing pains", etc.)

Pediatric Orthopedic Surgery

During this rotation, you will:

  • Evaluate new clinic patients by history and physical examination
  • Develop a plan for further evaluation of the orthopedic problem(s) with the efficient use of appropriate diagnostic tests
  • Learn when it is appropriate to initiate referral for orthopedic surgical consultation
  • Develop a treatment plan once the orthopedic problem has been clearly identified
  • Observe orthopedic surgical procedures likely to be encountered by patients in a pediatric rehabilitation practice such as scoliosis repair, contracture release and hip reconstruction
  • Become familiar with post operative restrictions and rehabilitation plans

Genetics

The key learning areas in this rotation will be for you to:

  • Develop a systematic approach to the examination and diagnosis of patients with genetic diseases
  • Develop an appreciation for the indications and components of genetic counseling
  • Become familiar with the genetic syndromes most commonly referred to a pediatric rehabilitation practice such as Down syndrome, Prader Willi, metabolic disorders, hereditary ataxias and neuropathies, etc.

Developmental pediatrics

During this rotation, you will:

  • Describe normal growth and development including physical growth, developmental skills attainment, and transitional issues
  • Understand and develop behavioral management plans within the family centered model
  • Understand the social impact of a disabled child on the family and community as well as the impact of the family and community on a disabled child
  • Evaluate and identify interventions to assist children and their families to participate successfully in age/stage appropriate education, recreation and vocational activities.

Night Call

You will take night call from home. During call, you will have an attending rehabilitative medicine specialist available for consultation as needed.

Didactic Training

Mayo Clinic's Pediatric Rehabilitation Medicine Fellowship Program allows you dedicated time to participate in an extensive didactic training program that includes:

  • Lecture series in pediatric orthopedics, pediatric neurology, pediatric radiology and others
  • Pediatric morning report, noon conferences and grand rounds
  • PRM and PMR lecture series, grand rounds, seminar days and journal clubs
  • Mayo Multidisciplinary Simulation Center

Fellows will present reports on current research projects for critical review annually. In addition, fellows may attend one national PRM-related meeting for educational purposes during their program and any other national meeting for which they have an abstract accepted for presentation.

Research Training

Our goal during this training is to support you in your area of academic interest. The time dedicated to research during training will be utilized to prepare you to become an independent investigator upon completion of your training. At Mayo Clinic, there are many opportunities for you to pursue basic science, translational, clinical or educational research. We will work to match your interest with the research interests of a dedicated mentor.

Each fellow will be encouraged to take research courses within Mayo Graduate School. Typical coursework will begin with an introduction to clinical research and statistics and will include a course in aspects of research in pediatrics and adolescent medicine. These courses will aid in the development of a scholarly approach to patient care.

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