Mayo Clinic's Adult Neurology Residency is divided into two parts: one initial year (PGY-1) of graduate medical education in internal medicine followed by three years (PGY-2 through PGY-4) of residency training in adult neurology.
The guiding principle of our training program is graduated responsibility culminating in independent practice at an extremely high level of clinical competence.
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 that 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 the PGY-1 year can be found on the ABPN website.
Mayo offers both categorical and advanced programs, with six categorical slots and three advanced slots. In general, no separate interview with the Department of Internal Medicine is required for those interested in the categorical program. Because we have six categorical slots and nine residents each year, we cannot guarantee a categorical position for all nine trainees.
If Mayo Clinic's campus in Rochester, Minnesota, is high on your list, it is best to rank both the categorical and advanced programs, and have a backup PGY-1 year planned. A separate interview is necessary if you are interested in Mayo Clinic's campuses in Phoenix/Scottsdale, Arizona, or Jacksonville, Florida, or a non-Mayo Clinic medical facility.
PGY-2, -3, -4
You begin your Adult Neurology Residency (PGY-2) with hospital and outpatient experiences. Early in your training, you spend an outpatient month working closely with faculty in the Department of Neurology's Section of Education, refining your skills of neurological examination, history taking, presentation and differential diagnosis.
Hospital-based rotations include:
- General neurology
- Stroke and cerebrovascular disease
- Neurology critical care
- Emergency neurology
The first two (of three) months of child neurology are also completed during the PGY-2 year. You have one month of psychiatry, as is required of all neurology residents by the ABPN.
Elective time is available to residents during every year of training. Most of your PGY-3 year is spent in clinical neurophysiology, neuropathology, elective rotations and outpatient subspecialty rotations in four different areas. You also have two months in the Neurology/Neurosurgery Intensive Care Unit and one month leading the hospital consult service.
In the PGY-4 year, you serve as a senior resident at the hospital and outpatient clinic with greater responsibility in all clinical settings. During hospital assignments, you supervise and teach junior residents and medical students, see and manage routine and emergency admissions, and provide consultations for other inpatient services.
As your experience increases through residency, you are given greater responsibility for patient management. Our residents have found the mix of clinical responsibilities, staff supervision and teaching to be ideal.
The Adult Neurology Residency includes these rotations:
|Outpatient and inpatient adult neurology||19 months||PGY-2, -3, -4|
|Child and adolescent neurology||3 months||PGY-2, -4|
|Core clinical neurophysiology||2 months||PGY-3|
|Electives||9 months||PGY-2, -3, -4|
Sample rotation schedules
Each year also includes one half-day of continuity clinic each week.
|July||Emergency neurology and elective|
|August||Junior resident education (outpatient)|
|September||General neurology (inpatient)|
|December||General neurology (inpatient)|
|April||Emergency neurology and elective|
|June||Neurocritical care and stroke (inpatient)|
|August||Hospital consult service|
|June||Multiple sclerosis and epilepsy|
|August||Movement and neuromuscular|
|November||Senior resident education (outpatient)|
Adult neurology inpatient services
During your inpatient assignments, you learn to evaluate and treat neurological emergencies in the emergency department at Mayo Clinic Hospital, Saint Marys Campus. You evaluate a wide variety of neurological disorders in the inpatient setting and participate in teaching rounds each day in the hospital.
The Neurology Critical Care Service has admitting privileges to the shared Neurology/Neurosurgery Intensive Care Unit. Any patient with an acute, critical neurological disorder is admitted by this service and managed primarily by a team of residents and an attending neurologist. The Neurology 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 neurological disorders requiring inpatient care.
As a PGY-2 resident, you spend up to three two-week periods as the night emergency neurology junior resident (colloquially called the ninja) caring for patients on one of the non-ICU inpatient services and in the Epilepsy Monitoring Unit, as well as seeing patients in the emergency room in conjunction with a PGY-4 resident, according to a night-float model.
Adult neurology outpatient services
In the outpatient clinic, you evaluate patients with both common and unusual neurological conditions and participate in daily teaching case discussions. For one month during each of the PGY-2 and PGY-4 years, you work in the outpatient clinic with staff consultants in the Section of Education, who have been chosen specifically because of their expertise in neurological education.
There are several outpatient clinics within the Department of Neurology that focus on subspecialty areas of neurology. All residents have required rotations in the movement disorders, multiple sclerosis, epilepsy and neuromuscular clinics.
Additional time may be spent in these clinics, or elective time can be spent in any of more than 15 other subspecialty clinics listed below.
You attend an adult outpatient continuity clinic for one half-day each week for all three years of neurology residency. You develop experience in the long-term management of patients who require ongoing care for common and uncommon neurological disorders.
In the PGY-3 and PGY-4 years, you have the option to spend a portion of your continuity clinic time at outreach sites in smaller regional communities or at the Federal Medical Center, Rochester, Minnesota.
Child and adolescent neurology
Your child and adolescent neurology assignments are divided between outpatient clinic and hospital consult services for two months during the PGY-2 year and one month during the PGY-4 year.
You gain experience in dealing with acute and outpatient pediatric problems. You learn the appropriate evaluation of neonatal, infant, child and adolescent patients with neurological problems. You also learn from experienced child epileptologists in the pediatric epilepsy monitoring unit.
During the PGY-3 year, you spend two months in a clinical neurophysiology rotation. This assignment includes didactic instruction and practical experience in the basics of:
- Autonomic function testing
- Electroencephalography (EEG)
- Electromyography (EMG)
- Evoked potentials
- Nerve conduction studies
After completing the core clinical neurophysiology rotation, you can spend two or four additional elective months in EMG, or one to four months in EEG or sleep medicine.
You spend two months training in neuropathology during the PGY-3 year. This rotation gives you direct experience with autopsy material under the direction of a full-time neuropathologist. Your training also includes case reviews, brain cutting and microscopy.
Throughout your residency, you receive regular didactic and clinical instruction in neuroradiology. You can gain additional experience by using elective time to interpret imaging studies with Mayo's team of more than 35 neuroradiologists or observe interventional neuroradiologic procedures.
You have nine months of elective rotations to use throughout the three years of your neurology residency. In addition to further training in rotations outlined above, your elective options include these related clinical and laboratory specialty areas:
- Learn to evaluate and treat disorders such as neuromyelitis optica, autoimmune central nervous system (CNS) disorders with or without associated neoplasm, Lambert-Eaton myasthenic syndrome, myasthenia gravis, and autoimmune peripheral nerve disorders in the Autoimmune Neurology Clinic
- Participate in assay interpretation in the Neuroimmunology Laboratory
- Evaluate patients with neurological, psychiatric and medical disorders in the Behavioral Neurology Clinic, ranging from the commonplace to the exotic
- Learn the anatomical and pharmacological foundations of various cognitive disorders
- Gain experience in interpreting neuropsychological tests
- Treat a wide variety of hemorrhagic and ischemic cerebrovascular disorders
- Learn the procedures and applications of noninvasive cerebrovascular tools, including transcranial Doppler and carotid ultrasound
- Participate in clinical and epidemiological research
During this elective, which is taken after the core clinical neurophysiology two-month course, you choose one or more rotations in these areas:
- Electroencephalography (EEG). During the initial two-month clinical neurophysiology rotation, you 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.
- Electromyography (EMG). During the initial two-month clinical neurophysiology rotation, you learn to perform nerve conduction studies and EMGs. After this, you may choose to work full time in the EMG laboratory for another two to four months. During the additional months, you evaluate patients with a wide range of neuromuscular disorders and gain experience with more specialized electrophysiologic techniques.
- Provide subspecialty consultations in the Epilepsy Clinic
- Evaluate patients before and after epilepsy surgery
- Assist with epilepsy drug investigational studies
- Participate in the multidisciplinary epilepsy subspecialty conference
After a total of six months of training, which includes the two-month required clinical neurophysiology course, you may be eligible for subspecialty certification by the American Board of Electrodiagnostic Medicine. To receive board certification by the ABPN, one year of fellowship training is required.
- Learn the approaches to and management of a wide variety of primary and secondary headache disorders, both common and rare
- Care for patients with common and unusual movement disorders, learning clinical evaluation and treatment approaches in the Movement Disorders Clinic
- Access an extensive video library of movement disorders
- Gain exposure to the electrophysiologic evaluation of patients with movement disorders as well as treatment with botulinum toxin injection in our Movement Disorder Laboratory
- See patients with immune-mediated disorders of the nervous system in the Multiple Sclerosis Clinic
- Learn to evaluate and treat multiple sclerosis and related demyelinating disorders
- Care for patients with common and unusual neuro-oncologic 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 as part of a multidisciplinary team
- Gain experience in ophthalmology as it relates to general medical and neurological problems
- See patients in the outpatient ophthalmology clinic and as part of the inpatient neuro-ophthalmology service
- Learn the anatomy and physiology of the vestibular and ocular motor systems through evaluating patients with complaints of dizziness, vertigo, diplopia, nystagmus and imbalance
- Gain familiarity with interpreting vestibular function testing and audiological tests
- Work with 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
- Assess and treat intractable pain disorders in the Pain Clinic
- Become familiar with both medical and invasive approaches to pain management
- Assist in the clinical assessment of patients with all forms of peripheral nerve disease
- Participate in regular peripheral nerve conferences and nerve biopsy reading
- Learn the appropriate use of electromyography, computerized automated sensory testing, autonomic function testing and nerve biopsies in the diagnosis of peripheral nerve disorders
- Work with patients on the inpatient physical medicine rehabilitation unit
- Gain outpatient experience in evaluating and treating disorders such as stroke, spinal cord injury, traumatic brain injury, and neck and back pain
- Help with the diagnosis and care of patients in a hospital psychiatry unit
- Learn about operant deconditioning procedures to manage chronic pain problems
A distinctive feature of our residency is the Department of Neurology's support of up to six months of research time during residency to complete clinical or basic science projects.
Under the guidance of your research mentor, and with the support of the Adult Neurology Residency research director and program director, you can use this elective time to design and execute your research project.
Residents who wish to transition to an extramurally funded academic career track may use this time to develop preliminary data, take advantage of the numerous education offerings in the Mayo Clinic Center for Clinical and Translational Science (CCaTS) or develop an application to the Clinician-Investigator Training Program.
After completing the two-month introductory clinical neurophysiology course, you can take this rotation, during which you:
- 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
- Learn to recognize the distinguishing auditory perceptual features of the major types of motor speech disorders and their implications for neurological localization and diagnosis
Rotations at other Mayo Clinic campuses
As part of your adult neurology training, you may spend two to four months on rotations at Mayo Clinic's campuses in Phoenix/Scottsdale, Arizona, and Jacksonville, Florida. These rotations offer a unique opportunity to work in a smaller 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.
There are many didactic opportunities associated with the Adult Neurology Residency. Clinical conferences, seminars, small discussion groups, journal clubs, didactic courses and one-on-one instruction are all integral parts of the program.
Formal didactic courses are also required during your residency and include core clinical and emergency neurology, basic neuroscience, neuroanatomy, and neuroradiology.
Your research opportunities at Mayo Clinic are outstanding. The Mayo Clinic neurosciences program encompasses all three Mayo campuses — Rochester, Minnesota; Jacksonville, Florida; and Phoenix/Scottsdale, Arizona — with more than 400 M.D.s and Ph.D.s, 16 departments and divisions, more than 200 federal grants, and 18 National Institutes of Health center grants and program projects.
All neurology residents complete at least one research project with a consultant mentor. These projects range from clinical studies to laboratory-based projects. Neurology residents often utilize the Center for Clinical and Translational Science (CCaTS), which provides free consultative services for patient-oriented research and educates residents and faculty in the design, conduct and analysis of their research.
Department of Neurology research grant funds are available to residents. The vast majority of our residents present their research at national or international meetings, supported by Mayo Clinic's liberal trip policy that financially supports trainee presentation and conference attendance trips throughout residency and fellowship.
Residents also frequently publish their findings in leading journals, and a recent survey showed that the Adult Neurology Residency classes of 2011 through 2013 already have more than 110 publications in print (and counting!).
Post-residency research training
Post-residency training options in research include the Ph.D. Program and the Clinician-Investigator Training Program.
- Ph.D. Program. Mayo Clinic Graduate School of Biomedical Sciences offers a Ph.D. Program in biomedical sciences with specializations in seven tracks. Though these Ph.D. Program tracks emphasize research, they also include a core curriculum for strong foundations 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.
Clinician-Investigator Training Program. The Clinician-Investigator Training Program at Mayo Clinic offers personalized training for selected individuals who wish to pursue careers as clinician-investigators. The program 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 or fellowship training program.
The Clinician-Investigator Training 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 Clinician-Investigator Training Program, please indicate your interest when you apply for the Adult Neurology Residency.
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 abroad and provide medical care to underserved international populations in well-planned and mentored settings.
The program provides selected participants up to $2,000 in financial support to help defray travel and basic living expenses. In recent years, we have had neurology residents train in Botswana, Ecuador, Malaysia, Cambodia and Kenya, among other countries.
Neurological education as a career track has a long history of support in our program. Teaching opportunities abound at Mayo Clinic and in the Adult Neurology Residency. You can teach Mayo Clinic School of Medicine students and visiting students from other medical schools through bedside instruction and formal didactic lectures.
A major senior resident responsibility is teaching junior neurology residents as well as residents from internal medicine, psychiatry and neurosurgery who rotate on the neurology services. Senior residents have the opportunity to join the faculty to teach the pre-clinical neuroscience course at Mayo Clinic School of Medicine. All residents complete a teaching skills course in the PGY-2 year so that they have the necessary skills to educate others.
Departmental and multidisciplinary conferences occur essentially every weekday morning and at noon. In addition to the regularly scheduled departmental conferences, there are resident-only conferences on Tuesdays. Residents direct a series of child and adult neurology case vignettes and participate in an evidence-based medicine journal club. Visiting professors lead small group discussions with the residents.