Accreditation

The Autonomic Disorders Fellowship is accredited by the United Council for Neurologic Subspecialties  (UCNS).

Certification

When you complete the fellowship, you will be eligible to sit for the UCNS autonomic disorders subspecialty certification examination.

Program history

Mayo Clinic has a long history of clinical and research activity related to autonomic disorders. The Mayo Autonomic Reflex Laboratory was founded in 1983 by Phillip Low, M.D., with Peter Dyck, M.D., and Jack P. Whisnant, M.D., who were instrumental in the early days. Until then, no quantitative tests of sudomotor or adrenergic function were available.

The quantitative sudomotor axon reflex test (QSART), which evaluates the integrity and function of the distal portion of the postganglionic sudomotor axon, was invented by Dr. Low. Patrick Caskey in Mayo's Section of Engineering helped with the design and construction of the unique sweat capsule. Tests of cardiovagal and adrenergic function were added later.

With the availability of beat-to-beat blood pressure recordings using a Finapres device, Mayo investigators coupled this technology with an evaluation of the phases of the Valsalva maneuver to provide a more detailed dissection of adrenergic baroreflex function in addition to a head-up tilt study.

Mayo Clinic's autonomic laboratory has become the nation's standard and the Mayo paradigm for the evaluation of sudomotor, adrenergic, and cardiovagal functions.

 The Autonomic Disorders Fellowship in Arizona begins in 2026.

Positions

There is one position available on a competitive basis each year in the Autonomic Disorders Fellowship program at Mayo Clinic's campus in Scottsdale, Arizona.

Qualifications

To apply to the Autonomic Disorders Fellowship, you must have completed an accredited four-year residency in neurology and be board-eligible for the American Board of Psychiatry and Neurology examination.

Also see general admissions requirements.

How to apply

Mayo Clinic School of Graduate Medical Education does not process printed applications to this program. You must apply through Recruit, a third-party application service. No matching program services are used.

Mayo's academic year begins in July. You must submit a completed application form and all required documentation no later than Sept. 1 the previous year.

Complete the following steps to apply:

1. Create an account to begin the online application for admission
2. All applications to Mayo Clinic School of Graduate Medical Education programs must include these application materials
3. After submission, view the required Supplemental Items and Documents
   1. Upload each required item in the Supplemental Items section (if applicable)
   2. Complete the Recommendation Request section (if applicable)

While in the Autonomic Disorders Fellowship, you are an integral part of the autonomic disorders team. Your responsibilities include evaluating and treating challenging outpatient cases as well as learning to perform and interpret autonomic studies.

Conditions and symptoms you evaluate and treat include:

• Autonomic neuropathies, such as those due to diabetes and amyloidosis
• Autonomic ganglionopathies
• Central autonomic disorders, such as multiple system atrophy and Lewy body disease
• Pure autonomic failure
• Baroreflex failure
• Orthostatic intolerance
• Postural Orthostatic Tachycardia Syndrome (POTS) and associated comorbidities
• Pain syndromes with associated autonomic manifestations, such as erythromelalgia
• Small fiber neuropathies
• Idiopathic orthostatic hypotension

Electives

You will receive eight weeks of elective time during your one-year fellowship.

Elective opportunities are available within neurology (movement disorders, neuromuscular, headache) and in other specialties (gastrointestinal motility disorders, aerospace medicine, rheumatology, etc.).

Didactic training

There is a requirement for you to participate in departmental conferences and in lecturing and training residents, fellows, and visitors in the autonomic lab and clinic. There is direct one-to-one interaction, supervision and education daily.

You will participate in clinical case conferences or research at:

• Neurology Grand Rounds, which are held at noon on Mondays
• Other departmental or interdepartmental conferences as needs and opportunities arise

Research opportunities

You will have excellent research opportunities during your training. The hands-on clinical experiences in this Autonomic Disorders Fellowship, combined with our highly trained laboratory and statistical support teams, create an environment well-suited to scientific investigation.

Your participation in any research project depends on your professional interests and capabilities. Attendance at a national neuroscience meeting is available for original presentations.

Find out more about research in the Department of Neurology.

Teaching opportunities

You will have the opportunity to give formal didactics related to autonomic disorders to neurology residents during their Academic Half Day curriculum.

You will also have the opportunity to use elective time to teach at Mayo Clinic Alix School of Medicine during the first year neuroscience course.

Conferences

• Neurology Grand Rounds, which are held at noon on Mondays.
• Other departmental or interdepartmental conferences as needs and opportunities arise.

Mentorship

A faculty adviser will be assigned to you to provide comprehensive educational advice and personal support. The adviser also serves as a point of contact, introducing you and your family to Mayo Clinic and the communities in which you will train.

Evaluation

To ensure you acquire adequate knowledge and develop the appropriate technical skills to meet program expectations, your performance is monitored carefully during the program. You will be formally evaluated by the supervising faculty member after each clinical rotation, and you will meet with the program director to review these evaluations. In addition, you will also regularly evaluate the faculty to ensure that your educational needs are being met.

The autonomic laboratory is at Mayo Clinic in Scottsdale, Arizona, and its facilities include three tilt-table study rooms.

Mayo Clinic has a very sophisticated, well-developed electronic medical record system. The system, which covers both inpatient and outpatient medical interactions, is integrated throughout all Mayo campuses and facilities. It allows for rapid retrieval of all clinical, laboratory, and imaging studies for patients.

A robust department intranet site provides ready access to extensive online resources for neurological education.

Each consultant has considerable experience in evaluating and treating people with complex neurological disorders, and each has individual clinical and research interests and expertise. The staff has collectively published many manuscripts in peer-reviewed journals.

Specific expertise of members of the staff and the reputation of Mayo Clinic lead to a high-volume practice with a high proportion of patients with complex and challenging medical problems. The experience of the staff, coupled with the high-quality, integrated and efficient practices of all clinical and laboratory specialties, makes Mayo Clinic one of the finest clinical practices of medicine in the world. 

In addition to caring for patients in clinical practice, Mayo Clinic's faculty is committed to teaching and facilitating the growth of medical knowledge. Many of our faculty members have published and lectured extensively and are highly regarded in their fields.

	Karissa Arca, M.D. Dr. Arca is a neurologist with specialization in autonomic and headache neurology. Her clinical focuses are diagnosis and management of disorders affecting the autonomic nervous system; interpretation of autonomic reflex screening; diagnosis and management of complex headache disorders, including those co-existing with autonomic disorders; and patient advocacy and education. Dr. Arca has a special interest in the cross-section of autonomic and headache disorders. In addition to her clinical activities, Dr. Arca is active in research and education. She is the course director for the first-year neuroscience course at the Mayo Clinic Alix School of Medicine and provides additional education to medical students during their clinical clerkships. View full profile
	Shannon Chiu, M.D. Dr. Chiu has interests in Parkinson disease, Lewy body dementia, atypical parkinsonism, tremor, dystonia, deep brain stimulation, and biomarker development in movement disorders. Dr. Chiu also has interests in medical education. View full profile
	Sri Raghav Sista, M.B.B.S. Dr. Sista treats Charcot-Marie-Tooth disease, chronic inflammatory demyelinating polyradiculoneuropathy, Guillain Barre syndrome, inflammatory myopathy, inflammatory sensory ganglionopathy, Lambert-Eaton myasthenic syndrome, Lumbosacral plexopathy, Myasthenia gravis, and POEMS syndrome. View full profile
	Julie Khoury, M.D. Dr. Khoury has interests in neuromuscular disorders, clinical neurophysiology, Myasthenia Gravis, amyotrophic lateral sclerosis, muscular dystrophy, and peripheral neuropathy. View full profile
	Jackie Jacobi, M.D. Dr. Jacobi is a board-certified neurologist at Mayo Clinic in Arizona. She did her internship and neurology residency at Mayo Clinic in Rochester, Minnesota. Following residency, she completed fellowships in clinical neurophysiology and peripheral nerve disorders also at Mayo Clinic in Rochester, Minnesota. She then went on to complete a third fellowship in traumatic brain injuries and sports neurology at Barrow Neurological Institute in Phoenix, Arizona. Dr. Jacobi specializes in neuromuscular conditions and sports related/traumatic neurologic injuries. She has a special interest in peripheral nerve injuries in athletes and the management of neurologic conditions in athletes. View full profile
	Mohamed Kazamel, M.B., B.Ch. Dr. Kazamel’s clinical focus is peripheral autonomic disorders like autonomic neuropathies and central autonomic disorders like multiple system atrophy (MSA). His research interest is focused on the autonomic neuropathies seen in autoimmune disorders, DM, amyloidosis, and acute hepatic porphyrias. Another area of research interest is amyotrophic lateral sclerosis (ALS) epidemiology and validation of fluid and tissue biomarkers used to track ALS progression.  View full profile