Clinical training

The Clinical Neurophysiology Electroencephalography Fellowship begins with a two-month clinical neurophysiology introductory course that covers all areas of clinical neurophysiology. The anatomy, physiology, pathophysiology and clinical neurophysiological features of disease are emphasized, along with the technical aspects of testing methods.

Rotation descriptions

During the subsequent months, you alternate rotations in the Epilepsy Monitoring Unit, Clinical Neurophysiology Laboratory and outpatient clinic.

Electroencephalography (EEG)

During the time spent in the Clinical Neurophysiology Laboratory, you interpret a large number of EEG records from adults and children with a wide variety of disorders. Routine EEG, continuous EEG monitoring and tele-EEG via remote digital interpretation are performed.

Over the duration of the fellowship, you are given increasingly independent responsibility to oversee complex problems, occasionally receive emergency calls, oversee and perform continuous EEG and surgical monitoring, learn about evoked potentials, teach residents, and present lectures and seminars.

There is a strong emphasis on EEG in epilepsy. You are exposed to a variety of seizures, the monitoring techniques used to evaluate them (including continuous EEG monitoring), and intraoperative and extraoperative neurophysiological techniques used for recording during surgery.

You also have the opportunity to rotate to the Sleep Center, rotate to the electromyography (EMG) or autonomics labs, or participate in neurophysiological intraoperative monitoring to get a broad experience in clinical neurophysiology.

Epilepsy

During the time spent on the epilepsy services, you take care of patients on the inpatient epilepsy monitoring service, see patients in the epilepsy outpatient clinic and may see patients on the hospital epilepsy consulting service.

The schedule of clinical activities is designed to achieve a balance between outpatient and inpatient EEG and patient care, as well as ensure that you have experience with different aspects of epilepsy care and EEGs. You work with both adult and pediatric patients and are involved with anti-seizure drug therapy and surgical treatment for both new-onset seizures and drug-resistant epilepsy.

Dedicated forms of surgical intervention include scalp-based and intracranial video-EEG monitoring, intraoperative and extraoperative electrocortical stimulation for functional brain mapping, Wada testing, electrocorticography and motor strip mapping, and central and peripheral neurostimulation programming.

The rotations are designed so that you have gradually increasing responsibilities in these areas. By the end of your fellowship, you should be able to perform these activities independently.

Didactic training

Clinical conferences, lectures, lecture-demonstrations, seminars, small discussion groups and one-on-one instruction are all integral parts of the Clinical Neurophysiology Electroencephalography Fellowship.

You have the opportunity to attend weekly conferences on EEG and EMG. There is a weekly multidisciplinary epilepsy surgery conference. These conferences include clinical EEG case reports, lectures and lecture-demonstrations about:

• Electronics and instrumentation
• Essential neurophysiology
• Scalp EEG
• Intracranial EEG
• Intraoperative EEG
• EEG in special care units
• Evoked potential studies
• Autonomic function studies

You also may attend other weekly seminars and conferences in neurology, neuropathology and pediatric neurology.

During your fellowship, you participate in a series of formal didactic sessions and regularly scheduled conferences in all aspects of clinical neurophysiology. There are regular conferences in clinical neurophysiology, intensive care unit EEG, surgical epilepsy, movement disorders and sleep disorders. Opportunities for teaching and research also are available.

Research training

You are encouraged to complete at least one investigative project during your training. The type of research project you select depends on your interests and capabilities and the time available. Opportunities are available for collaborative studies with other clinical and basic science areas at Mayo Clinic's campuses in Phoenix/Scottsdale, Arizona, and Rochester, Minnesota.

When you complete your research, you are expected to present it at a scientific meeting or prepare it for publication in a scientific journal. This experience teaches you how to comprehend and critically evaluate other reported investigations and gain insight into the conduct and principles of research.

Additional training

Evoked potentials

You have the opportunity to study in Mayo Clinic's Clinical Neurophysiology Laboratory, learning about the techniques and interpretation of evoked potential studies. This includes exposure to:

• Visual evoked potentials
• Brainstem auditory evoked potentials
• Somatosensory evoked potentials
• Intraoperative evoked potentials and neurophysiological intraoperative monitoring

Sleep Disorders Center

The Mayo Clinic Sleep Disorders Center is a multidisciplinary center staffed by consultants in pulmonary medicine, neurology and psychiatry.

Elective rotations in the Sleep Disorders Center are available in order to give you experience performing and interpreting nocturnal polysomnography and multiple sleep latency tests. Here, you also have the opportunity to see patients with a wide variety of sleep disorders, including:

• Narcolepsy
• Sleep apnea syndrome
• Parasomnia
• Insomnia

A separate one-year Sleep Medicine Fellowship is available at Mayo Clinic's campus in Rochester, Minnesota. This fellowship fulfills training requirements for certification by the American Board of Sleep Medicine.

Electromyography (EMG)

In the Clinical Neurophysiology Laboratory, you can also learn about techniques used for assessing neuromuscular disorders. You have the opportunity to learn the basics of EMG and nerve conduction studies during nondedicated time in EEG.

There is an opportunity to interact with the Clinical Neurophysiology Electromyography Fellowship to augment learning in a wide variety of neuromuscular disorders, including:

• Neuropathies of all types
• Anterior horn cell diseases, such as amyotrophic lateral sclerosis
• Neuromuscular junction disorders, such as myasthenia gravis
• Myopathies

Autonomic laboratory

If you would like experience in the autonomic laboratory, you can arrange time in this area during your fellowship. Mayo Clinic's autonomic division in the Clinical Neurophysiology Laboratory has two clinical components:

• Clinical autonomic reflex studies
• Cardiology electrophysiology exposure

Evaluation

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