Faculty availability is a high priority in the Clinical Neurophysiology, Electromyography Fellowship. Your rotations, clinic schedules and research time are designed to maximize your interaction with faculty members. Although you will learn and see patients with several specialists, you will develop your own style for evaluating and managing patients.

Clinical training

The clinical experience during Clinical Neurophysiology, Electromyography Fellowship includes direct training under the supervision of the consultants working in the Electromyography Laboratory. By the time you successfully complete this program, you will have performed studies on patients with all types of neuromuscular disorders, including:

• Spine and limb disorders
• Peripheral neuropathy
• Myopathy
• Motor neuron disease
• Disorders of neuromuscular transmission

First six months

The fellowship begins with a two-month Clinical Neurophysiology Introductory Course. The course is a formal didactic program covering all areas of clinical neurophysiology. You will study the anatomy, physiology, pathophysiology, pathology and clinical neurophysiological features of disease while learning basic EMG methodologies. You will be tested in these areas before performing clinical studies on patients.

You will spend the next four months gaining experience by performing EMG studies on patients with a wide variety of neuromuscular disorders. You will also identify and begin to implement one or more research projects.

Second six months

During the second six months, you will have the opportunity to learn more advanced techniques - including single-fiber electromyography, evoked potentials and surgical monitoring.

You will perform EMG studies on patients with more complicated neuromuscular problems and take increasing responsibility to work independently on most problems. If you wish, you also can gain experience in quantitative sensory, computer-assisted myometry and autonomic laboratories.

In addition, during the last three months, you will teach neurology residents from Rochester who elect to take a two-month rotation in the Mayo Arizona Electromyography Laboratory. Dedicated time will be provided so you can complete your research projects.

Didactic training

Clinical conferences, lectures, lecture-demonstrations, seminars, small discussion groups, and one-on-one instruction are all an integral part of Mayo Clinic's clinical neurophysiology programs.

Throughout the fellowship, you will participate in a series of formal didactic sessions and regularly scheduled conferences in all aspects of clinical neurophysiology including:

• Bi-monthly EMG/Neuromuscular case conference
• Weekly Neuroscience conference
• Monthly Neuromuscular Journal Club

Research training

You are encouraged to complete at least one investigative project during your training. The type of research project you select will depend on your interests and capabilities and the time available. Opportunities are available for collaborative studies with other clinical and basic science sections at Mayo Clinic.

When you complete your research, you will be 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 will have the opportunity to study in Mayo Clinic's EMG and EEG laboratories learning about the techniques and interpretation of evoked potential studies. This includes exposure to:

• Brainstem auditory evoked responses
• Pattern reversal visual evoked responses
• Somatosensory evoked potentials

Movement disorders

In EEG and EMG laboratories, you also will learn about techniques for assessing movement disorders - including tremors, myoclonus, seizures, botulinum injections and others

Sleep Disorders Center

The Sleep Disorders Center is staffed by consultants in pulmonary medicine.

You may spend time in the laboratory, where you can gain experience in 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

Autonomic Laboratory

If you would like experience in the Autonomic Laboratory, you can arrange time in this area before or after completing your clinical neurophysiology fellowship. This three-month experience includes lectures, supervised reading, training in autonomic testing, and possibly a research project under the supervision of staff.

Mayo Clinic's Autonomic Laboratory focuses on clinical studies. Routine tests performed in the laboratory include:

• QSART (quantitative sudomotor axon reflex test)
• Orthostatic BP and HR response to tilt
• Heart rate (HR) and response to deep breathing (HRDB)
• The valsalva ratio (VR)
• Beat-to-beat BP (BPBB) to valsalva maneuver, tilt and deep breathing
• Tests to detect sympathetically maintained pain or reflex sympathetic dystrophy (RSD)
  • Resting sweat output
  • QSART

Research extension

After a one- or two-year fellowship, you may apply for an extension in one of the research programs. This additional 12 months of training will be devoted to research under the supervision of the laboratory director. This extension requires the endorsement of the chair of the Neurology Education Committee.