The Clinical Neurophysiology Electromyography Fellowship curriculum is flexible, and any of these areas may be emphasized, depending on your individual interests and needs.

Clinical training

The clinical experience during this fellowship includes direct training under the supervision of the consultants working in the Electromyography Laboratory. By the time you successfully complete your training, you will have participated in the clinical evaluation and 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 the two-month Clinical Neurophysiology Introductory Course. The course is a formal didactic program covering all areas of clinical neurophysiology. You study the anatomy, physiology, pathophysiology, pathology and clinical neurophysiological features of disease while learning basic electromyography (EMG) methodologies. Practical and content-based tests in these areas will be given before you may perform clinical studies on patients.

During the next four months, you perform patient EMG studies, refine your clinical skills and gain experience with a variety of neuromuscular disorders. You also participate in didactic sessions and present occasional conferences. During this time and throughout the remainder of the fellowship, you have your own neuromuscular clinic each week staffed by neuromuscular consultants and ongoing development of skills. You also have exposure to pediatric patients undergoing sedated EMG.

Second six months

During the second half of the year, you have the opportunity to learn more advanced techniques, including single-fiber electromyography, evoked potentials and intraoperative neurophysiological monitoring.

You perform EMG studies on patients with more-complicated muscular problems. If you wish, you can gain experience in quantitative sensory testing, autonomic testing and intraoperative monitoring. There also are opportunities for some participation in muscle and nerve biopsy reading sessions as well as exposure to sister fields in rheumatology if desired, although this fellowship is not intended to provide competence in these areas.

The Clinical Neurophysiology Electromyography Fellowship also provides the opportunity to rotate to the Electroencephalography Laboratory and Movement Disorder Laboratory to get a broad experience in clinical neurophysiology. As per the common program requirements, a dedicated two-month exposure to another area in clinical neurophysiology is required that includes electroencephalography (EEG) and intraoperative monitoring.

In the last six months, you assume increased responsibility for patients' clinical care and help supervise other EMG resident trainees. You also prepare a variety of seminars and lectures for other residents. By the end of one year, you will have presented at several conferences on major topics in clinical electromyography.

Didactic training

Clinical conferences, lectures, lecture-demonstrations, seminars, small discussion groups and one-on-one instruction are all integral parts of Mayo Clinic's clinical neurophysiology programs. You have the opportunity to attend weekly conferences in both the EEG and EMG laboratories.

These conferences include clinical EEG and EMG case reports, lectures and lecture-demonstrations about:

• Electronics and instrumentation
• Evoked potential studies
• Autonomic function studies
• Basic neurophysiology
• Ultrasound

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

During your clinical neurophysiology 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 EEG, EMG, epilepsy, neuromuscular and peripheral nerve disorders, movement disorders, and sleep disorders.

Research training

Regardless of the neurophysiology fellowship you select, 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 in your program. 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 the findings 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.

Teaching opportunities

Opportunities are available for you to teach rotating residents and medical students.

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 Mayo Clinic's EEG and EMG laboratories, you can also learn about techniques for assessing movement disorders, including tremors, myoclonus, seizures, botulinum injections and other conditions.

Autonomic laboratories

If you would like experience in the autonomic laboratories, you can arrange a time in these areas 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 laboratories have three clinical components:

• Clinical autonomic reflex laboratory
• Research and development autonomic laboratory
• Thermoregulatory laboratory

Routine tests performed in the clinical autonomic reflex laboratories include:

• QSART — quantitative sudomotor axon reflex test
• Orthostatic blood pressure (BP) and heart rate (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
• Salivation test
• Tests to detect sympathetically maintained pain or reflex sympathetic dystrophy (RSD):
  • Telethermography or infrared thermometry
  • Resting sweat output
  • QSART
• Thermoregulatory sweat test — a three-month experience in the autonomic laboratories that includes lectures, supervised reading, training in autonomic testing and possibly a research project under the supervision of staff

Evaluation

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