Your training will encompass clinical, didactic, and research components as described below. The MS Fellowship is designed to train individuals for an academic career in neurology. Approximately half of the time is spent in the evaluation of multiple sclerosis and other demyelinating disease patients. The remainder of the time is spent in research or other scholarly academic endeavors.

Clinical training

You will be responsible for evaluating patients in the outpatient clinic and the Saint Marys and Methodist Campuses of Mayo Clinic Hospital. This provides a wealth of opportunity to learn the full spectrum of disability from this disease. A wide range of inflammatory diseases that mimic MS also are seen, including:

• Sarcoidosis
• CNS Vasculitis
• Acute disseminated encephalomyelitis
• Paraneoplastic syndromes
• Histiocytic disorders
• Devic's disease (neuromyelitis optica)
• Connective tissue diseases
• Tumefactive multiple sclerosis
• MOG-immunoglobulin G (IgG) associated disorder

A high proportion of patients referred for MS or a related CNS demyelinating disease are evaluated by the Section of Multiple Sclerosis, providing you optimal training on all aspects of a patient's evaluation and care.

In addition, Mayo Clinic MS specialists are available to other specialists (e.g., neurologists, internists, physical medicine and rehabilitation specialists, rheumatologists, psychiatrists) who request their assistance in evaluating and planning treatment.

Over the first three months of the fellowship, you will undergo a period of acclimation, during which your role as a physician in the care of MS patients is reviewed by mentors.

Over the course of the fellowship, you will be trained in the comprehensive evaluation of patients with multiple sclerosis. This includes experience in the management of relapses and progressive disease and the appropriate choice of medicine for each disease stage.

Research training

Mayo Clinic is a premier site for the conduct of clinical trials involving the use of novel and currently approved therapeutic agents.

After the initial three months, you will spend 50 percent of your time seeing patients in the MS clinic and 50 percent on a research project. The project will be performed in conjunction with one of the faculty members who have funded research programs. Areas of training include:

• Cellular immunology
• Cell signaling
• Neurovirology
• Mechanisms of demyelination
• Mechanisms of remyelination
• Experimental neuropathology
• Genetic epidemiology
• Epidemiology of MS in the Olmsted County population
• MRI image analysis and processing

You are expected to participate in weekly neuroimmunology seminars to review your research progress and to interact with other research groups in immunology and neuroscience.

Didactic training

Clinical conferences, seminars, small discussion groups, journal clubs, didactic courses, and one-on-one instruction are an integral part of Mayo Clinic's Multiple Sclerosis Fellowship Program.

Course work

Formal didactic courses are available during the fellowship. Understanding statistical principles as applied to biomedical investigation is an important component of the fellowship. Mayo Clinic offers a number of courses in epidemiology, biostatistics, and design and conduct of clinical trials.

Conferences

Throughout your fellowship you will participate, and periodically present, at weekly conferences:

• Mondays - weekly departmental teaching conferences (Grand Rounds)
  At Grand Rounds, research presentations are given by Mayo Clinic faculty, visiting faculty, or neurology residents. Clinical pathological conferences are held several times a year.

• Wednesdays - Multiple Sclerosis and Autoimmune Neurology clinical case conference
  Weekly clinical case conferences are held with input from experts in the inpatient neurology, the child and adolescent neurology, neurosurgery, and neuro-ophthalmology divisions.

• Fridays - subspecialty conferences
  These conferences focus on the pathophysiology, diagnosis, and management of neurological disorders. Subspecialty conferences are presented on a rotating basis by all subspecialty divisions of the Neurology Department.

In addition to the regularly scheduled departmental conferences, you will attend resident conferences on Tuesdays. Residents and fellows also participate in an evidence-based medicine journal club.

Visiting professors have small group discussions with neurology residents and fellows. Topics covered include child and adult neurology vignettes and neuroethics.

Additional training

There is an opportunity to extend the one-year clinical fellowship for a second year of either clinical or basic research. Mayo Clinic also funds a two-year Clinician-Investigator Program that provides financial resources (e.g., salary, supplies) for unique individuals who are interested in pursuing a basic science or academic career.

Interested applicants should contact the program director for more information.

Evaluation

To ensure that you acquire adequate knowledge and develop your technical skills, your performance is monitored carefully during the course of your program training.

At the completion of each rotation, fellows are evaluated by the faculty to whom they were assigned. This is accomplished through Mayo Clinic's Residency Management System, MedHub. MedHub is linked to the six core competencies identified by the Accreditation Council for Graduate Medical Education (Patient Care, Medical Knowledge, Interpersonal Skills and Communication, Professionalism, Practice-Based Learning and Improvement, and Systems-Based Practice).

Completed faculty evaluations are reviewed by the program director, who assigns a pass/fail grade based on the scores and comments by the faculty member. Upon approval of the evaluation by the program director, the evaluation immediately becomes available electronically to the fellow in the MedHub system.