The Neuroanesthesiology Fellowship is designed to allow you, with the aid of an adviser, to tailor a training program to best suit your goals and interests.

Your fellowship is based on the guidelines for a clinical neuroanesthesiology fellowship training program proposed by the Society for Neuroscience in Anesthesiology and Critical Care. However, the program model has been modified to correspond not only to specific practice parameters at Mayo Clinic but also afford you a greater deal of flexibility without compromising your education.

Rotation schedule

Rotation descriptions

Clinical neuroanesthesiology

The rotation in clinical neuroanesthesiology consists of direct care of both adult and pediatric patients having neurosurgical procedures in the operating rooms and radiology suites. This includes intracranial, neurovascular, peripheral nerve, and spine procedures, as well as procedures that require the use of various neurophysiologic monitoring modalities.

As a fellow, you're expected to advance your practice so that you can supervise the care of neurosurgical patients with the oversight of a staff anesthesiologist. You are not required to complete all six months of this rotation consecutively.

Neuroscience scholarship

The current practice of anesthesiology is strongly rooted in both basic science and clinical research. As the training of outstanding clinical and academic anesthesiologists is a primary goal of the Neuroanesthesiology Fellowship, it's important that you have an opportunity to be involved in anesthesiology research.

As such, you will be required to be involved in at least one scholarly activity project related to the field of neuroanesthesiology during the fellowship. With the help of a faculty mentor, you may design and conduct a clinical or laboratory-based project, or prepare a case report, review article, book chapter, or database-related project. You are expected to use this opportunity to gain experience in oral presentations and technical writing.

Neurocritical care

You will spend at least one month of your training in the Neurology/Neurosurgery Intensive Care Unit, working on a multidisciplinary team to care for critically ill patients with neurological diseases or neurosurgical patients.

You will be responsible for:

• Placement, interpretation, and management of invasive lines and hemodynamic management
• Airway and ventilator management
• Monitoring and management of intracranial pressure and other monitors of neurological well-being

In addition, you are involved in the management of issues arising from neurological pathophysiology such as intracranial hypertension, cerebral vasospasm, and systemic complications of brain injury, as well as other common problems encountered in critically ill patients such as sepsis, shock, and multiorgan system failure.

Neuromonitoring

Intraoperative neuromonitoring is often used to guide surgical procedures and avoid complications. These modalities are applied to intracranial, spine, and peripheral nerve procedures and include electroencephalography, electrocorticography, electromyography, and evoked potential monitoring such as somatosensory, brainstem auditory, and motor evoked potential modalities.

You will spend at least one month working with the clinical neurology team during this rotation in the operating room with cases that involve neurological monitoring.

Electives

Electives can consist of additional time in clinical neuroanesthesiology, neuroscience scholarship, neurocritical care, or neuromonitoring, or a special elective organized by you with the help of your adviser and the approval of the fellowship director. This can be especially helpful if you have a specific interest in clinical adult or pediatric neuroanesthesia, research, or critical care, as it allows additional time in these rotations.

Didactic training

You have numerous opportunities to expand your knowledge of not only neuroanesthesiology but also general and other anesthesiology subspecialties. You will participate in a formal neuroanesthesiology didactic program that consists of 24 one-hour lectures given by staff anesthesiologists during the course of the fellowship. The curriculum covers all major aspects of neurophysiology, clinical neuroanesthesiology (vascular, pediatric, interventional and functional), neuroradiology, neurological monitoring, neurocritical care, and ethics.

The Department of Anesthesiology holds a neuroanesthesiology morning conference on a biweekly basis. Lectures are generally 15 minutes long. Topics are selected by the presenter and cover a broad range of aspects pertinent to the fields of neuroscience, neuroanesthesiology, and neurocritical care. Presenters include staff neuroanesthesiologists, residents during their clinical rotation in neuroanesthesiology, and neuroanesthesiology fellows. Residents and fellows are assigned a faculty mentor who assists in finding a topic and organizing a presentation for their lecture.

You also have the opportunity to attend the weekly Anesthesiology Grand Rounds conference, departmental journal clubs, morbidity and mortality conferences, and resident didactic lectures. You also have the opportunity to attend didactic lectures in other relevant departments such as critical care, neurology, and neurophysiology.

If you still need to complete the American Board of Anesthesiology written or oral examination, you have the opportunity to attend departmental review lectures for the written board examination and practice oral examinations with the multiple American Board of Anesthesiology oral board examiners on staff at Mayo Clinic.

Mentorship

You are assigned a faculty adviser for the duration of the Neuroanesthesiology Fellowship. The adviser assists in selecting a rotation schedule and electives, finding and facilitating a relationship with a mentor for the neuroscience scholarship rotation, and serving as a source of advice and support during training.

On clinical rotations, you will be formally evaluated by supervising faculty and meet on a regular basis with your advisers to discuss your evaluations and progress in the program. The Neuroanesthesiology Fellowship provides you with solid mentorship, as we believe mentorship is a critical component to training outstanding neuroanesthesiologists and future leaders in this exciting subspecialty.