Clinical training

Six months of the first year is spent in the specialized Neuroscience Intensive Care Unit (NICU) and three months in non-neuroscience ICUs. The second year is divided between the Neuroscience ICU, non-neuroscience ICUs, ICU neurology consults, and electives.

You start a major research project within the first two months and are closely mentored throughout. Research entails primarily clinical research, with efforts greatly facilitated by Mayo Clinic's extensive medical record system, the Division of Biomedical Statistics and Informatics, and a specialized media support department. During the fellowship, you publish multiple manuscripts and present them at meetings.

Rotation descriptions

Neuroscience ICU

Approximately 10 months of your fellowship are spent in the Neuroscience Intensive Care Unit (NICU), a 20-bed unit that is shared between Neurology and Neurosurgery.

The neurocritical care team is the primary provider for all patients (except those who are recovering from uncomplicated neurosurgery or those who are undergoing epilepsy grid monitoring) admitted to the NICU.

You are expected to perform all central line placements, intubations and bronchoscopies with expert supervision by anesthesia staff. Opportunities exist to perform other procedures, including thoracentesis, chest tube placement and paracentesis.

Uniquely, all acute stroke management is directed by the NICU team, including determining eligibility for thrombolysis and endovascular therapy. The patient is transferred to the stroke team after 24 hours of ICU stay depending on his or her medical readiness.

Neuroscience ICU team and rounds

Mayo Clinic's campus in Rochester, Minnesota, has four neurointensivists who share call. The rounding team is made up of the consultant, NICU fellow, a day and night resident (12-hour shifts), nurse practitioner or physician assistant, neurology pharmacist, charge nurse, and nurse manager. An anesthesia team co-manages mechanical ventilation.

In the second year of the fellowship, you take night pager calls from the neurology emergency medicine resident as well as the NICU resident. This transition prepares you for upcoming years after training.

Step-down care, otherwise known as the progressive care unit (PCU), is physically located in the NICU. These patients remain under the care of NICU team, whether they are ICU or PCU status. Neither general neurology nor stroke neurology staff rounds on any patients while they are physically in the NICU.

ICU neurology consults

Approximately two months of your training is allotted to neurology consultations within the other ICUs at Mayo Clinic Hospital, Saint Marys Campus, and Mayo Clinic Hospital, Methodist Campus. This includes medical, surgical, trauma, cardiac and cardiothoracic surgery ICUs.

Other ICUs

You rotate through the medical, surgical, and transplant ICUs for a minimum of six months.

Research

All four of the neurointensivists are highly published and cited. The experience of your mentors is broad and includes chapter writing, research articles and participation in clinical trials. You have two to three months allocated for research, and more can be requested in electives. You are required to participate in research projects.

Electives

Approximately three months of elective time is available in your training. Common options include neurosurgery, neuroanesthesia, electroencephalography (EEG), infectious disease ICU consulting, or additional research.

Didactics

Clinical conferences, seminars, small discussion groups, journal clubs, didactic courses, and one-on-one instruction are all integral parts of the Neurocritical Care Fellowship.

Formal didactic courses are available. 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.

A dedicated neurocritical care course is given by expert neurointensivists every summer to prepare trainees for rotations in the Neuroscience ICU. Major topics covered include acute ischemic stroke, subarachnoid hemorrhage, status epilepticus, bacterial meningitis, acute neuromuscular respiratory failure, traumatic brain injury and brain death.

Conferences

Throughout your fellowship, you participate in and periodically present at these conferences:

Mondays

• Neurology Grand Rounds. Research presentations are given by Mayo Clinic faculty, visiting faculty or neurology residents. Clinical pathological and vascular conferences are held several times a year.
• Cerebrovascular Conference. Cerebrovascular cases are presented and discussed. This is held jointly with the Department of Neurologic Surgery every other Monday.
• Neurosurgery Morbidity and Mortality Conference. Held monthly.

Tuesdays and every other Wednesday

• Core Curriculum. This is a comprehensive critical care curriculum that covers all aspects of critical care and includes board review sessions every year.
• Neurology Morbidity and Mortality Conference. Held monthly.

Wednesdays

• Clinical case conferences. Each week, critical care conferences are held at Mayo Clinic Hospital, Saint Marys Campus, which alternate among the adult inpatient neurology, child and adolescent neurology, neurosurgery, and neuro-ophthalmology divisions.

Thursdays

• Critical Care Grand Rounds. A broad range of topics relating to critical care are discussed on a weekly basis.

Quarterly

• Journal clubs
• Combined neurocritical care and neurosurgical trauma conference

Research training

A major goal of Mayo Clinic's critical care specialists is to continue a long tradition of clinical research in critical care neurology. Clinical epidemiological research is emphasized in division research activities, including clinical treatment trials and medical records research. These types of research are a natural extension of Mayo's extensive experience with patient care, a unique records system and a unique local population base.

Development of independent research projects is encouraged and supported with training in database management and biostatistics.

When you complete your research, you are expected to present it at a scientific meeting or prepare it for publication in a scientific journal. Past fellows have been very successful, with some completing up to 15 manuscripts a year.

Trips

During your first year of fellowship, you are allowed 10 presentation trip days. Approximately three days are allowed for each trip. Mayo reimburses costs incurred up to $1,750 for each trip.

During your second year of fellowship, you are allowed 10 presentation trip days and five attendance trip days with the same reimbursement guidelines. An attendance trip does not require that you present research.

Vacation

Vacation is limited to 15 days a year.

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 Neurocritical Care Fellowship. You are formally evaluated by supervising faculty members on a regular basis and meet with the program director to review these evaluations. In addition, you regularly evaluate the faculty to confirm that your educational needs are being met.