Curriculum
During the seven-year Neurologic Surgery Residency, you will receive advanced education in all aspects of neurosurgery, including both outpatient and hospital settings, with a full six months of dedicated intensive care unit (ICU) training. As a trainee, you will participate in the care and surgery of all neurosurgery patients as an integral member of the neurosurgical team.
Progressive responsibility and surgical experience under the direction of the neurosurgical faculty is assured throughout the residency. Each clinical rotation has specific competencies, goals, and learning objectives, in addition to the general departmental academic requirements.
Opportunities for enhanced training in a subspecialty area can be enfolded within the seven-year curriculum; present options include complex spine, oncology, peripheral nerve, critical care, and skull base.
Clinical training
As a resident, you will be required to spend a minimum of 54 months of clinical neurosurgery training prior to graduation. A unique feature of the neurosurgery training at Mayo Clinic is our mentorship model, in which residents complete dedicated clinical rotations working directly under faculty members for two to three-month rotations. This provides for the development of a longitudinal relationship between the resident and staff, as well as an opportunity for true immersion in a particular practice model, and complete continuity of care for the patients and families on those services.
Two years of dedicated research and career development time are afforded during senior residency. Supplemental clinical rotations, enfolded fellowships, and visiting electives may be arranged during this period. Additional provisions are allowed for residents desiring to expand their training by an additional year or longer, so as to obtain a doctorate in neurosciences through Mayo Clinic Graduate School of Biomedical Sciences.
The capstone of our program is the chief resident experience. During that year, the chief runs an independent service in a transition to practice role taking on the privilege of responsible patient management and patient care in a one to one relationship with the patient.
Another key aspect to our program is the ability to rotate at other sites during your time in the program. We have pediatric rotation alternatives at Phoenix Children's hospital as well as the Mayo Clinic campuses in Arizona and Florida.
The typical rotation sequence for Mayo Clinic neurosurgery residents is:
- PGY-1
- PGY-2
- PGY-3
- PGY-4
- PGY-5 and PGY-6
- PGY-7 (chief resident)
PGY-1
During your first year, you will spend five months on the medical neurology services, including one month as junior and two months as senior residents in the neurosciences ICU. You will spend one month on the critical care service ICU, one month on neuro-anesthesia, four months on the chief resident service, one month in neurosurgery outpatient clinic, and one month on the services of Jamie Van Gompel, M.D., the neurologic surgery program director and department vice chair of education, as well as Frederic Meyer, M.D., the neurologic surgery enterprise chair at Mayo Clinic and the executive dean of education for Mayo Clinic College of Medicine and Science.
By the end of this first year, you will have a basic understanding of neurological disease and be competent to perform a neurological history and examination. You will have a strong knowledge base for evaluating and caring for critically ill patients in an intensive care setting. In addition, you will have performed basic neurosurgical procedures including intracranial pressure (ICP) monitor placement, external ventricular drain, laminectomy exposures, and basic craniotomies.
This first year is expected to lay the foundation of knowledge and skills required for a superlative career in neurosurgery.
PGY-2
During this year, you will spend additional time in the ICU as well as serve a junior role on our chief service and perform stereotactic and functional surgery rotations. You will also enjoy ample opportunity to work one-on-one with staff neurosurgeons as a first assistant in the operating room.
PGY-3
You are assigned to rotations on the clinical neurosurgery services of the various neurosurgery consultants during your third year. The clinical assignment system is unique in that you work one-on-one with each staff neurosurgeon for intervals of several months' time before rotating. This allows the evolution of a strong teaching mentorship.
Throughout this PGY-3 year, your surgical skills will significantly advance. It is expected that during this time, depending on your individual skill set, you will perform critical portions of each operation with the staff surgeon serving as an assistant and coach. Therefore, your surgical skills improve dramatically during this year. It is also expected that you will better define your clinical interests and begin to formalize your career goals. PGY-3 rotations concentrate on spine, intraaxial brain tumors, peripheral nerve, and epilepsy.
PGY-4
Over the course of fourth year, residents typically complete additional rotations on complex cranial, complex spine, cerebrovascular, skull base, and endovascular surgery. Additionally, a block of neuropathology is used to prepare for the ABNS board exam.
A formal, required curriculum of skull base, microvascular, and peripheral nerve techniques is simultaneously completed, both to facilitate anatomic study and to prepare you for senior-level roles. Final planning decisions are made for upcoming career development years.
PGY-5 and PGY-6
Up to 24 months are allocated for career development, typically taken as a single block during the PGY-5, PGY-6, and PGY-7 time frame. Dedicated laboratory research, enfolded fellowships, visiting electives at Mayo Clinic's campuses in Florida and Arizona, and acquisition of advanced degrees are common academic pursuits during this time. Flexibility and adaptability to the needs of each individual resident's career are emphasized.
For residents who are pursuing a one- or two-year research block, application for a Neurosurgery Research and Education Foundation (NREF) training grant is highly encouraged. If basic research is chosen, a research plan should be developed the preceding year with a mentor identified. Clinical research projects also may be chosen, and potentially pursued, via the Clinician-Investigator Training Program or a master's degree.
The emphasis during the research year is toward the development of critical scientific methodology and production of meaningful contributions to basic science or clinical knowledge. For those pursuing additional clinical neurosurgery training, the goal is to develop advanced surgical training in a subspecialty area of interest.
Within these two years, both research and advanced clinical training can be combined. Furthermore, you are strongly encouraged to rotate to Mayo Clinic in Jacksonville, Florida, or Mayo Clinic in Phoenix/Scottsdale, Arizona, for advanced clinical training, notably in endovascular surgery, complex adult spine surgery, or minimally invasive spine surgery.
PGY-7 (chief resident)
During the final 12 months of training, chief residents have responsibility for managing their own clinical service and operating room. This is unique among training programs.
Perhaps the greatest strength of our singular training program is that the Mayo Clinic chief residency allows senior trainees to function as junior faculty with the privileges of an autonomous starting operating room in which they are the primary surgeons. Chief resident cases are booked on an elective basis from their own active clinical practices. Further, the chief residents manage all emergency neurosurgery cases and in-house consultations, providing for consultant-level decision-making and management across the full breadth of neurosurgery.
During this time, the chief resident alternates emergency call, elective surgery, and outpatient consultation on a daily basis with chief resident partners — a schedule akin to that of our full-time faculty.
Rotation descriptions
You will work with these specialists:
- Edward Ahn, M.D. Pediatric neurosurgery concentrating on Shunts, Intrauterine surgery, cranial vault remodeling, and general pediatric surgery
- John Atkinson, M.D. Pituitary tumors, spine surgery, and sympathectomy
- Terry Burns, M.D., Ph.D. Intra-axial brain tumors, Gamma Knife, and awake brain surgery
- Mohamad Bydon, M.D. Spinal oncology and minimally invasive spine surgery
- M.J. Clarke, M.D. Spinal oncology and spine surgery
- David Daniels, M.D., Ph.D. Pediatric neurosurgery with emphasis on brain tumors and intraventricular endoscopy
- Benjamin D. Elder, M.D., Ph.D. Normal Pressure Hydrocephalus and complex spine surgery
- Jeremy Fogelson, M.D. Complicated spinal deformity correction
- William Krauss, M.D. Spine tumor and spine surgery
- Giuseppe Lanzino, M.D. Endovascular and open vascular surgery
- Kendall Lee, M.D., Ph.D. Deep brain stimulation, pain, and functional neurosurgery
- Michael Link, M.D. Skull base, acoustic neuromas, Gamma Knife, and vascular surgery
- W. Richard Marsh, M.D. Epilepsy and spine surgery
- Fredric Meyer, M.D. Brain tumors, vascular, and epilepsy surgery
- Kai Miller, M.D., Ph.D. Epilepsy and pediatric neurosurgery
- Ian Parney, M.D., Ph.D. Intra-axial brain tumors, Gamma Knife, and awake brain surgery
- Maria Peris Celda, M.D., Ph.D. Skull base, pituitary tumor surgery, and acoustic neuromas
- Bruce Pollock, M.D. Gamma Knife, trigeminal neuralgia, and brain tumors
- Luis Savastano, M.D., Ph.D. Endovascular and open vascular surgery
- Robert Spinner, M.D. Peripheral nerve surgery
- Jamie Van Gompel, M.D. Skull base, endoscopic pituitary surgery, and epilepsy
Extramural rotations
You may choose to complete clinical rotations at Mayo Clinic in Jacksonville, Florida, or in Phoenix/Scottsdale, Arizona. Mayo Clinic fully funds all incumbent costs, including travel, housing, automobile rental, and licensure fees.
These rotations have been approved by the Accreditation Council for Graduate Medical Education and American Board of Neurological Surgery as containing significant educational merit. Mayo Clinic encourages trainees to take advantage of the associated opportunities, including advanced exposure to additional subspecialty training, notably in vascular and complex spine surgery. The cumulative case volume available for training at Mayo Clinic's campuses in Minnesota, Florida, and Arizona is approximately 7,000 cases annually.
Conferences
Didactic conferences are held on a daily basis for one hour, prior to the initiation of the day's operative calendar. Conferences are held in the neurosurgery department at Mayo Clinic Hospital — Rochester, Saint Marys Campus, and resident attendance is mandatory.
The typical weekly schedule is:
Neurosurgery Grand Rounds — Monday
A monthly conference, held every first Monday. The rest of Monday grand rounds conferences alternate between research grand rounds, visiting professor lectures, and a monthly morbidity and mortality conference dedicated to discussion of complications and quality assurance issues. Didactic lectures and presentations by visitors, Mayo staff, and residents also complement this forum. All faculty and residents attend grand rounds conference.
Administrative and Clinical Conferences — Tuesday
Complex cases are presented by Drs. Meyer, Van Gompel, Link, Lanzino, and Parney, in which preoperative diagnosis, surgical approaches, technical pearls, and postoperative complications are discussed. Additionally, program leadership meets monthly with residents to communicate any changes or updates and receive frequent feedback.
Spine Board Preparation Clinical Conference — Wednesday
Wednesdays are rotating spine conferences focusing spinal disorders. The agenda alternates between spine journal club, spine trauma case conference, non-trauma case conference, and didactic lectures. The course is taught by joint faculty from the orthopedic surgery and neurological surgery departments. Case conferences are resident-driven, whereas didactic lectures are consultant-driven.
Core curriculum — Thursday
Thursdays of every month rotate between resident-led, board-focused didactic lectures, pediatric journal club, cranial journal club, and conferences hosted by investigators presenting their research to help inform you of opportunities available for pursuit during your career development years. Once per quarter, the chairman holds a conference, during which Dr. Spinner meets with the residents to discuss a broad range of academic, administrative, or other salient topics.
Neuro-Oncology Conference — Friday
The conference every Friday is a multispecialty-combined gathering in which four interesting brain tumor cases are presented and discussed. The faculty from all the neuroscience specialties including neurology, medical oncology, neuropathology, neurosurgery, and neuroradiology are in attendance. The format of this conference is standardized and educationally targeted, incorporating the case presentation, pertinent radiology, surgical approach, pathology, and adjunctive treatment with an open forum for discussion and analysis as required and appropriate.
Additional conferences
Multiple subspecialty conferences are held daily throughout Mayo Clinic, which are all open to neurosurgery residents. These include a neuroradiology conference, surgical epilepsy conference, pediatric neuro-oncology conference, skull base tumor board conference, and many others.
Case conferences
The mandatory one-hour teaching conferences five days a week from 7 to 8 a.m. focus on both general and subspecialty neurosurgery. The subspecialty conferences include vascular, spine, epilepsy, neuro-oncology, and neuroradiology. These are held in conjunction with the appropriate medical and radiological services.
You will regularly contribute to the educational process, preparing case presentations, journal clubs, and didactic lectures.
Call frequency
Call schedules vary by individual rotation. Mayo Clinic's Department of Neurologic Surgery follows the duty hour guidelines of the Accreditation Council for Graduate Medical Education (ACGME).
All residents share the in-house emergency call assignments equally during the time that they are assigned to clinical neurosurgery service, as well as during certain elective and basic science rotations. Therefore, the frequency of a resident being in the hospital overnight to cover trauma and the emergency room is modest.
Residents on clinical neurosurgery services are expected to respond to calls regarding their own patients throughout the day and night. In-hospital night call covering emergencies occurs on average one out of every 10 to 13 days, as does "backup call," which is typically taken from home. Residents are provided with meal allowance funds in accordance with call coverage.
Teaching opportunities
You will have the opportunity to teach Mayo Clinic Alix School of Medicine students and visiting students from other medical schools, through bedside instruction, formal didactic lectures, and voluntary participation in the anatomy curriculum.
Additional training opportunities
Clinician-investigator
The Clinician-Investigator Training Program is available to residents who wish to prepare for an academic career involving a significant research component. This competitive program provides support for an additional one to two years of research outside of the usual scheduled resident rotations.
Upon completion, a certificate in clinical investigation for a master's degree in neurosurgery is awarded.
Clinical research training program
The Center for Clinical and Translational Science offers programs designed to train future investigators in clinical research through a curriculum focused on research methodology, complemented by mentor-based training in the research environment.
Options include a master's degree in clinical research, or a shorter program awarding a certificate in clinical research.
Doctoral degrees
A formalized pathway is available to neurosurgery residents for obtaining a doctorate in molecular neuroscience, biomedical engineering, or molecular physiology, which requires a minimum of two to three years of study and research, culminating in a dissertation.
The in-residency doctoral program has been designed to maximize flexibility, allowing for an individualized curriculum, with appropriate oversight from an advisory and mentorship committee.
This program, offered in conjunction with Mayo Clinic Graduate School of Biomedical Sciences, should be strongly considered by neurosurgical residents interested in obtaining advanced basic science experience for a career in academic neurosurgery.
Career development
Residents are encouraged to meet formally and informally with the department chair, program director, and individual mentors on a regular basis to discuss career goals. The program director takes a sincere interest in tailoring a resident's training program to career objectives and actively participates in job searches on behalf of the residents.
Mayo Clinic neurosurgery residents have been highly successful in competing for both academic and private practice positions, consistent with their individual goals.
Evaluation
Performance is carefully monitored throughout the course of the Neurologic Surgery Residency with an eye toward operative skill, clinical judgment, academic productivity, and career development. After each clinical rotation, you will be evaluated formally by your supervising faculty.
Additionally, you will meet individually with the program director on a semiannual basis to review your performance and discuss career goals in detail to dynamically individualize your training program.
You will sit for the American Board of Neurological Surgery written examination during your PGY-2 and PGY-3 years for self-assessment, and for credit during their PGY-4 year. A three-month neuropathology rotation provides supplemental basic science education and opportunity for independent study immediately prior to formal examination.
As part of our regular examination of residents to monitor their progress and also help prepare for the future oral board examination, annual oral examinations in clinical neurosurgery and neurology are administered. The format is similar to that of the certifying oral examination given by the American Board of Neurological Surgery after completion of training. Feedback from the program director and director of resident education is provided.
An electronic case log program tracks all resident operative cases, with salient details auto-populated from the operative report and prepared for review and submission to ACGME case log. The case volume and mixture is carefully analyzed to ensure that each resident is obtaining in-depth expert training in all areas of neurosurgery. If areas of deficiency are identified, the resident's rotations are adjusted accordingly to provide an appropriately balanced education.