Foot and ankle surgery                              

During the foot and ankle rotation, all residents are involved in a curriculum that includes didactics for all major topics of foot and ankle surgery. This is a self-directed program through our learning management system with asynchronous lectures. There is a weekly case-based conference that highlights the asynchronous lecture topic. This is interactive and enables residents to understand and apply what has been learned in the lecture to patient care. The curriculum includes didactic sessions on 15 lecture topics and a board review.

All residents rotate on the foot and ankle rotation during residency. They are actively involved in the care of patients with fractures, tendon issues, post-traumatic arthritis and deformities, neuromuscular disorders, degenerative and inflammatory arthritis, deformities, and sports injuries. Residents receive comprehensive education and clinical exposure to all aspects of foot and ankle surgery. You will develop the skills needed to evaluate, manage, and treat foot and ankle disorders.

Hand surgery, including microsurgery

The Mayo Clinic Division of Hand Surgery provides orthopedic surgery residents with a robust curriculum to learn how to effectively evaluate and treat common hand and wrist disorders. With 18,450 outpatient visits, 1,800 new patient evaluations, and more than 4,000 surgical procedures performed each year, residents quickly become well-versed in general hand and wrist surgery, as well as complex wrist reconstruction, brachial plexus reconstruction, microsurgical reconstruction (replantation, free tissue transfers, tumor reconstruction, toe to hand transfers), surgery of the arthritic hand, tendon transfers, and pediatric/congenital hand surgery.

Highlights of the hand surgery rotation include an online education platform combined with virtual or in-person conferences, a one-week microvascular surgery animal training course (PGY-2 year), and extensive use of the surgical skills lab. 

Adult reconstruction

The Division of Adult Reconstruction Hip and Knee Arthroplasty is comprised of 10 fellowship-trained, high-volume surgeons. In addition to performing a large volume of primary total hip arthroplasties (THAs) and primary total knee arthroplasties (TKAs), the unique and world-class expertise in the division drives a tertiary referral practice as well. This includes a large volume (one-third of the entire practice) of revision THAs, revision TKAs, periprosthetic joint infections, oncologic reconstructions around the hip and knee, and hip preservation procedures.

Moreover, all surgical approaches, numerous implant vendors, and state-of-the-art robotics are used at Mayo Clinic. This has allowed the group to be some of the foremost innovators in primary and revision hip and knee arthroplasty.

In addition to the complex practice and well-known surgical skills, the group includes the preeminent academic leaders throughout the world including a past president of AAOS, a current AAOS Board of Directors member, immediate past president of the closed Knee Society, first vice president of the closed Knee Society, and multiple other international and national leaders in various organizations. Seven of the 10 faculty of the division are members of the closed Hip Society and seven of the 10 faculty of the division are members of the closed Knee Society. Mayo hip and knee surgeons (and residents presenting hip and knee research) perennially play a prominent role in national and regional meetings with their high-quality research.

Musculoskeletal oncology

The Division of Orthopedic Oncology provides residents with a diverse and robust experience in the management of patients with benign and malignant tumors involving the axial and appendicular skeleton. Each service is led by a senior resident or fellow. A junior resident (basic science or an intern) is also part of the team, fostering the mentorship model of Mayo Clinic. The residents become skilled in the workup and management of bone and soft-tissue masses and have a unique opportunity to work with orthopedic surgeons whose only focus is on orthopedic oncology.

Educational highlights: 

• Weekly multidisciplinary case-based orthopedic oncology conference. Residents on the service present cases and the care of the patient is discussed in a multidisciplinary fashion with medical oncology, radiation oncology, and pathology.
• A virtual didactic course that outlines the basics of orthopedic oncology, as well as an in-depth discussion on bone and soft-tissue tumors.
• Ample opportunities to become involved with clinical research projects.
• Cadaver lab teaching on the common approaches in orthopedic oncology in addition to endoprosthetic reconstruction.

Clinical highlights: 

• A high volume of primary and metastatic bone and soft-tissue oncology with tumors involving the extremities, spine, and pelvis.
• The senior resident or fellow is expected to run the service and develop the operative plan and or discuss non-operative treatments for all patients on the service. They will be the lead assistant during all surgical cases. They will become well-versed in the operative management of patients with musculoskeletal tumors.
• The junior resident will be responsible for assisting the senior resident or fellow in the day-to-day responsibilities of the service. In addition, will have ample operative experience. This provides residents with early exposure to orthopedic oncology.
• Collaboration with multiple teams across various specialties. Cases often involve plastic and reconstructive surgery, spine surgery, and upper and lower extremity arthroplasty teams.

Orthopedic trauma

The Orthopedic Trauma Service (OTS) provides orthopedic trauma coverage on the St. Marys campus of Mayo Clinic Hospital, a 1,265-bed Level-1 Trauma hospital.

OTS is made up of four teams, each made up of one consultant (attending) surgeon, one senior resident (OTS chief), one junior resident (OTS junior), and one advanced practice provider. Other team members are present on a rotating basis and include a plastic surgery intern, emergency medicine residents, and rotating medical students. 

Educational highlights:

• Daily fracture rounds. Cases done the prior day are reviewed each morning, including critical discussions of operative indications, intraop decision making, and technical points, as well as postoperative management. All team members are present for this conference.
• Weekly OTS conference. One morning per week each team of residents or staff present on a topic germane to orthopedic trauma. The format is discussion-based, with Socratic teaching throughout. The residents are responsible for working together with and educating other team members, including interns from orthopedic surgery, plastic surgery, and emergency medicine.
• The curriculum for the conference is based on a rotating schedule designed to ensure exposure to the most commonly encountered topics (tibia fractures, ankle fractures) as well as an in-depth discussion of more complex trauma topics (damage control orthopedics, pelvic and acetabular fractures, and complex elbow trauma).

Clinical highlights:

• High-volume. Combined, the OTS teams perform approximately 2,000 surgical cases per year.
• The OTS chief is expected to run the service including evaluation, coordination of care, and development of operative and/or non-operative treatment plans for all patients on their service. This includes delegation of responsibilities to other team members and supervision of other team members. Although Mayo Clinic’s Orthopedic Surgery Residency is primarily a mentorship model, this will be one of the few times you will work with a team of residents.
• The OTS junior is responsible for emergent consultations from the emergency department and hospital floor. However, on operative days, the advanced practice providers cover the pager to allow the junior resident to be in the operating room. The OTS junior will become increasingly comfortable with the execution of common orthopedic trauma operations, including hip fracture nailing, cemented hip arthroplasty, ankle fracture surgery, and long bone nailing.

Pediatric orthopedics

Education in the pediatric orthopedic service is based on the mentorship model. Each resident is paired with a pediatric consultant for an entire quarter. For pediatric orthopedics, this means that you will have daily contact in the clinic and surgery with the same team for three months. There is a broad exposure to this specialty where the residents not only learn how to do the surgery but also how to speak with families and children. This skill is developed with many one-on-one interactions from the emergency department to the recovery room. Clinically each service is slightly different, however, the resident will learn about non-operative and operative treatment of common pediatric fractures, pediatric spinal deformity, pediatric sports medicine, hip dysplasia, and more.

Our division is also one of only a few centers in the United States that are performing novel scoliosis surgery without fusion (anterior vertebral body tethering). This brings patients from around the world to visit us in Rochester.

The services are organized with a robust conference schedule which includes weekly pre-operative and post-operative conferences. In addition, a curriculum conference occurs each week to provide a generalized education on all aspects of our specialty. The division has recorded a year’s worth of curriculum which can be viewed throughout the rotation. Each service also can book time in our surgical skills lab where complex and simple surgeries can be practiced prior to the performance. This resource is extremely rare in residencies across the United States. Because of our focus on education, our most recent OITE scores for pediatrics were over 85%.

Finally, if residents are interested, our division has been very successful in finding and fostering clinical research which has been successfully parlayed into abstracts for national and international meetings. These projects then have an excellent track record for manuscript publication. We have had many residents successfully match in the top pediatric orthopedic fellowships (Dallas, Houston, and San Diego).

Shoulder and elbow reconstruction

The Shoulder and Elbow Division has created a comprehensive and enduring curriculum to cover the entire spectrum of shoulder and elbow orthopedics that is used for all learners rotating through shoulder and elbow services. The curriculum is housed within our learning management system and all residents and fellows complete all components of the curriculum during their time on the shoulder and elbow service.

While on service with the shoulder and elbow surgeons (six surgeons in our practice have a primary emphasis on shoulder and elbow), you will be intimately involved in all aspects of care for shoulder and elbow problems. This includes degenerative and traumatic conditions. This division plays a prominent role in the American Shoulder and Elbow Surgeons (ASES), and the national shoulder and elbow academic landscape. Residents on service will become increasingly comfortable with modern techniques and implants, including advanced open and arthroscopic techniques.

Spine surgery

During the spine rotation, all residents will participate in a curriculum covering the topics relevant to orthopedic surgery of the spine from the occiput to the sacrum. The program features a set of weekly conferences which include faculty participation from both orthopedic and neurosurgery. Conferences will cover both case-based presentations, journal club, and didactics geared at the in-training and board exams. The weekly conference schedule generally features a highlighted topic such as cervical myelopathy or spinal cord injury, with resources available online for more in-depth self-directed learning.

During the time that residents spend on the spine service, they will learn how to evaluate patients in the outpatient, inpatient, and ER settings. They will be exposed to the nonoperative and operative treatment of degenerative, traumatic, oncologic, and deformity conditions of the spine. Surgical techniques will encompass the full spectrum of open and minimally invasive approaches as well as the use of traditional techniques and developing technologies including 3D navigation and robotics. By the end of the rotation, the goal is for residents to develop the skills needed to manage and treat disorders of the spine seen in the community or academic setting.

Sports medicine 

Resident education has long been a major focus for the Division of Orthopedics and Sports Medicine at Mayo Clinic. Like other divisions, the mentorship model allows for one-on-one teaching in both the clinic and OR settings. In addition to the traditional teaching in these areas, there are many other educational resources and opportunities offered to residents to help further their sports medicine education and surgical skills.

Once per week, there is a large, multi-disciplinary conference that covers a wide variety of sports medicine cases and topics. There is also a weekly sports medicine surgery case-based conference that is designed specifically for orthopedic residents. This conference is topical in nature and covers cases from the 10 most commonly tested areas of sports medicine surgery including ACL, meniscus, patellofemoral instability, multi-ligament knee injuries, cartilage, hip/FAI, shoulder instability, rotator cuff, shoulder arthritis, and sports elbow. To complement this conference, a virtual didactic curriculum is available to all residents that include high-yield lectures on each of these topics that can be viewed at any time. Additionally, the virtual curriculum contains essential instruction on some of the foundations of sports medicine including “How to Read an MRI of the Knee/Shoulder/Hip/Elbow” and “How to Perform the Physical Exam of the Knee/Shoulder/Hip/Elbow.” This strong didactic teaching is coupled with a focus on the development of surgical skills both inside and outside of the operating room.

To hone their skills, residents have access to a dry surgical skills lab, a high-fidelity virtual reality arthroscopy simulator, and a state-of-the-art procedural skills lab for the cadaveric practice of both open and arthroscopic procedures. With this combination of excellent resources, highly motivated residents, and experienced consultants, we have found that our residents obtain an incredibly well-rounded education in orthopedic sports medicine. 

Off-campus rotations

As a PGY-3 or PGY-4, there is an opportunity for an off-campus rotation. Each rotation is three months in length. Travel expenses to the rotation are paid in addition to housing and a rental car while on the rotation. The rotation site provides furnished accommodations for the dates of the rotation only, allowing for arrival the day before the assignment begins and departure the day after the assignment ends.   

The program currently has four off-campus rotations.

Two residents every quarter can rotate to Mayo Clinic's campus in Jacksonville, Florida. There are a number of rotations including sports medicine, shoulder and elbow, musculoskeletal oncology, and hip and knee arthroplasty.

One resident per quarter can rotate to Nemours Children's Clinic within Wolfson Children's Hospital at Baptist Medical Center in Jacksonville, Florida. Many residents take advantage of an ongoing relationship with Nemours. Here, residents get exposure to a high volume of pediatric trauma and complex pediatric reconstructive surgery.

One resident per quarter can rotate to Gillette Children's Specialty Healthcare in Minneapolis, Minnesota. Gillette Children's hospital is a busy pediatric surgery center. Residents rotating at Gillette get experience with trauma and complex reconstruction.

One resident per quarter can rotate to R. Adams Cowley Shock Trauma Center at the University of Maryland Medical Center in Baltimore, Maryland. The trauma rotation at Shock Trauma was initiated to give residents exposure to a high volume of ballistic and non-penetrating orthopedic trauma. Residents who are considering trauma fellowships have enjoyed this exposure as a supplement to the trauma training at Mayo Clinic Rochester.