Clinical training

The Pain Medicine Fellowship follows the requirements set forth by the Accreditation Council for Graduate Medical Education (ACGME) and its residency Review Committee for anesthesiology.

Rotations during the fellowship include physical medicine and rehabilitation, neuroradiology, neurology, chronic pain clinic, cancer pain or palliative care, and pain rehabilitation.

Rotation schedule

Rotation descriptions

Core clinical experience

• Mayo Clinic Pain Clinic. Pain medicine fellows train under the supervision of the pain clinic faculty. You participate in the evaluation and treatment of patients with a wide variety of pain problems, including cancer pain, spine pain, sympathetically mediated pain, neuropathic pain, visceral pain, and myofascial pain. You are expected to completely evaluate your patients and present your findings and treatment plans to pain medicine faculty. Typical treatment plans may include interventional pain procedures, medications, physical therapy, or behavioral modification. Fluoroscopically guided interventional pain procedures are performed in the on-site procedural facility located within the Mayo Clinic Hospital.
• Hospital-based pain consultation services at Mayo Clinic Hospital. You learn how to evaluate postoperative pain patients, manage complications, and — most importantly — organize and safely manage a hospital-based pain consultative service. All hospital-based pain service activities are directly supervised by pain medicine faculty. The hospital training experiences are incorporated throughout the eight- to nine-month rotation in the pain clinic.

Additional rotations available

• Anatomy dissection laboratory. An anatomy course, offered through Mayo Clinic in Rochester, Minnesota, is organized specifically for pain medicine trainees and conducted on an annual basis. You are asked to dissect anatomical areas of interest that are relevant to pain medicine training and practice. Pain medicine trainees and faculty subsequently meet in the anatomy laboratory to review the dissection with the assistance of an anatomy faculty. In addition, novel interventional pain techniques are both taught and practiced during this week of both didactic and hands-on cadaveric training.
• Hospice and palliative care. During this rotation, you learn basic concepts of hospice care, including eligibility and certification; cancer pain and symptom management in terminal patients; and ethical issues related to death and dying. Information about palliative sedation, depression, and anxiety management is taught during this rotation. You are supervised by faculty specialists in palliative care during this rotation.
• Neurology. During this rotation, you develop the necessary knowledge, attitudes, and skills required to manage patients with neuropathic pain and chronic headaches.
• Psychology and behavioral medicine. Trainees learn to recognize psychologic symptoms and syndromes and to initiate appropriate treatment and consultation. This knowledge base enables fellows to differentiate between symptoms that are suggestive of a primary psychological disorder from those suggestive of a primary neurological disorder.
• Regional anesthesia. During this segment, you learn to prevent, recognize, and treat immediate and potentially life-threatening complications that can occur after interventional pain management techniques. Fellows complete the Accreditation Council for Graduate Medical Education (ACGME)-required training regarding airway management, intubation, sedation, and IV access, among other skills.
• Electromyography (elective). This elective is specifically tailored to trainees who have attained prior competence in EMG and wish to hone their skills prior to departing the fellowship. You perform routine and complex nerve conduction studies (NCS) and needle EMG independently in a supervised setting.
• Integrative medicine (elective). During this rotation, you will learn how integrative medicine focuses on wellness-promoting treatments that complement conventional medicine. You evaluate patients based on evidence-based techniques offering patients a holistic approach for optimal health and healing. Integrative medicine is a practice that:
  • Promotes wellness and treating the whole person
  • Reaffirms the importance of relationships between the practitioner and the patient
  • Accentuates the innate capacity of the body to heal
  • Makes use of all appropriate therapeutic approaches for health and healing
• Neuroradiology (elective). During the rotation, you develop the knowledge and skills necessary to make appropriate decisions regarding the use of available imaging techniques including X-ray, CT, and MRI. If you are interested, you can learn the indications and techniques for intradiscal procedures and vertebral augmentation.
• Neurosurgery (elective). You gain experience in assessing patients for neurosurgical intervention for spine and limb pain. You are involved in preoperative and postoperative assessment. You also receive education regarding basic surgical skills, such as surgical preparation, sterile technique, skin suturing technique, and postoperative wound assessment and management.
• Physical medicine and rehabilitation (elective). During the two weeks, you gain experience in assessing chronic pain patients using a rehabilitation model. You develop the necessary knowledge, attitudes, and skills to initially evaluate and appropriately refer patients for therapy, including the development of a rehabilitation plan of care. In addition, you are exposed to physical and occupational therapy treatment sessions for the patients they evaluate and refer for therapy.

Call frequency

Typically call is taken from home and usually no more than one weekend every six weeks. Mayo Clinic College of Medicine and Science follows the recommendations of the Accreditation Council for Graduate Medical Education (ACGME).

Moonlighting

Moonlighting is allowed at the discretion of the program director. It should not interfere with your required learning and must not violate the work hour rules of the ACGME or visa regulations. Moonlighting should not compromise your education but rather enhance it.

Research training

You are expected to participate in scholarly activity and clinical research during your training. Education in the fundamentals of clinical research is provided throughout the year by the pain faculty. You work with a mentor on developing a research project of your choosing and are provided with dedicated research time based upon the progression of the study every month. Mayo Clinic has an abundance of resources to facilitate and support this aspect of your training.

Didactic training

The pain medicine curriculum covers all ACGME-required didactics delivered by Mayo Clinic faculty on a weekly or biweekly basis. Additional educational opportunities include pain journal club, pain morbidity, and mortality conferences, grand rounds, invited guest speakers, and numerous additional multispecialty conferences.

Teaching opportunities

You have the opportunity to teach pain-related subjects to Mayo Clinic residents, residents rotating from other hospitals, and visiting medical students.

Evaluation

To ensure you acquire adequate knowledge and develop the appropriate technical skills to meet program expectations, your performance is monitored carefully during the Pain Medicine 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 your educational goals are being met.