For a total of nine of your 26 four-week blocks, your days will be split between the hospital and clinic.

In the mornings, you'll participate in rounds and care conferences on the rehabilitation unit, as well as acute care consultations and follow up visits in the children's hospital. In the afternoons, you will have PRM clinics.

This half-day schedule reflects a common real-life practice pattern.

In addition, you will spend two blocks of full days in the hospital and another two blocks of full days in the outpatient clinics. With this combination, you will have a minimum total of six months PRM inpatient and six months PRM outpatient.

Rotation schedule

*Neurology, rheumatology, orthopedic surgery, genetics, NICU, PICU, general pediatrics, radiology/neuroradiology, urology, sports. Rotation length is 2-4 weeks.

**Electives could include more time in any of the core or subspecialty rotations, or it could be in any other specialty such as hematology-oncology, endocrine (including bone clinic), developmental pediatrics, neurosurgery, psychology, pediatric pain service, palliative care, pain rehabilitation program, pulmonology, and others.

Outpatient pediatric rehabilitation clinics
During your outpatient pediatric rehabilitation rotations, you evaluate and manage a wide variety of diagnoses in youth ages birth to 21, including participating in multidisciplinary clinics.

• Cerebral palsy
• Spina bifida
• Muscular dystrophies and myopathies
• Hereditary Peripheral neuropathies and peripheral nerve injuries
• Musculoskeletal disorders and sports injuries
• Inflammatory joint disease and other rheumatologic disorders
• Chronic pain
• Limb deficiency and amputation
• Plagiocephaly and torticollis
• Developmental delays due to hereditary and acquired disease
• Spinal cord dysfunction
• Gait disorders
• Functional neurologyic disorders
• Cancer

You will also:

• Evaluate, prescribe, and follow up on age-appropriate assistive devices and technology, such as orthotics, prosthetics, seating systems, adaptive equipment, gait aids, augmentative communication, and environmental accessibility aids in order to improve independent function
• Evaluate for and perform pediatric rehabilitation procedures such as botulinum toxin (including salivary glands) and phenol injections, baclofen pump refills, and programming
• Advocate for care needs within systems of care including educational, vocational, transition, and home care systems 

Inpatient rehabilitation service
During your pediatric inpatient rehabilitation rotations, you serve as the primary physician for children and adolescents admitted to the rehabilitation unit. In addition, you provide consultation and follow-up services for children in the pediatric acute care hospital and assist in decision-making regarding next steps of care.

The Mayo Clinic Children's Hospital is a "hospital within a hospital" near the rehabilitation unit. Pediatric rapid response and code teams as well as consultation services from any of the general or specialty pediatrics teams are readily available for children on the rehabilitation unit.

Primary diagnoses on the rehabilitation unit include:

• Acquired brain injury
• Spinal cord dysfunction
• Multitrauma (Mayo Clinic Hospital, Saint Marys Campus, is a Level 1 Pediatric Trauma Center)
• Stroke
• Cerebral palsy
• Cancer

You will learn to:

• Identify and manage common medical conditions associated with childhood onset disorders
• Lead rehabilitation team conferences
• Plan and coordinate transitions of care

Procedures during your inpatient months include electromyography (EMG), selective dorsal rhizotomy monitoring, and injections.

General pediatric hospital
During this two-week rotation, you become familiar with general acute pediatric conditions and post-op monitoring warranting hospitalization, as well as pediatric fluid, nutrition, and medication management.

NICU
Two-weeks in the NICU allow you to better understand what infants and their families experience at the beginning of life. You become familiar with the risk factors for future disability and manage basic preemie care with ample support. Handling and assisting with the care of a 2-pound premature infant in the neonatal intensive care unit (NICU) provides context for the years to come.

PICU
The two-week Pediatric Intensive Care Unit (PICU) rotation is intended to familiarize you with the identification and management of life-threatening emergencies, respiratory failure management, postoperative care, and airway management. You develop a deeper understanding of disorders of consciousness, end of life and palliative care, transplants, and initial trauma care.

Pediatric neurology
During your one-month pediatric neurology rotation, you evaluate and treat a wide variety of pediatric neurologic presentations and diagnoses such as: genetic syndromes, epilepsy, acquired central nervous system and peripheral neuromuscular dysfunction, movement disorders, developmental delays and regression, and headaches.

Pediatric rheumatology
During your two-week pediatric rheumatology rotation, you are likely to see individuals with juvenile inflammatory arthritis, systemic lupus erythematosus, seronegative spondyloarthropathies, juvenile dermatomyositis, and noninflammatory causes of musculoskeletal pain.

Pediatric orthopedic surgery
You rotate with the pediatric orthopedists for one month. This includes OR observation as well as outpatient clinical evaluation of a wide variety of bone and soft tissue abnormalities, including: fractures, torsions, scoliosis, hip dysplasia, and genetic bone syndromes. You learn about optimal timing and conditions for various procedures. For example, learning directly from a pediatric orthopedic surgeon about surgical indications for hip dysplasia in a child with cerebral palsy and then actually observing the operation enables you to provide more informed care and advice to future similar patients.

Genetics
During your two-week genetics rotation, you refine your history-taking skills and learn to look for signs of common genetic disorders that are referred to rehabilitation clinics as well as identify initial steps for genetic testing and therapeutics.

Community advocacy
You tour numerous facilities in the Rochester area that provide support to youth with disabilities, so that you can assist in connecting your patients and families with appropriate groups and activities.

Radiology/neuroradiology
Hip subluxation and scoliosis measurements, fractures, and all manner of CNS abnormalities in the developing child are emphasized during this two-week rotation.

Sports
Sports injuries are evaluated and treated during this two-week rotation. This rotation is under the guidance of pediatricians with sports certification, PMR sports medicine physicians, and our own PRM staff with sports certification. An adapted sports clinic is growing.

Urology
Understanding the pathophysiology, presentation, diagnosis, and management of neurogenic bowel and bladder are the goals of this two-week rotation.

Call frequency

Night call when rotating on the rehabilitation unit is taken from home. During call, you have an attending rehabilitation medicine physician available for consultation. Call frequency maximum is twice per week but more likely once per week during the two months you are exclusively covering the rehabilitation unit. There are limited to no patient care responsibilities on the weekend. Patient care responsibilities on the weekend are limited to none. The vast majority of PRM training rotations/months have no night call.

Moonlighting

You may moonlight with program director approval. Moonlighting must not interfere with the required learning and must not violate the work-hour rules of the Accreditation Council for Graduate Medical Education (ACGME) or visa regulations.

Research

The goal during this fellowship is to support your area of academic interest. The time dedicated to research during this program is utilized to prepare you to become an independent investigator upon completion of your training. At Mayo Clinic, there are many opportunities to pursue basic science, translational, clinical, or educational research. Your personal interests are matched with the research interests of a dedicated mentor.

You are encouraged to take research courses within Mayo Clinic Graduate School of Biomedical Sciences. These courses aid in the development of a scholarly approach to patient care.

During your final year, you present research at the annual PM&R research seminar.

Didactics

Mayo Clinic's Pediatric Rehabilitation Medicine Fellowship outlines specific goals and objectives for each rotation block. They contain current supportive literature relevant to the topics discussed and are based on the published outline from the American Board of PMR Pediatric Rehabilitation Medicine for the certification examination. In addition, a structured review of the "Pediatric Rehabilitation: Principles and Practice (Edition 6)" occurs with staff.

You have dedicated time to participate in didactic training, including:

• PM&R educational conferences, journal club, and an annual research seminar
• Dedicated pediatric rehabilitation medicine lecture series and journal club
• Pediatric morning report, noon conferences, and grand rounds
• Lectures and grand rounds in pediatric orthopedics, pediatric neurology, pediatric radiology, and others

Regional and national conferences

You receive time and financial coverage to attend one national subspecialty-related meeting during your fellowship. You may also attend one regional conference. You receive time and support to attend any national meetings for which you have an accepted podium or lecture presentation, poster, or committee participation.

Teaching opportunities

Teaching is valued at Mayo Clinic. As a fellow, we aim to offer you opportunities to teach and to help you refine your teaching skills.

With abundant online “teach the teacher” resources, education lectures, and individual mentoring, you will have opportunities to teach formally and informally.

With support, you will determine curriculum for the PRM lecture series, inviting guests as well as developing a couple of your own lectures. You’ll provide a lecture at PM&R grand rounds once, review pediatric rehabilitation goals and objectives with PM&R residents on a weekly basis, and present your research once during the research seminar.

You’ll lead PMR residents in an annual pediatric journal club and help plan the PRM quarterly journal clubs.

You may be asked to teach residents from other specialties on occasion.

Evaluation

Evaluation is expected as we all strive for excellence. Staff evaluates the fellow every rotation, providing feedback with compliments and suggestions for improvement.

Fellows evaluate staff and their experience on each rotation. Feedback is anonymous (mixed with resident and past fellows) and serves to allow us to improve staff teaching skills and rotation structure and content.

Fellows participate in the fellowship education committee and help set goals for improvement.