Curriculum

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Clinical training

The Physical Medicine and Rehabilitation (PM&R) Residency at Mayo Clinic's campus in Rochester, Minnesota, features 33 blocks of required rotations in six broad areas and approximately three (four-week) blocks of electives.

To further enhance your training experience, you have the option to use elective time to rotate to other Mayo Clinic sites, including the Mayo Clinic campuses in Jacksonville, Florida, or Phoenix/Scottsdale, Arizona; or the Mayo Clinic Health System in Minnesota and Wisconsin.

Your training includes a continuity clinic during the last two years. During all three years, you may also choose to serve as a team physician for a local sports team.

Year 1

The first year is split between six (four-week) blocks on the inpatient rehabilitation service at Mayo Clinic Hospital — Rochester, Saint Marys Campus, five four-week blocks rotating through various outpatient clinics, and one month on the hospital PM&R consult team. Inpatient rotations are divided between two (four-week) blocks on the spine and brain rehabilitation teams, followed by two more (four-week) blocks. Outpatient rotations include general PM&R clinic, neurology clinic, pediatric rehabilitation, hand clinic, and a block of research/outpatient spinal cord injury medicine.

Year 2

You will spend around six weeks on the inpatient pediatric rehabilitation service with the remainder of the year in various outpatient settings. Rotations include sports medicine, musculoskeletal medicine, amputee rehabilitation, pain medicine, and six (four-week) blocks of EMG training. You also begin your continuity clinic this year for one half-day each week.

Year 3

During your senior year, you return to the inpatient rehabilitation service as a supervising resident for four (four-week) blocks. You also rotate on the inpatient cancer rehabilitation service. Other required rotations include outpatient brain injury clinic, ultrasound-guided injection clinic, and spine center clinic. You will also have the opportunity for elective rotations in various subspecialties and the ability to do away rotations at Mayo Clinic Square Sports Medicine; the Mayo Clinic campuses in Jacksonville, Florida, or Phoenix/Scottsdale, Arizona; or the Mayo Clinic Health System in Minnesota and Wisconsin.

Rotation descriptions

Inpatient rehabilitation services

During your inpatient rehabilitation rotations, you serve as the primary care physician for rehabilitation patients, conduct patient care conferences with the rehabilitation team, and lead clinical discussion groups. A typical patient load includes eight to 10 patients.

Residents assume an increasing level of practice independence as their experience and abilities dictate. There are no consulting staff "private" patients. The residents work side by side with the PM&R staff to care for patients.

There are three services in Mayo Clinic's 38-bed rehabilitation unit:

Spinal cord rehabilitation service
Brain rehabilitation service
Pediatric rehabilitation service

The spinal cord injury and brain rehabilitation services each have three residents and one staff physiatrist. While you are assigned to an adult rehabilitation service, you are responsible for approximately seven to 10 patients. The rehab unit admits more than 700 patients a year.

Trained allied health personnel perform most ancillary procedures, such as starting intravenous fluids (including blood), performing venipunctures and electrocardiograms, and drawing blood gases.

Cancer inpatient rehabilitation service

You rotate for six weeks on the cancer rehabilitation service at Mayo Clinic Hospital — Rochester, Methodist Campus, where you are trained in end-of-life care and goals of care, neurological complications of cancer, cancer pain management, cognition, and mood issues in medically complex patients, bone metastases, and lymphedema.

Pediatric rehabilitation services

Your residency includes 10 weeks of pediatric rehabilitation services consisting of inpatient care, consult service, and outpatient care. You learn to assess and manage children with developmental disabilities, cerebral palsy, muscular dystrophy, spina bifida, and acquired disorders such as brain trauma and spinal cord injuries.

You also participate in special pediatric clinics, such as the pediatric pain clinic as well as the spina bifida and cerebral palsy clinics, and community outreach programs for children.

Hospital inpatient consultation services

While assigned to hospital inpatient consultation services, you work with staff physiatrists to provide consultation services and regular follow-up for inpatients. Mayo Clinic Hospital — Rochester, Saint Marys Campus has programs for neurosurgery, trauma, pediatrics, and peripheral vascular disease.

Clinic outpatient consultation services

While on outpatient rotations, you see a wide variety of conditions. You gain experience in arthritis, amputee, spine conditions, and sports rehabilitation. You learn to diagnose and manage occupational arm and hand injuries and work closely with physical medicine and rehabilitation hand specialists, orthopedic surgeons, physical therapists, and occupational therapists.

You gain musculoskeletal examination skills and learn to diagnose and treat musculoskeletal injuries of all types. You also learn important techniques and indications of cardiopulmonary exercise testing.

During the outpatient neurology rotation, you learn to diagnose and treat cerebrovascular and seizure disorders, and inherited or acquired central and peripheral nervous system disorders.

Neurology outpatient

During the outpatient neurology rotation, you learn to diagnose and treat cerebrovascular and seizure disorders, movement disorders, and inherited or acquired central and peripheral nervous system disorders.

Electromyography Laboratory

You gain extensive experience in electromyography during this unique six (four-week) block rotation in the Electromyography Laboratory. You perform enough electromyographic studies to qualify for certification by the American Board of Physical Medicine and Rehabilitation.

Mayo campus rotations

You may complete rotations at Mayo Clinic's campuses in Jacksonville, Florida, or Phoenix/Scottsdale, Arizona, during the PM&R Residency. These practices offer pain clinic as well as outpatient and inpatient PM&R experience in a community-based practice.

Mayo Clinic funds your authorized additional costs of travel, housing, automobile rental, and licensure fees. Our residents consistently rate these rotations very highly.

Electives

Inpatient and outpatient elective rotations are available to meet your interests and career goals. Your options include electives in the Department of Physical Medicine and Rehabilitation or in other departments.

Didactic training

Clinical conferences, seminars, small discussion groups, journal clubs and one-on-one instruction are integral parts of Mayo Clinic's PM&R Residency.

Your didactic training includes:

Clinical conference and case presentations presented by physical medicine and rehabilitation consultants, residents, or guest faculty. Attendance is required.
Weekly conferences in sports and inpatient rehabilitation services. Attendance is required while you are on these specific rotations, otherwise, attendance is optional.
Journal club, which meets once a month. You are assigned to review approximately one to two articles a year, but monthly journal club attendance is required.
A comprehensive introductory PM&R curriculum and a research training curriculum.
A comprehensive anatomy course with prosected cadavers paired with a musculoskeletal and ultrasound exam course providing hands-on training and observation of joint and spine examination skills.
A spine injection course where residents practice fluoroscopically guided injections on cadavers.
Resident didactic sessions that focus on biomechanics; pathophysiological basis of tissue healing and repair; the use of different modalities; and disorders of bones, joints, nerves and muscles.
A two-month clinical neurophysiology course integrated into the electromyography rotation.
A one-week prosthetic/orthotic course.

Residents present clinical case conferences to the department once a year during their PGY-3 year. An annual Resident Seminar Day provides a forum for presentation of senior residents' research.

Additionally, in an education conference, PM&R consulting staff members present case presentations covering topics in all subspecialty areas within physical medicine and rehabilitation.

Research training

The research training program includes planning a research project that you complete during your residency. Projects frequently involve musculoskeletal ultrasound, epidemiology of specific disorders, or new rehabilitation interventions. This experience improves your ability to think analytically and critically review literature. Research funding is available for approved projects.

During the residency, you prepare two seminar presentations that represent the introduction and results of your research project.

PM&R residents are encouraged to submit their research work for presentation at national meetings. If accepted, the department supports attendance at those meetings. In addition, each resident is offered one trip to attend a meeting of his or her choice as an educational and networking opportunity.

Clinician-Investigator Training Program

A Clinician-Investigator Training Program also is available as part of the PM&R Residency. This opportunity would extend your training by approximately 18 to 24 months. The Clinician-Investigator Training Program is an excellent choice if you are planning a career that would emphasize research in an academic center.

Call frequency

Your call schedule varies by individual rotation. Mayo Clinic follows duty hour recommendations of the Accreditation Council for Graduate Medical Education (ACGME).

Generally, you are on call every fourth night and every other weekend while you are assigned to an inpatient rehabilitation service. During the remaining months of your residency, you cover weekend consult service, which typically adds up to a total of three to four times each year.

Teaching opportunities

You have the opportunity to teach Mayo Clinic Alix School of Medicine students, physical therapy students and visiting students from other medical schools through bedside instruction, physical examination workshops and formal didactic lectures. In addition, residents and fellows from other Mayo Clinic departments occasionally rotate through PM&R.

Practice board exams

To prepare for board examinations, you participate in the yearly self-assessment prepared by the American Academy of Physical Medicine and Rehabilitation. You also complete mock oral exams twice each year. Conducted by Mayo Clinic's consulting staff, these oral exams prepare you for the second part of the physical medicine and rehabilitation boards.

Committee assignments

We feel that committee participation is an effective way to promote professional development. Residents may participate on committees both at Mayo Clinic and within national organizations.

Moonlighting

Moonlighting is permitted for licensed residents at the PGY-2 level or above. Moonlighting activities may be scheduled during times when you are assigned to consultative or outpatient rotations, as long as they do not interfere with your clinical or research-related duties. No moonlighting is allowed while you are assigned to inpatient rotations.

Evaluation

The Mayo Clinic PM&R Residency is committed to following the guiding principles as put forth by the ACGME Outcome Project. Residents should expect to be evaluated for progress toward achieving competency in these areas: