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Curriculum

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Clinical training

During the first year of rheumatology training, fellows rotate through outpatient and inpatient experiences within rheumatology and outside rheumatology. Required first year core rotations are in electromyography (EMG), physical medicine and rehabilitation (PM&R), and radiology. The second year is committed to research along with clinical rotations (outpatient/inpatient).

Second year training continues similarly with required core rotations in endocrinology/metabolic bone clinic, muscle pathology, pediatric rheumatology at Phoenix Children’s Hospital and Mayo Clinic Sports Medicine Campus in Tempe, Arizona. Elective options become more widely available during the second year of training, although some may also be completed during the first year. Current elective rotation opportunities include:

  1. Integrative medicine
  2. Pain medicine
  3. Headache
  4. Hand surgery
  5. Hematology (with a focus on CAR-T cellular therapy)
  6. Combined muscle histopathology and metabolic bone disease as a 4-week away rotation at Mayo Clinic Rochester, Minnesota

Rotation schedule

Rotations are generally divided into 2-to-4 week durations depending on the rotation.

Most commonly, each fellow will be on a repeating 2-week cycle. Each fellow will spend 2 weeks on the inpatient rotation, then 2 weeks on the outpatient procedure rotation, and then 2 weeks on the outpatient research rotation. This rotation will continue for a total of 52 weeks. Friday mornings are protected time for educational sessions at the Scottsdale campus for all fellows.

Most rotations are on-site at Mayo Clinic in Phoenix/Scottsdale, Arizona. Some required rotations are at external nearby off-sites such as Phoenix Children's Hospital, Mayo Clinic Sports Medicine Campus in Tempe, Arizona, and Mayo Clinic in Rochester, Minnesota. the rheumatology ambulatory care clinic at Valleywise.

Inpatient rotation: Outpatient clinics in the morning at the Scottsdale campus and inpatient service in the afternoon at the Phoenix hospital campus.

Procedure rotation: Outpatient clinics in the morning and procedure/ultrasound clinic in the afternoon, both at Scottsdale campus.

Research rotation: Most of the week is protected for research. Some clinical time with outpatient Valleywise clinic on Tuesdays as a full day. Two half-days of specialty and/or interdisciplinary clinics at the Scottsdale campus.

Requested external rotations, electives, trip time, and vacation time are scheduled during non-inpatient rotations.

Year 1

Rotation Time
Outpatient rheumatology clinics 4 half-days per week*
Hospital consulting service 2 half-days per week*
Research days 1.6 half-days per week*
Procedure/Ultrasound Clinic 1.3 half-days per week*
Electromyography (EMG) (Scottsdale, AZ) 1 week
Physical medicine and rehabilitation 2 weeks
Musculoskeletal radiology 2 weeks
Electives 1 week

*Approximate half-days per week over the academic year. Not adjusted for electives, conference trips, and vacations.

Year 2

Rotation Time*
Outpatient rheumatology clinics 4 half-days per week*  
Hospital consulting service 2 half-days per week*
Research 1.6 half-days per week*
Procedure/Ultrasound Clinic 1.3 half-days per week*
Pediatric rheumatology, Phoenix Children's Hospital (Phoenix, AZ)

2 weeks
Orthopedic sports medicine (Tempe, AZ)

2-4 weeks
Electives 1-2 weeks
Elective: Metabolic bone and muscle pathology (Rochester, MN) 4 weeks

*Approximate half-days per week over the academic year. Not adjusted for electives, conference trips, and vacations.

View of the Mayo Clinic Phoenix campus and the surrounding landscape.

Procedures and ultrasound

All landmark-guided and ultrasound-guided arthrocentesis and soft tissue injections are performed under the supervision of Mayo Clinic staff rheumatologists. Procedural training in musculoskeletal arthrocentesis includes injections of soft tissue tendons and bursa, and aspiration and injections of large, medium, and small joints. There is a strong emphasis on diagnostic ultrasound as well. Diagnostic and interventional procedures are performed in the ultrasound procedure clinics which are supervised by musculoskeletal ultrasound certified faculty. Our division also performs specialized procedures like trigger finger release, synovial biopsies, and nerve blocks.

To enhance ultrasound skills, simulated ultrasound diagnostic and interventional training is provided via standardized patients and cadaver lab.

Fellows will learn synovial fluid analysis on a polarized microscope to identify crystalline arthritis and will have regularly scheduled procedure clinics.

Didactic training

Most of these sessions are held on Friday mornings from 0800 to 1200. Core curriculum conferences, case conferences, ultrasound hour, journal club, board review sessions, and one-to-one instruction with staff rheumatologists are integral parts of the Rheumatology Fellowship.

Conferences

There are numerous opportunities to participate in various departmental and divisional conferences. The following conferences are part of the fellowship:

  1. Clinical case conference
  2. Journal Clubs
  3. Core curriculum conferences
  4. Board review sessions
  5. Ultrasound didactic and practical sessions including cadaver lab and standardized patients
  6. Morbidity and Mortality conferences
  7. Our division regularly participates in the weekly Rheumatology Grand Rounds alongside other Mayo Clinic sites across the country
  8. Inter-disciplinary radiology-rheumatology conference
  9. Inter-disciplinary nephrology-pathology-rheumatology conference
  10. Inter-disciplinary pulmonology-pathology-radiology conference.
  11. Weekly internal medicine grand rounds are also available for fellows to attend
  12. The fellows also participate in the Phoenix Rheumatology Association events which bring together rheumatologists practicing across the valley

Research

This may be a retrospective patient record review, quality project, meta-analysis, or similar project. A pragmatic prospective clinical research project is an option as well. 

A research mentor will be assigned to you early in the first year of training. Mayo Clinic Center for Clinical and Translational Science (CCaTS) is a central hub for institutional advancement of research and education at Mayo Clinic. The center provides tools and expert consultation to support every aspect of medical research, including basic discovery science, clinical and community-engaged research, and late-stage application and commercialization.

Initial biostatistical support is also available to trainees.

Fellows are expected to complete a quality improvement project in addition to the research project.

Call frequency

The home call schedule is different for each rotation. Mayo Clinic follows the recommendations of the ACGME regarding work hours.

Moonlighting

Moonlighting is discouraged due to the significant time commitment required for the fellowship training program.

Teaching opportunities

Fellows will teach medical students from Mayo Clinic Alix School of Medicine, transitional year, and internal medicine residents through bedside teaching, small group exercises, and formal didactic lectures. Fellows have access to a variety of resources from our Academy of Education Excellence to develop skills as educators. 

Evaluation

To ensure that you acquire adequate knowledge and technical skills, performance is carefully monitored during the Rheumatology Fellowship. You are evaluated formally by the supervising faculty member after each clinical rotation, and you will meet with the program director to review these evaluations. In addition, you will also regularly evaluate the faculty to ensure that your educational needs are being met.

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