Educational Purpose

Fellows generally are assigned one rotation on the sleep service per year. To qualify for ABIM sleep board certification, an additional 1 year full-time Sleep Medicine is required. The purpose of the rotation and elective time in sleep medicine is to gain experience with diagnosis and management of patients with sleep disorders primarily in the out-patient setting and sleep laboratory. This involves:

•Development of a body of knowledge concerning nosological characterization and treatment of particular sleep disorders using a multidisciplinary approach

•Developing efficiency and facility in the diagnosis and management of chronic sleep problems for both ambulatory and hospitalized patients

•Developing an appreciation of diagnostic testing available for sleep disorders

•Developing an understanding in the management of non-invasive positive airway pressure for the treatment of conditions such as respiratory failure and sleep-disordered breathing.

Teaching Methods

Fellows see both inpatient and outpatient new consultations along with follow-up patients in the outpatient setting. Fellows on a sleep rotation are expected to participate in all the outpatient clinics and read sleep screening test on a daily basis for the VA patients. Fellows are supervised by two attendings during the clinic sessions and direct feedback is provided at the time of clinical service. A structured sleep intake form is provided to the fellows and notes are reviewed.

The fellow is responsible for review of any diagnostic testing performed on their patients, ideally within 3 days of study completion. Polysomnogram interpretation will be reviewed with the supervising attending. Fellows should attend the weekly polysomnography conference. Ancillary testing, such as pulmonary function tests, oxygen desaturation studies, trending oximetry, CPAP adherence downloads are to be reviewed in detail with the attending physicians.

Mix of Diseases, Patient Characteristics, and Types of Clinical Services

Diverse disease types are encountered in this clinic. A large group of patients with sleep apnea is also followed in this clinic, where adherence monitoring and an individual action plans are developed.

Fellow Evaluation Method

Fellows are evaluated by the supervising attending physicians at the end of each rotation. Verbal feedback is given on an ongoing basis. An ABIM-format evaluation is completed by all attendings and reviewed with the fellow at the completion of the rotation. If an attending physician judges that a fellow is not performing adequately in any area of evaluation, he or she must explicitly provide constructive feedback as soon as possible.

Fellows in return, evaluate their attending physicians and the rotation in terms of patient mix, experience as well as the number of procedures by filling in an evaluation form at the end of the rotation.