Sleep Medicine Fellowship Research Articles

Book Review—Pediatric Sleep Problems: A Clinician's Guide to Behavioral InterventionsMeltzerLisa J.CrabtreeValerie McLaughlin American Psychological Association: Washington, DC. 282 p.ISBN: 978-1-4338-1983-4.

Book Review—Pediatric Sleep Problems: A Clinician's Guide to Behavioral InterventionsMeltzerLisa J.CrabtreeValerie McLaughlin American Psychological Association: Washington, DC. 282 p.ISBN: 978-1-4338-1983-4.

The uncertain fate of otolaryngology in sleep medicine.

Since 2011, otolaryngologists have been required to complete a 1-year fellowship in sleep medicine in order to be eligible for the ABOto Sleep Medicine Certification Examination (ASMCE). Resultantly, the number of sleep medicine board-certified otolaryngologists has plunged since that time. This push toward extinction comes at a time when otolaryngologists have been cast into the spotlight for the diagnosis and treatment of obstructive sleep apnea, the prevailing disorder in sleep medicine. To reverse the trajectory of this subspecialty, 2 changes need to occur: increase the exposure to sleep medicine/surgery during residency and improve access to sleep medicine fellowships featuring a strong otolaryngology presence.

Poster abstracts – 1st Global Conference on Emergency Nursing & Trauma Care: Dublin, Ireland, 18–21 September 2014

Human being spends around one third of life in sleep, so normal sleep characteristics and its disorders have been the focus of attention of many scientists and physicians since long ago. The historical art works and scientific documents about sleep are the proof of this reality. However, modern sleep medicine with its own diagnostic procedures, therapeutic strategies, and sleep monitoring techniques is a new branch of medicine that has been introduced to the world not more than half a decade ago, primarily in the second half of the 20th century.Physicians and scientists in any branch of medicine have encountered challenges and obstacles while taking their primary steps. It is not surprising that we, as sleep specialists and scientists, may encounter many problems during the process of developing this new branch of medicine in our country. Although these problems differ in many aspects among various countries, there are some similarities.Since the development of sleep medicine, many professional sleep societies have evolved, many exclusive sleep journals have been published, guideline for accreditation of centers have been developed and also formalized fellowship training programs in medical universities all over the world have been established. Such developments have been helpful in reaching some milestones in overcoming some obstacles and challenges, although there is still a long way to reach the peak. Sharing the information regarding the situation of sleep medicine practice and training as well as challenges that each of us face in our daily practice and research can help us continue to improve global sleep health.While writing this chapter we connected to the major sleep scientists and physicians all over the world and asked for sharing their knowledge of development of sleep medicine in their countries. We discovered extremely valuable resources of what is going on in the practice of sleep medicine each country. In this chapter we will discuss the topic of sleep medicine in a couple of countries including China, Iran, South Korea, Russia, India, Saudi Arabia, Vietnam, Egypt, Armenia, Turkey, Nigeria and Morroco. For each country, we will first give some general information about the countries, their health care systems, sleep medicine practices, training, fellowship programs, and sleep medicine societies. Finally, we will discuss the costs of practicing sleep medicine and go through the challenges of practicing in this new field of medicine in each country.

Introducing insomnia meditation therapy: A novel behavioural intervention for insomnia

Insomnia is a common condition, which is often trivialized by treating physicians. Primary Insomnia is widely viewed as a disorder of underlying inappropriate hyper-arousal interfering with sleep. Pharmaceutical treatments are effective during their duration of use but one needs to be cautious with potential adverse effects. Behavioral interventions maintain their efficacy long after the treatment period but their use is limited for a variety of reasons including the significant time involvement. There has been growing interest in alternative and complementary therapies with much of their appeal in their ability to be used in conjunction with or instead of conventional pharmaceutical therapies. Insomnia Meditation Therapy was developed during a Sleep Medicine fellowship at the University of Toronto as an easy to learn, brief behavioral intervention. Learning Objectives: (1). Review current evidence for underlying hyperarousal as it relates to Insomnia; (2) Become familiar with a novel meditation intervention specifically targeting hyperarousal; and (3) Review promising preliminary clinical results and ongoing future research. Thirty-four participants had three instructional sessions of meditation in a group format over the course of a month during 2011–2012. Each session lasted 45 min and incrementally taught breathing exercises, a technique of meditative imagery (MI) and a Non-Judgmental Awareness (NJA) meditation. Participants were asked to practice once during the day and immediately prior to bedtime for 20–30 min each time. The impact of IMT was assessed by validated questionnaires, AIS and PSQI. In addition the seven components of the PSQI were independently evaluated to determine which aspect of sleep quality improved. The results showed that 65% ( N = 22) participants’ improved as assessed by scores on both the AIS and PSQI. Specifically the mean AIS score of these 22 participants improved from 12.9 to 7.9 (SD = 3.6) at 3–4 weeks post introduction of IMT. Furthermore an analysis of the PSQI components revealed participant improvement as follows: 45.5% on daytime dysfunction, 44% on sleep efficiency, 39% on sleep latency, 38% on sleep quality, 34% on sleep duration, 21% on decreased medication use. Thus a substantial number of participants improved, and the improvements were substantial and critical. Not only did 65% of participants improve, on average they improved to a point of clinical significance (AIS < 10). Sleep quality improved (latency, efficiency and daytime dysfunction) and there was a trend towards decreased medication use. The implications of these observations are far reaching indeed if confirmed in future research. Compared to the other major meditation therapy developed to date (MBT-I), IMT is easier to teach and learn, less time invasive and less demanding for the practitioner and professional, produces a palpable reaction during the first session and has demonstrated improved nocturnal sleep and daytime function at 3–4 weeks post introduction. It can be considered the ultimate wind down routine prior to bedtime and be used in conjunction with other behavior and pharmaceutical treatments. The mentorship and opportunity offered by Drs. Colin Shapiro and Henry Moller, Sleep Research Laboratory and Sleep and Alertness Clinic, Toronto, Ontario, Canada.

The Future is Here

Change is the only constant in health care; and with change comes uncertainty, anticipation and trepidations. The adoption of the Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act (ACA), is undoubtedly the most sweeping health care law passed by Congress since the creation of Medicare in 1965. The ACA is ushering in fundamental transformation that is likely to change the landscape of healthcare delivery in the U.S. It is very likely that the implementation of the ACA provisions will have signifi cant unintended and unforeseen consequences for medical professionals, patients, insurers and businesses. 1 Despite this uncertainty, it is clear that the ACA will shift the emphasis toward improving the outcome of care and reducing costs, perhaps by focusing on integration of care among providers and across care settings. Within this broad context of change, the fiof sleep medicine is undergoing its own radical transformation. Sleep medicine is no longer a specialty about a single disease, a single test, or a single device; instead, sleep medicine professionals provide care transcending organ based specialties, caring for one third of human life, a critical third that has direct impact on every aspect of health. The challenge before us is to develop care models that meet three aims: optimal patient experience, including quality and satisfaction; improving the health of population; and decreasing the cost of care. What are the key themes that are likely to infl uence the practice of sleep medicine in the new era of health care reform? I will highlight several areas that require our attention in the coming year.

What Can Sleep Medicine Do?

Free AccessDepartmentsWhat Can Sleep Medicine Do? Allan I. Pack, M.B.Ch.B., Ph.D. Allan I. Pack, M.B.Ch.B., Ph.D. Address correspondence to: Allan I. Pack, M.B.Ch.B., Ph.D., John Miclot Professor of Medicine, Director, Center for Sleep and Circadian Neurobiology, Chief, Division of Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania, 125 South 31st Street, Suite 2100, Philadelphia, PA 19104(215) 746-4806(215) 746-4814 E-mail Address: [email protected] Center for Sleep and Circadian Neurobiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA Search for more papers by this author Published Online:June 15, 2013https://doi.org/10.5664/jcsm.2772Cited by:3SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONThe editorial “A Warning Shot Across the Bow: The Changing Face of Sleep Medicine”1 is a cautionary tale. It would seem that a “warning shot” is an understatement. This comes on top of another cautionary tale2 that 25% of sleep medicine fellowships did not fill up last year, i.e., before recent events. None of this should come as a surprise since the writing has been on the wall for some time (see commentary I wrote in December 20113).We should not have positioned sleep medicine as a diagnostic discipline based on one test for one diagnosis. The perception of our field nationally is that we simply make money by testing, if not over-testing. It is a perception that we need to counter by accreditation standards to avoid over-testing.Sleep medicine is a chronic care management discipline with management of many highly prevalent chronic disorders. Accreditation should be based on outcomes of care, not diagnostic criteria, as recommended by the Institute of Medicine report in 2006 (Recommendation 9.2).4The positive aspect is that as medicine moves to emphasizing patient-centered outcomes, we are in a field that has major assets: (a) highly prevalent disorders that directly affect patient lives, and (b) effective treatments that directly benefit patients. We need, however, a new vision for this field. We need new accreditation standards that help implement this vision and emphasize outcomes of care and comprehensive management of all sleep disorders, based on a team approach, not just sleep apnea. Given “dead canaries” and “warning shots,” we need change now before the next editorial is about an even more catastrophic event.DISCLOSURE STATEMENTDr. Pack has indicated no financial conflicts of interest.CITATIONPack AI. What can sleep medicine do? J Clin Sleep Med 2013;9(6):629.REFERENCES1 Quan SF, Epstein LJA warning shot across the bow: the changing face of sleep medicine. J Clin Sleep Med; 2013;9:301-2, 23585742. LinkGoogle Scholar2 Quan SFGraduate medical education in sleep medicine: did the canary just die?J Clin Sleep Med; 2013;9:101, 23372460. LinkGoogle Scholar3 Pack AISleep medicine: strategies for change. J Clin Sleep Med; 2011;7:577-9, 22171193. LinkGoogle Scholar4 Colten HR, Altevogt BMSleep disorders and sleep deprivation: an unmet public health problemWashington, DC: National Academies Press; 2006. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited by Sleep breathing disorders: have we reached the tipping point?Suarez-Giron M, Isetta V, Masa J, Egea C, Riha R, Bonsignore M and Montserrat J ERJ Open Research, 10.1183/23120541.00172-2017, Vol. 4, No. 2, (00172-2017), Online publication date: 1-Apr-2018. Hwang D and Melius B The Affordable Care Act and the Future of Sleep Medicine Narcolepsy, 10.1007/978-3-319-23739-8_31, (417-435), . Cost Minimization Using an Artificial Neural Network Sleep Apnea Prediction Tool for Sleep StudiesTeferra R, Grant B, Mindel J, Siddiqi T, Iftikhar I, Ajaz F, Aliling J, Khan M, Hoffmann S and Magalang U Annals of the American Thoracic Society, 10.1513/AnnalsATS.201404-161OC, Vol. 11, No. 7, (1064-1074), Online publication date: 1-Sep-2014. Volume 09 • Issue 06 • June 15, 2013ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationMay 1, 2013Accepted for publicationMay 1, 2013Published onlineJune 15, 2013 Information© 2013 American Academy of Sleep MedicinePDF download

The Current State of Sleep Medicine Education in US Neurology Residency Training Programs: Where Do We Go from Here?

To evaluate the current state of sleep medicine educational resources and training offered by US neurology residency programs. In 2010, a 20-item peer reviewed Sleep Education Survey (SES) was sent to neurology residency program directors surveying them about sleep medicine educational resources used in teaching residents. Pearson product momentum correlation was used to determine correlation of program attributes with resident interest in pursuing a career in sleep medicine. Of the programs completing the survey, 81% listed a formal sleep rotation and 24% included a forum for sleep research. A variety of innovative approaches for teaching sleep medicine were noted. Program directors noted that 5.7% residents entered sleep medicine fellowship training programs in the preceding 5 years. Programs that had a more substantial investment in sleep medicine teaching resources were more likely to report residents entering a sleep medicine training program. This is the first report providing an analysis of the current state of sleep medicine training in US Neurology Residency Programs. Our data provide evidence that investment by the residency program in sleep education may enhance the ultimate decision by the neurology trainee to pursue a career in sleep medicine.

Graduate Medical Education in Sleep Medicine: Did the Canary Just Die?

it is for this reason that the admission ticket for recognition as a new medical specialty by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties includes a suffi cient number of active training programs and trainees in the prospective specialty. Because without practitio-ners, there is no specialty. In the most recent Sleep Medicine fellowship match, 64 programs offered 129 positions to start in July 2013. Thus, it is alarming that 31 positions or ~25% went unfi lled. It is possible that in some cases programs deliberately did not rank any candidates leading to seemingly unfi lled positions on the match list. Conversely, candidates may have per-ceived that some programs were of insuffi cient qual-ity. However, given the openings in some prestigious programs, it is likely that there is a paucity of demand. This begs several questions. Is this the beginning of a trend, i.e., the proverbial “Canary in the coal mine”? And if so, why?Unfortunately, it is impossible to know if this past year’s match is a blip in the radar or a harbinger of future results. However, if these results portend the outcome of future matches, several explanations are possible. First, potential trainees have become aware that there is decline in polysomnography use and re-imbursement, thus making specialization in Sleep Medicine less fi nancially attractive. Second, many trainees enter the fi eld after having already completed 4 to 6 years of post graduate medical training. Thus, some may view the extra year of training required for Sleep Medicine as neither intellectually nor fi nancial-ly worthwhile. Third, and perhaps the most potential-ly worriesome, Sleep Medicine may not be perceived as intellectually stimulating with most patients being evaluated and treated for sleep disordered breathing problems.What can be done? Obviously, there must be in-creased efforts to develop new practice paradigms to make Sleep Medicine fi nancially viable and not com-pletely dependent on performing laboratory polysom-nography. More importantly, we as Sleep Medicine practitioners need to promote our fi eld to potential trainees. Large numbers of the general populace suffer from sleep disorders and thus the potential to improve the quality of life for many is great. Furthermore, there is diversity to the fi eld. It is not just about treat-ing sleep disordered breathing although some believe this to be the case. Moreover, there are few disciplines where medical devices, pharmaceuticals and behav-ioral modalities are all used as primary treatments for patients. We should be communicating to potential trainees that Sleep Medicine is a diverse and complex specialty with the potential to help many patients. If we can do this, our fi eld will have a promising future. If not, there will be uncertainty.

Development and Growth of a Large Multispecialty Certification Examination: Sleep Medicine Certification—Results of the First Three Examinations

This paper summarizes the results of the first three examinations (2007, 2009, and 2011) of the Sleep Medicine Certification Examination, administered by its six sponsoring American Board of Medical Specialty Boards. There were 2,913 candidates who took the 2011 examination through one of three pathways-self-attested practice experience, previous certification by the American Board of Sleep Medicine, or formal Sleep Medicine fellowship training. The 2011 exam was the last administration in which candidates who had not previously been admitted could take it without completion of formal Sleep Medicine fellowship training. As expected, the number of candidates admitted to the 2011 examination through the practice experience pathway increased, and the overall scores of these candidates were on average lower than the other candidates. Consequently, the pass rate for all first takers of the 2011 examination (65%) was lower than that observed from the 2009 examination (78%) and the 2007 examination (73%). For each administration, candidates admitted through the fellowship training pathway scored the highest; over 90% of them passed the 2011 and 2009 examinations.

Certification in Sleep Medicine

A recent editorial in Anesthesiology, “Sleep Medicine and Anesthesia: A New Horizon for Anesthesiologists,” discussed the role anesthesiologists can play along with physicians from other specialties in the care of patients with sleep disorders.1In addition, it noted the establishment of the Society of Anesthesia and Sleep Medicine, which is designed to promote discussion, education, development of clinical standards, and research related to issues common to anesthesia and sleep. The American Board of Anesthesiology (ABA) wants anesthesiologists to be aware that the American Board of Medical Specialties has recently (March 2011) approved an application from the ABA to join other boards in the sponsorship of subspecialty certification in sleep medicine.The Sleep Medicine Certification Program was developed jointly a few years ago by the American Boards of Internal Medicine, Family Medicine, Otolaryngology, Pediatrics, and Psychiatry and Neurology. It is designed to recognize excellence among physicians who are specialists in the care of patients with sleep problems and specific sleep disorders. With the acceptance of the ABA's request, anesthesiologists may now join graduates of residency programs from other specialties in being able to enter fellowship programs in sleep medicine that are approved by the Accreditation Council for Graduate Medical Education. In addition, qualified anesthesiologists now will be authorized to take the examination that can lead to certification by the ABA in the subspecialty of sleep medicine.Anesthesiologists interested in obtaining subspecialty certification in sleep medicine must be diplomates of the ABA and participants in the ABA's Maintenance of Certification program in Anesthesiology; they also are required to have completed successfully an Accreditation Council for Graduate Medical Education-approved sleep medicine fellowship to qualify for the subspecialty examination in sleep medicine. Applicants who completed training in anesthesiology before July 1, 2009, are eligible to apply for the sleep medicine examination without fellowship training if they have been certified by the American Board of Sleep Medicine or can provide attestation of significant practice experience in sleep medicine.The Sleep Medicine Certification Examination is a comprehensive, 1-day, computer-based examination. It is administered by the American Board of Internal Medicine to candidates from all eligible specialties. The next examination will be given November 10, 2011, but the application cycle for this examination ended June 1, 2011. The subsequent examination will be administered in 2013 and will be the final one in which anesthesiologists can qualify with practice criteria alone. Additional information is available on the ABA Web site*or by calling the ABA office at 866-999-7501.†The American Board of Anesthesiology, Inc., Raleigh, North Carolina. browndl@ccf.org

Return from the Darkside–Sleep Medicine Fellowship Training: Past, Present and Future

At the time this editorial comes to press, I will be nearing completion of my 6½ years of service on the Internal Medicine Residency Review Committee (IMRRC) of the Accreditation Council of Graduate Medical Education (ACGME). Six and a half years is a long time to serve on any committee, and the IMRRC is no exception. I will not miss the hours of hard work, time away from home or the sometimes heated debate, but I always will cherish the camaraderie among fellow educators and the privilege of representing the sleep medicine community on this important body. The IMRRC a frequently misunderstood committee. I have been told by some that serving on the IMRRC is analogous “going over to the dark side,” and that the IMRRC and the ACGME are the “enemy.” This cannot be further from the truth. Although the IMRRC does sanction Sleep Medicine and other training programs that are non compliant with its requirements, the IMRRC in virtually every instance tries to improve the medical educational experience at the programs it accredits. With respect to Sleep Medicine, it is not commonly appreciated that accredited training and American Board of Medical Specialties (ABMS) board certification would not be possible today without the action taken by the ACGME. For years, organized Sleep Medicine had petitioned the ABMS for a certification examination, but had been consistently rebuffed. However, the ACGME, under the leadership of the late Dr. Marvin Dunn, agreed that Sleep Medicine was an emergent medical specialty and ACGME accredited Sleep Medicine training was born.1 Because the ABMS generally does not wish to have accredited training without a parallel examination process, ABMS board certification in Sleep Medicine became possible. Thus, during my service on the IMRRC, I have witnessed and participated in the development of the training requirements for Sleep Medicine fellowships and observed the accreditation of 71 Sleep Medicine fellowships.2 These events would not have been possible without the understanding and assistance of the IMRRC which solicited input from our community in the developing policy and program requirements. What then is the immediate future for Sleep Medicine training? In July 2012, in parallel with implementation of new program requirements for Internal Medicine subspecialties, there will be new program requirements for Sleep Medicine. Although the format of the program requirements will be different and will include the new ACGME common requirements with their focus on duty hours, core educational content related to Sleep Medicine will not be markedly different. There will be greater flexibility for training programs that emphasize pediatrics and a requirement for all key clinical faculty including the program director to be certified in Sleep Medicine by an ABMS member board. It also is likely that a provision to allow residents trained in Anesthesiology to enter Sleep Medicine training will be added to be consistent with their eligibility to take the ABMS certification exam. Moreover, the IMRRC will continue review all Sleep Medicine programs irrespective of their sponsoring specialty. However, the greatest changes will occur in assessment of fellows' meeting the six ACGME competencies: Medical Knowledge, Patient Care, Practice-based Learning, Communications, Professionalism and Systems-Based Practice. Evaluation methods will now require direct observation of these skills, solicitation of opinions from patients and staff and objective assessment tools. In general, the leadership of the ACGME is attempting to move to a less proscriptive and more outcomes-based accreditation process with longer accreditation cycles for programs in good standing. In the long-term, Sleep Medicine training will reflect the practice of Sleep Medicine. The IMRRC never makes changes in training program requirements without input from its constituent specialty communities. Thus, as the practice of Sleep Medicine evolves more toward ambulatory testing, and emphasizing the cognitive value of a Sleep Medicine specialist in the evaluation and treatment of all sleep disorders, not just sleep disordered breathing, fellowship training will need to mirror these changes in practice. It will be important for Sleep Medicine educators to provide input to the IMRRC for these changes to occur. Finally, as I return unscathed from the dark side, remember, the IMRRC is not your enemy, and in most cases it wants to be your friend.

Return from the Darkside–Sleep Medicine Fellowship Training: Past, Present and Future

Return from the Darkside–Sleep Medicine Fellowship Training: Past, Present and Future

Evaluating, Diagnosing, and Treating Sleep Disorders

&lt;P&gt;We live 24 hours per day, yet we pay attention to only those hours during which we are awake. Nonetheless, the hours spent asleep may be as important to our quantity and quality of life as food. Little attention has been paid to the sleeping child, and sleep-related problems tend to present to the child healthcare practitioner only when the youngster’s sleep disturbs the parents’ sleep. Indeed, the sleepless child has received majority attention from the pediatric community, and sleeplessness has for years been relegated to the realm of only developmental and/or behavioral disorders. However, we have come a long way in the past 15 years in understanding that sleep in infants, children, and adolescents is much more than a purely developmental phenomenon. Equal importance has been given to neurophysiologic, ontogenetic, and other physiological aspects of sleep.&lt;/P&gt;&lt;h4&gt;ABOUT THE GUEST EDITOR&lt;/h4&gt;&lt;P&gt;Shephen H. Sheldon, DO, FAAP, is Professor of Pediatrics, Northwestern University, Feinberg School of Medicine, and Director of the Sleep Medicine Center of Children’s Memorial Hospital. He is active in the clinical practice of pediatric sleep medicine and is involved in pediatric sleep medical education and research.&lt;/P&gt;&lt;P&gt;Dr. Sheldon is a graduate of the Midwestern University’s Chicago College of Osteopathic Medicine and completed his residency in pediatrics at Rush-Presbyterian-St. Luke’s Medical Center, Chicago. He has also completed a visiting faculty fellowship in medical education at Southern Illinois University Medical School and a fellowship in Sleep Disorders Medicine at the University of Chicago. &lt;/P&gt;&lt;P&gt;He has served as a consultant to the U.S. Public Health Service (USPHS) as a facilitator during the organizing conference for education/training in primary care pediatrics and internal medicine and has served as a grant reviewer for the USPHS and the National Institutes of Health (NIH) in research in primary care pediatrics. He served on the Education Committee of the Ambulatory Pediatrics Association and participated in the task force for the development of the medical school core curriculum for pediatric clerkships. He has served as Chair of the Continuing Medical Education Committee, and is a member of the National Sleep Medicine Course Committee, Education Committee, and Fellowship Training Committee of the American Academy of Sleep Medicine. &lt;/P&gt;&lt;P&gt;Dr. Sheldon served on the Board of Directors of the American Academy of Sleep Medicine from 2000 to 2006 and as Secretary/Treasurer 2003 to 2006. He was Board Liaison to the Continuing Medical Education Committee, is ad hoc member of the Fellowship Training Committee, and functions as a Center Accreditation Site visitor. He has served on the Board of Directors of the American Sleep Medicine Foundation as its Secretary, and is past Chair of the Educational Research Advisory Board. He also serves as Associate Editor, &lt;cite&gt;Journal of Clinical Sleep Medicine&lt;/cite&gt;, serves on the Board of Directors of the American Insomnia Association, and is active in the American Academy of Pediatrics. Dr. Sheldon was appointed to the American Board of Pediatrics in 2005 as representative to the American Board of Medical Specialties Sleep Medicine Policy and Examination Committee, and is a Diplomate in Sleep Medicine of the American Board of Pediatrics. He has co-chaired the Task Force of Smoke Detectors and Arousals in Children for the Standards Advisory Committee of Underwriter’s Laboratories.&lt;/P&gt;&lt;P&gt;He is the author of &lt;cite&gt;Pediatric Differential Diagnosis&lt;/cite&gt;, &lt;cite&gt;Pediatric Sleep Medicine&lt;/cite&gt;, &lt;cite&gt;Evaluating Sleep in Infants and Children&lt;/cite&gt;, &lt;cite&gt;Atlas of Sleep Medicine in Infants and Children&lt;/cite&gt;, and the forthcoming &lt;cite&gt;Differential Diagnosis in Sleep Medicine&lt;/cite&gt;, and is Senior Editor of the textbook &lt;cite&gt;Principles and Practice of Pediatric Sleep Medicine&lt;/cite&gt;.&lt;/P&gt;

Sleep Medicine Fellowships—Accomplishments and More Issues

This year marks a relatively obscure event for most of us. It is the end of the initial accreditation cycle for those Sleep Medicine programs who were the vanguard of the ∼20 institutions that were the first to receive approval by the Accreditation Council for Graduate Medical Education (ACGME) for Sleep Medicine training. Obviously, for these institutions, it means considerable time spent by the program director and faculty in the preparation of the “PIF” (Program Information Form) and “dreaded” anticipation of the inevitable site visit. However, for the rest of us who fortunately will not have to complete a PIF, it is a marker of the gradual maturation of Sleep Medicine as a specialty of medicine. ACGME accreditation of our training programs means acceptance by the medical community that we have both a distinct base of scientific knowledge and a focused area of medical practice. The accreditation process also became the impetus for the development of an American Board of Medical Specialties (ABMS) certification examination in Sleep Medicine with the first examination to be given next month. These events are a result of hard work by colleagues who are too numerous to be recognized in this abbreviated message. Several years ago, I was fortunate to serve you as a member of the AASM (American Academy of Sleep Medicine) Board of Directors and was a participant in a discussion of what to include in our strategic plan. At that time, there were slightly over 25 AASM accredited fellowships, and there was considerable debate concerning whether a goal of 50 fellowship programs was achievable. Some of us, myself included, thought that this was unlikely to occur. Fortunately, I am not making my living as a psychic, and I am happy to report that I was quite wrong. At the current time, there are 57 ACGME accredited fellowship programs with 142 training positions1. However, our field's success in developing training programs raises an additional important issue. How many Sleep Medicine clinicians does this country require? If we conservatively count only those individuals who become ABMS certified and those who will be eligible for certification, there will be 142 people entering the field each year plus those who will become certified by taking the examination through practice/American Board of Sleep Medicine eligibility (over 1900 will be taking the first exam). Will this be sufficient to sustain our field? Do we need to encourage the development of more training programs? In comparison, there are 183 adult Pulmonary and/or Critical Care Medicine training programs with ∼550 first year positions and 91 Clinical Neurophysiology training programs with 282 positions in one year programs similar to Sleep Medicine training1. At a time when there is a debate in our field as to the role of the Sleep Medicine clinician in the delivery of patient care, these are critical questions, and ones that should be addressed in the near future. Another issue related to fellowship training is the content and length of training. In the next year, there will be a scheduled revision of the training requirements for Sleep Medicine. The Sleep Medicine community will be asked for input regarding the relevance of the current requirements for the practice of Sleep Medicine now and over the next several years. Should there be additions or deletions to the requirements? Is a one year training program appropriate? Should training be at least two years, similar that required by virtually all the Internal Medicine and Pediatric subspecialties? This latter question has significant cost and person power implications, but may be important in development of academic sleep clinicians. This two year anniversary of initial accreditation of Sleep Medicine training programs may not directly affect most of us. Nonetheless, it serves as a reminder that important issues related to person power and the practice of Sleep Medicine remain unresolved and should be addressed in the near future.

“If I were AASM President I would…”

“If I were AASM President I would…”

Otolaryngology and Sleep Medicine Fellowships

Otolaryngology and Sleep Medicine Fellowships

Education and training in the field of sleep medicine.

Sleep disorders are highly prevalent but are under-recognized and under-diagnosed by the majority of health care providers. This article reviews recent studies of sleep medicine education in the United States and abroad and the reasons offered by most instructors for the lack of adequate education at their institutions. Quantity and quality of sleep medicine education have been lacking. Knowledge assessment is an important aspect of educational research, and several instruments for the assessment of sleep knowledge have been developed. A noteworthy development is the Sleep Academic Award program of the National Center on Sleep Disorders Research. This twenty-site, NIH-funded program has developed model interventions and sleep training curricula that are being widely disseminated. Sleep medicine fellowship training programs have also been established in the past decade and serve as the major vehicle for advanced specialty training. Finally, a number of strategies for introducing sleep medicine topics and issues into the medical curriculum have been proposed. Considering the paucity of publications in this area, our review was not restricted to studies in the past year.