Clinical Sleep Training at Beth Israel Deaconess Medical Center

Program Specialty / Subspecialty:

Sleep Medicine (through the Department of Medicine)

Program Address:

KB 023 (Pulmonary Office)
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
Phone: (617) 667-5864
Fax: (617) 667-4849
Program E-mail: rthomas1@bidmc.harvard.edu

Program Director: Robert Joseph Thomas, M.D.

Program Contact:
Andy Omann, Education Specialist
Divisions of Nephrology & Pulmonary, Critical Care and Sleep Medicine
Beth Israel Deaconess Medical Center
330 Brookline Avenue - GZ409
Boston, Massachusetts 02215
Phone: (617)667-2751
Fax: (617)667-1604

Program History

The Sleep Medicine Training Program has been in existence since 1985, affiliated with the American Academy of Sleep Medicine accredited Multidisciplinary Sleep Disorders Center at the Beth Israel Deaconess Medical Center. The training program was accredited by the AASM in 2002, and most recently by the Accreditation Council for Graduate Medical Education (ACGME). Separate Pulmonary and Neurology Programs were accredited by the AASM.  The latest accreditation, in the first round of Sleep Medicine Fellowship accreditations, occurred in October 2005, with program recognition from July 2005. The program now combines resources from Neurology and Pulmonary medicine, and is under the administrative overview of the Department of Medicine. The current program capacity is 4 full-time slots, and an expansion to 6 is being planned. Prior to that, since the inception of training, more than 20 Fellows have completed training in this program.

Program Duration

One (full time clinical) and two (half time clinical, half time sleep research) options are available. Potential hybrid options that are being considered, if ACGME approval is possible, include sleep-epilepsy.

Prerequisite Training / Selection Criteria

Board eligibility or certification in Internal Medicine, Neurology or Psychiatry through an ACGME accredited program is a minimal requirement. Those who have additional boards are also eligible (e.g., Pulmonary Medicine, Clinical Neurophysiology). Other requirements include state license, a valid DEA certificate, and appropriate letters of reference.

Goals and Objectives for Training

• Training in clinical sleep medicine, adult and pediatric. This includes the full spectrum of sleep disorders, not just sleep apnea.
• Training in sleep laboratory technology, adequate to run an independent sleep laboratory and technician training program.
•  Training in sleep laboratory medicine, including the skills to directly treat sleep apnea syndromes.
• Training in sleep research methodology adequate to prepare a unit with intent to publish (e.g., abstract, review, original paper). Those who do a 2-year clinical/research pathway will have a major research project, with intent to apply for a K series award on completion of the Fellowship.
•  The opportunity to work in a highly integrated care environment, as sleep medicine is truly multi-disciplinary.
• Continued development of individual candidates as physicians and healers.
• Program Certifications: AASM, ACGME

Program Resources

Teaching Staff
 Dr. Robert Joseph Thomas, Dr. Jean Matheson and Dr. Geoffrey Gilmartin (all certified in Sleep Medicine) are the core faculty. Supervisory responsibilities include all aspect of training, including clinic precepting, review of polysomnographic data, didactic instructions, technical instruction, and assessment of competence. Supporting faculty are Dr. Richard Ferber (Pediatrics), Dr. Leonard Kaban (Maxillofacial Surgery), Dr. David Caradonna (ENT), Dr. Gail Demko (Dental Sleep Medicine), Dr. Albert Galaburda (Behavioral Neurology, Neuropsychiatry), Dr. Peter Zimetbaum (Cardiology), Dr. Donald Schomer (EEG) and Dr. Lisa Strauss (Psychology).

Facilities
Training sites are: 
Beth Israel Deaconess Medical Center, Boston
Children’s Hospital, Boston
Massachusetts General Hospital, Boston

Educational Program – Basic Curriculum

Clinical component
Fellows obtain an exposure to the full spectrum of adult and pediatric (through a rotation at the Children’s Hospital Sleep Disorders Center, Boston) sleep disorders. The minimum targets mandated by the ACME are 200 / 300 adult and 40 / 40 pediatric new and follow-ups visits. The elective rotation includes maxillofacial surgery, neuropsychiatry, ENT, dental sleep medicine, EEG, and sleep laboratory technology. Direct instruction is provided for scoring polysomnograms, Multiple Sleep Latency and Maintenance of Wakefulness Testing, Actigraphy and use of sleep logs. Fellows read an average of 300 + sleep studies, each reviewed by a Board Certified sleep physician, and integrates laboratory with clinical data for optimal patient management.

Research Component
The one year track has a research requirement of an abstract, paper or review article / chapter. Opportunities are continuously available for all these options, in human (clinical and physiological) and animal sleep research. The 2-year program is described is more detail below, but completion of a major research project under a research mentor is a requirement.

Participant’s supervisory and patient care responsibilities

The Fellow is responsible for the comprehensive management of the patient. This includes clinical evaluation and follow-up, arranging sleep laboratory investigations, interpretation of data and reporting, directly supervised by the Attending Physician. Fellows enhance communication and continuous management by using e-mail via PatientSite (a HIPPA compliant communication tool developed by the Beth Israel Deaconess Medical Center). The management plan and implementation (including drugs use) is under the direct guidance of the Attending Physician. The second year Fellow in a 2-year program is expected to teach the first year Fellow the basics of polysomnogram scoring and interpretation.

Procedural requirements

Fellows will be required to be trained in, and demonstrate proficiency in: i) Scoring of polysomnograms and sleep latency / wakefulness maintenance testing. ii) Set-up of polysomnographic recordings. iii) Actigraphic set-up and interpretation. iv) Assessment of attention by computerized testing.

Didactic components

There is an extensive didactic component to the program, as required by the ACGME. Every month, the following occur: i) A weekly multi-disciplinary sleep conference. ii) A weekly core sleep science conference. iii) A monthly journal club. iv) A monthly research meeting. v) A monthly mini-sleep board review. vi) Thrice weekly polysomnogram interpretation sessions. vii) A monthly Harvard Sleep Grand Rounds. viii) “MD sleep laboratory nights” once a month, where Fellows learn in a hands-on fashion, supervised by the Attending Physician, the management of the most complex sleep apnea patients.

2-year program

This track is primarily for those who wish to establish an academic career in sleep medicine. Approximately 50% of the clinical work is done in each year, with the electives and pediatric rotation in the first. This leaves most of the second year and significant portions of the first year (40-50% and 60-70%) for research. A research mentor and project are established during the first three months. Completion of a major research project / paper is expected by the end of the 2-year period. There is an option of participating in the Scholars in Clinical Science Program (Harvard Medical School) in the second year, if a local junior faculty appointment is in the career path.

Evaluation

A detailed evaluation program is modeled around the “General Competencies in Sleep Medicine”, and summarized below. Details of each component may be obtained upon request. Evaluation forms specific to each component have been prepared and administered online. Fellows are evaluated every 3 months by Attending Physicians. Fellows provide feedback that seek to continuous modify the training experience.
 

Research options and opportunities

Funding is available through NIH and private foundations in the following areas (examples):

• Human and animal hypoxia, hemodynamics, vascular effect
• Central and peripheral autonomic regulation and hypoxia
• Functional brain imaging of sleepiness and sleep disorders
• Signal analysis using large public datasets (Sleep Heart Health Study, CHIME)
• Sleep stability in rodent heart failure models
• Phenotyping of complex forms of sleep apnea
• Carbon dioxide based therapeutics in complex sleep apnea syndromes