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:
Catherine Nadir
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

Since 1985, the Sleep Medicine Training Program at Beth Israel Deaconess Medical Center (BIDMC) has provided superb, multidisciplinary training in all aspects of Sleep Medicine. The fellowship is accredited by the Accreditation Council for Graduate Medical Education (ACGME), and our Sleep Disorders Center is accredited by the American Academy of Sleep Medicine. Our program combines resources from Neurology and Pulmonary Medicine at BIDMC and Children’s Hospital Boston (CHB), and is administered through the Department of Medicine at BIDMC. We usually train 3 fellows each year, but we can accommodate more when funding permits. Over 30 fellows have completed training in our program and gone on to successful careers in academic medicine and clinical practice.

Adult and Pediatric Sleep Medicine Tracks

The Program is tailored to the needs of each trainee, with an emphasis on adult or pediatric sleep medicine. Fellows on the adult track spend about 75% time caring for adult sleep medicine patients and interpreting sleep studies at BIDMC, whereas fellows on the pediatric track spend 75% time caring for children and reading sleep studies at CHB.

Program Duration

The sleep medicine clinical fellowship lasts 1 year.  Many options are available for individuals interested in additional training in clinical or basic sleep research.

Prerequisite Training / Selection Criteria

Applicants must be board eligible or certified in Internal Medicine, Neurology, Family Medicine, ENT, Anesthesiology, or Psychiatry through an ACGME accredited program. Those who have additional boards are also eligible (e.g., Pulmonary Medicine, Clinical Neurophysiology). Other requirements include fluency in English, a MA state license, and DEA certificate. The program uses the National Residency Matching Program. Candidates who have shown prior academic interest and potential are preferred, including prior sleep related research. Selection is not based on the primary certification of the prospective candidate – our program trains individuals with a variety of backgrounds.

Goals and Objectives for Training

  • Training in the full spectrum of adult and pediatric sleep medicine.
  • Training in sleep laboratory technology, sufficient to run an independent sleep laboratory and technician training program.
  • Training in sleep medicine skills needed to treat complicated adult and pediatric sleep apnea syndromes.
  • Training in sleep research methodology adequate to prepare an poster, review article, or original research paper.
  • 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 Resources

Teaching Staff
Dr. Robert Joseph Thomas and Dr. Jean Matheson are the key faculty, supported by Dr. Thomas Scammell, Dr. Jacqueline Chang, and Dr. Melanie Pogach; all are certified in Sleep Medicine. Training in pediatric sleep medicine is provided by Dr. Kiran Maski,  Dr. Umakanth Khatwa, Dr. Dennis Rosen, and Dr. Eliot Katz. Supporting faculty include 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
Children’s Hospital- Boston
Massachusetts General Hospital

Educational Program – Basic Curriculum

Clinical component
Fellows will be exposed to the full spectrum of adult and pediatric sleep disorders. Sleep medicine relevant outcomes and milestones form the core of the training program. Elective rotations include maxillofacial surgery, neuropsychiatry, ENT, dental sleep medicine, EEG, and sleep laboratory technology. Some of these such as EEG are optional, based on the past training of the Fellow. Direct instruction is provided for scoring polysomnograms, Multiple Sleep Latency and Maintenance of Wakefulness Tests, Actigraphy, home sleep testing, sleep quality tracking, and use of sleep logs. Fellows read an average of 300 + sleep studies, each reviewed with a Board Certified sleep physician, and integrate laboratory with clinical data for optimal patient management.

Research component
Fellows are expected to prepare a poster, primary research paper, or review article/chapter.

Participant’s supervisory and patient care responsibilities
Fellows are responsible for the comprehensive management of their patients, under the supervision of an Attending Physician. This includes clinical evaluation and follow-up, arranging sleep laboratory investigations, and interpretation and reporting of sleep studies.

Sleep lab requirements
Fellows must demonstrate proficiency in: i) Scoring of polysomnograms, MSLT, and MWT; ii) Set-up of polysomnographic recordings; iii) Set-up and interpretation of actigraphy; iv) management of complex breathing disorders in the sleep laboratory.

Didactic components

The program includes an extensive, high-quality didactic component.. Fellows interpret polysomnograms with Attendings 2-3 times each week.  A multi-disciplinary sleep conference and core sleep science conference are held weekly. Sleep journal club, a research meeting, a mini-sleep board review session, and Harvard Sleep Grand rounds each occur monthly. In addition, fellows spend most of the night at the sleep lab with an attending to learn management of complex breathing disorders once each month.

Research year(s)
Many options are available for trainees who wish to establish a career in academic sleep medicine as more than 80 faculty at Harvard University conduct research on sleep, circadian rhythms, or mechanisms of sleep apnea. Fellows interested in research are strongly encouraged to select a research mentor and begin design of their project during the first 3-6 months of their clinical year to leave ample time for obtaining funding and preparing for the research. Research funding can often be obtained from the Harvard Training Program in Sleep, Circadian and Respiratory Neurobiology, the American Academy of Sleep Medicine, the American Heart Association, the NIH, or other sources.
As sleep medicine is a relatively young field, there are many exciting and unanswered questions to pursue.  Prior fellows have conducted research in:

  • Human and animal hypoxia, hemodynamics, vascular effect
  • Central and peripheral autonomic regulation and hypoxia
  • Functional brain imaging of sleep
  • Clinical laboratory database analysis
  • Signal analysis using large public datasets (Sleep Heart Health Study, CHIME)
  • Phenotyping of sleep apnea
  • Mouse models to understand the causes of sleepiness and cataplexy in narcolepsy
  • Neuropathological studies of narcolepsy and traumatic brain injury
  • Basic research to define the neural circuitry that regulates sleep and circadian rhythms

Evaluation

A detailed evaluation program is modeled around the “General Competencies in Sleep Medicine” and Milestones as applied to sleep medicine. Fellows are evaluated every 3 months by their Attending Physicians, and in turn, Fellows provide feedback on the program to improve the training experience. The program is dynamic and responsive to changes in health care and sleep medicine and thus is continuously innovating and evolving.

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