Clinical Sleep Medicine Training Program
Sleep Medicine [Interdisciplinary program through Neurology, Medicine, and Pediatrics]
Program History
The Sleep Medicine Training Program has been in existence since 2005 and is affiliated with the American Academy of Sleep Medicine accredited Multidisciplinary Sleep Disorders Centers at the University of Miami and Miami Veterans Medical Center and our sponsoring institution, Jackson Memorial Medical Center. The first round of Sleep Medicine Fellowship accreditations, occurred in October 2005. Our training program is currently seeking accreditation by the Accreditation Council for Graduate Medical Education (ACGME) for the coming year. The program combines resources from Neurology, pediatric and adult Pulmonary and ENT. The current program capacity is 2 full-time slots, and an expansion to 4 is being planned for the 2008-9 training year.
Program Duration
The program duration is one year of clinical training. An optional additional year split between clinical and research may be available in the future.
Prerequisite Training / Selection Criteria
Board eligibility or certification in Internal Medicine, Neurology, Pediatrics 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, including the full spectrum of adult and pediatric sleep disorders.
- Training in sleep laboratory technology, running of an independent sleep laboratory and technician training.
- Training in sleep laboratory medicine, including the skills to treat sleep apnea syndromes.
- Training in sleep research methodology and participation in ongoing research projects.
- The opportunity to work in a highly integrated clinical environment, including the surgical sleep unit and behavioral sleep medicine program
- Career development of individual candidates as physicians and as advocates of Sleep Medicine.
Program Resources
Teaching Staff
Dr. Dalia Lorenzo (Neurology), Dr. Bruce Nolan (Neurology), Dr. Shirin Shafazand (Pulmonary) are the core faculty and are all board certified in Sleep Medicine. Supervisory responsibilities include all aspects of training, including clinic precepting, review of polysomnographic data, didactic instructions, technical instruction, and assessment of competence. Supporting faculty are Dr. William Wohlgemuth (board certified in Behavioral Sleep Medicine), Dr. Shahriar Shahzeidi (Pediatric Pulmonary), Dr. Douglas Wallace (Neurology), who are board eligible sleep specialists, Dr. Kenneth Nissim (ENT) and Dr. Daniel Atallah (Maxillofacial Surgery).
Facilities
Training sites are:
- Jackson Memorial Hospital
- Miami Veterans Administration Hospital and Medical Center
- University of Miami Miller School of Medicine Sleep Disorders Center
Miami, Florida
Educational Program – Basic Curriculum
Clinical component
Fellows obtain an exposure to the full spectrum of adult and pediatric (through rotations at the University of Miami/Jackson Memorial Hospital Children's Sleep Disorders Center, Miami) sleep disorders. The minimum encounter numbers mandated by the ACGME are 200 / 300 adult and 40 / 40 pediatric new and follow-ups visits. Additional clinical experience in neurology and pulmonary clinics are also available. Elective rotations include surgical sleep medicine, behavioral 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 in human sleep research with a focus on REM behavior disorder, insomnia, sleep disorders in traumatic brain injury and stroke.
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 and coordination of surgical sleep boards. These activities are directly supervised by the Attending Physician. The management plan and implementation (including drugs use) is under the direct guidance of the Attending Physician.
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) Performance of polysomnographic recordings to include seizure montages and parasomnia acitivation procedures. iii) Actigraphic set-up and interpretation. iv) Interpretation of EEG v) administration of laboratory and clinic services.
Didactic components
There is an extensive didactic component to the program. The program features an ongoing biweekly core sleep topic review, journal clubs held three times monthly, a bimonthly research meeting. a monthly administrative meeting, twice weekly supervised polysomnogram interpretation sessions, and a monthly sleep laboratory night session, supervised by the Attending Physician, where the fellow receives hands-on training on the management of sleep apnea patients.
Evaluation
The program features a detailed evaluation program as prescribed by the ACGME and modeled around the general competencies in Sleep Medicine. Fellows are evaluated every 3 months by Attending Physicians. Fellows provide feedback that seek to continuous modify the training experience.