ELECT ENSLE - The Sleep Medicine Experience

Primary Goals of Elective:

To acquire an extended knowledge of the principles of Sleep Medicine and the practice thereof within an academic outpatient Sleep Medicine specialty clinic.

Specific Objectives:

The student will be able to:

1. (PC) Demonstrate the ability to obtain and document a comprehensive sleep medicine history.
2. (MK) Demonstrate an understanding of the basic neuroanatomy of Sleep and Wake, with a knowledge of the neurotransmitters and structures involved.
3. (MK) Demonstrate an ability to discuss the “two-process model” of sleep-wake regulation, and describe how this may be used to understand perturbations of sleep and wake.
4. (MK, PC) Discuss the mechanisms by which sleep apnea can contribute to cardiovascular risk.
5. (PC) Demonstrate the ability to perform and document a physical exam with an emphasis on the upper airway, to establish presence of features predisposing to sleep apnea.
6. (PC, MK) Be able to discuss the pharmacologic principles and patient-relevant issues (such as adverse effects of) various types of medications used to treat daytime sleepiness.
7. (PC, MK) Be able to discuss the pharmacologic principles and patient-relevant issues (such as adverse effects of) various types of medications used as hypnotics.
8. (PC, MK) Discuss the various types of sleep diagnostic studies, including full-night polysomnogram, split night polysomnogram, titration polysomongram, out of center sleep testing, actigraphy, and sleep logs, and be able to discuss when these should be used.
9. (PC, MK) Discuss diagnostic criteria for common sleep medicine problems, such as obstructive sleep apnea, restless legs syndrome, narcolepsy, idiopathic hypersomnia, and REM behavior disorder.
10. (PC, MK) Demonstrate the ability to perform a positive airway pressure (PAP) follow up visit, and discuss a methodical approach to troubleshooting PAP intolerance.
11. (I&CS) Communicate pertinent patient information relevant to Sleep Medicine problems to supervising providers in an efficient and logical way.
12. (SBP) Discuss health care delivery issues as related to underserved and unfunded patients with Sleep Medicine problems.
13. (PBL&I) Use online resources in investigation of clinical questions, to improve patient care, and support personal education.
14. (P) Attend all clinics and conferences attended by the clinic team and keep the team informed of their whereabouts at all times.
15. (I&CS, P, MK, PBL&I) Demonstrate the ability to present a Sleep Medicine-pertinent subject in an academic setting (Sleep Medicine Grand Rounds).
16. (MK, PC). Describe and recognize common signals used in formal polysomnographic testing, and recognize the common scored events in such studies, such as obstructive and central apneas, hypopneas, respiratory effort related arousals, and periodic limb movements of sleep.
17. (MK, PC) Describe the features of different sleep stages, and recognize these patterns on a standard polysomnogram.

SPECIFIC DUTIES OF SENIOR STUDENTS

• Students will be expected to function in a sub-intern capacity, and will be paired with a Sleep Medicine fellow for the month. Depending on the individual student’s abilities, students may see patients independently, and present cases to an attending. Documentation of these encounters will be reviewed by the attending faculty, and will be expected to be professional, accurate, concise, and relevant.
• Senior students will be expected to present an hour-long presentation at Sleep Medicine Grand Rounds in the last week of their elective. Topic will be determined during the first week of the elective.
• Students must come to the lab during testing hours to observe at least one setup, along with the initial portion of the sleep testing.
• Students will be evaluated by faculty and fellows using a standardized competency based evaluation form, and will be given a standardized test at the end of the block. Grand Rounds presentations will be given guided feedback.

Required Reading

Sleep Research Society Basics of Sleep Guide, 2^nd Edition. Amlaner CJ, Fuller PM (Eds).  2009.

              Chapters: 3, 4, 5, 6, 7, 8, 9, 10, 13, 14A&B, 18A&B, 21, 22

McCarty, DE. Beyond Ockham’s Razor: Redefining Problem-Solving in Clinical Sleep Medicine using a “Five Finger” Approach. J Clin Sleep Med 2010; 6(30:292-269

International Classification of Sleep Disorders, 3^rd Ed. (2014)

HOURS PER WEEK

This is a Monday-Friday 8am-5pm experience. No night call and no weekend call is required.  The exception to this is that all rotating students must come in to the Sleep Lab during testing hours (8pm) to observe at least one polysomnographic setup, along with the initial portion of a sleep study (typically we like students to see at least one REM cycle!). This is a vital portion of the rotation, as it will help “de-mystify” the experience of sleep diagnostic testing. This experience lasts 2-3 hours typically.

CONF    1 HRS          WARD  0 HRS        LAB 12 HRS      LIBRARY 4 HRS

OR  0  HRS         CLINIC 16 HRS        LECTURE  0 HRS          READING variable HRS

TOTAL NUMBER OF HOURS PER WEEK:    ~40   

 

ALL

Pass/Fail