UTMB Internal Medicine Residency
Pulmonary Sleep Ambulatory Elective
Goals, Competencies, Methods, and Assessments
Overall Goal
To make physicians into specialists in Internal Medicine by equipping them with
requisite knowledge, skills, and attitudes essential for them to demonstrate competence in
patient care, knowledge, practice-based learning and improvement, systems-based
practice, professionalism, and interpersonal and communication skills relevant to the
subspecialty of Sleep Medicine.
Patient Care
Goal
Residents must be able to provide patient care that is compassionate, appropriate, and
effective for the treatment of sleep problems and the promotion of health related to the
diagnosis, prevention, and control of sleep related diseases.
Competencies - Residents are taught how to:
 Demonstrate accurate, complete, and relevant history-taking in the care of patients
with sleep disorders, including apnea, parasomnias, circadian rhythm disorders,
insomnia, narcolepsy and related excessive daytime sleepiness disorders, and
sleep problems related to other factors and diseases such as medications, and
psychiatric and medical disorders. LSC, MPC/DO, WT, ITE
 Demonstrate the ability to perform a comprehensive and accurate physical
examination in the care of patients with sleep disorders. LSC, MPC/DO, WT, ITE
 Demonstrate familiarity with information obtained from patient history, physical
examination, physiologic recordings, imaging studies, psychometric testing, and
pulmonary function testing relevant to the diagnosis of sleep disorders. LSC,
MPC/DO, WT, ITE
 Demonstrate the ability to effectively present the results of a consultation orally
and in writing in the care of patients with sleep disorders. LSC, MPC/DO, WT,
ITE
 Demonstrate familiarity with the management of sleep disorders, including
treatment approaches for obstructive sleep apnea, nasal CPAP, bilevel PAP, upper
airway surgery, oral appliances, and position education; treatment approaches for
insomnia, to include cognitive behavioral therapies and pharmacological therapy;
treatment approaches for narcolepsy and idiopathic CNS hypersomnolence;
treatment approaches for parasomnias; and treatment of circadian rhythm
disorders. LSC, MPC/DO, WT, ITE
 Demonstrate familiarity with polysomnographic monitoring equipment and
interpretation of sleep studies. LSC, MPC/DO, WT, ITE
Medical Knowledge
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Goal
Residents must demonstrate knowledge of established and evolving biomedical, clinical,
epidemiological, and social-behavioral sciences, as well as the application of this
knowledge to the care of patients with sleep disorders.
Competencies – Residents are taught how to:
 Demonstrate a core fund of knowledge to prevent, diagnose, and manage all the
sleep disorders and patients mentioned in the patient care competency section
above. LSC, MPC/DO, WT, ITE
 Demonstrate a core fund of knowledge related to sleep disorders including
pulmonary physiology and pathophysiology. LSC, MPC/DO, WT, ITE
Demonstrate a familiarity with imaging techniques commonly employed in the
evaluation of patients with sleep disorders. LSC, MPC/DO, WT, ITE
Practice- Based Learning and Improvement
Goal
Residents must demonstrate the ability to investigate and evaluate their care of patients,
to appraise and assimilate scientific evidence, and to continuously improve patient care
based on constant self-evaluation, life long learning, and continuous quality or practice
improvement.
Competencies – Residents are taught how to:
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Demonstrate the ability to investigate and evaluate their patient care practice by
identifying strengths, deficiencies and limits in their knowledge and expertise.
LSC, MPC/DO, WT, ITE
Demonstrate the ability to incorporate formative evaluation feedback into daily
practice. LSC, MPC/DO, WT, ITE
Systems-Based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and
system of health care, as well as the ability to call effectively on other resources in the
system to provide optimal health care.
Competencies - Residents are taught how to
 Demonstrate the ability to work effectively in various health care delivery settings
and systems. LSC, MPC/DO, WT, ITE
Professionalism
Goal
Residents must demonstrate a commitment to carrying out professional responsibilities
and an adherence to ethical principles that they know.
Competencies - Residents are taught how to:
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Demonstrate an understanding of and commitment to all elements of
professionalism, including respect, compassion and integrity toward their patients,
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patient families, and other health care professionals. LSC, MPC/DO, WT, ITE
Interpersonal and Communication Skills
Goal
Residents must demonstrate interpersonal and communication skills that result in the
effective exchange of information and teaming with patients, their families, and
professional associates.
Competencies – Residents are taught how to:
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Demonstrate the ability to generate and maintain comprehensive, timely, and
legible medical records, procedure reports, and other written communication.
LSC, MPC/DO, WT, ITE
Teaching Methods
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MPC – Mentored Patient Care: Practical teaching and role modeling during direct
patient care during clinical rotations.
LSC - Lectures/Seminars/Conferences
 Grand Rounds
 Noon Conference
 Residents Conference
 Clinic Conference
 Morning Report
 Journal Club
 Morbidity and Mortality
 Clinical-Pathological Conference
 Board Review Sessions
 Quality Improvement Course
 Palliative Care Course
 Ultrasound Course
 Procedure Simulation
 Coding Course
 Professionalism
WRT - Weekly Reading/Testing/Feedback
Methods and Tools for Assessing Residents
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WT – Weekly Tests evaluating knowledge base for all competencies and
subspecialties.
DO - Direct Observation of competency-based performance by qualified faculty
guided by PGY-specific, milestone-based assessment tools. Included in MSF.
DO –P - Direct Observation by Peers evaluation of competency-based
performance, guided by PGY-specific, milestone-based assessment tools.
Included in MSF.
ITE - In-Training Exam
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Duty Hours for Residents
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The residency program follows the ACGME Duty Hour Requirements.
Duty hours are limited to 80 hours per week, averaged over a four-week period,
inclusive of all in-house call and moonlighting activities.
Residents must be scheduled for a minimum of one day free of duty every week
(when averaged over four weeks). At-home call cannot be assigned on these free
days.
Duty periods of PGY-1 residents must not exceed 16 hours in duration.
Duty periods of PGY-2 residents and above may be scheduled to a maximum of
24 hours of continuous duty in the hospital. Programs must encourage residents to
use alertness management strategies in the context of patient care responsibilities.
Strategic napping, especially after 16hours of continuous duty and between the
hours of 10:00p.m. and 8:00 a.m., is strongly suggested.
It is essential for patient safety and resident education that effective transitions in
care occur. Residents may be allowed to remain on-site in order to accomplish
these tasks; however, this period of time must be no longer than an additional four
hours.
Residents must not be assigned additional clinical responsibilities after 24 hours
of continuous in-house duty.
In unusual circumstances, residents, on their own initiative, may remain beyond
their scheduled period of duty to continue to provide care to a single patient.
Justifications for such extensions of duty are limited to reasons of required
continuity for a severely ill or unstable patient, academic importance of the events
transpiring, or humanistic attention to the needs of a patient or family. Under
those circumstances, the resident must: appropriately hand over the care of all
other patients to the team responsible for their continuing care; and, document the
reasons for remaining to care for the patient in question and submit that
documentation in every circumstance to the program director.
PGY-1 residents should have 10 hours, and must have eight hours, free of duty
between scheduled duty periods.
Residents in the final years of education (PGY2 and 3) must be prepared to enter
the unsupervised practice of medicine and care for patients over irregular or
extended periods. This preparation must occur within the context of the80-hour,
maximum duty period length, and one-day off-in-seven standards.
While it is desirable that residents in their final years of education have eight
hours free of duty between scheduled duty periods, there may be circumstances
when these residents must stay on duty to care for their patients or return to the
hospital with fewer than eight hours free of duty.
In unusual circumstances, residents may remain beyond their scheduled period of
duty or return after their scheduled period of duty to provide care to a single
patient. Justifications for such extensions of duty are limited to reasons of
required continuity of care for a severely ill or unstable patient, academic
importance of the events transpiring, or humanistic attention to the needs of the
patient or family. Such episodes should be rare, must be of the residents’ own
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initiative, and need not initiate a new ‘off-duty period’ nor require a change in the
scheduled ‘off duty period.’
 Residents must not be scheduled for more than six consecutive nights of night
float.
PGY-2 residents and above must be scheduled for in-house call no more frequently than
every-third-night.
Responsibilities, Supervision, Lines of Authority
Sleep medicine is co-managed by neurology and pulmonary subspecialties. Sleep studies
are supervised by the Neurology faculty (Prabhdeep Singh, MD) and most Sleep
disorders are managed in the Pulmonary outpatient clinic by the Pulmonary faculty. For
residents interested in a month of concentrated experience in sleep medicine, the faculty
contact is Dr. Sharma who will coordinate the resident’s time and supervision in the
pulmonary outpatient clinics and the evening sleep lab.
Educational Resources
UTMB Library Homepage
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