02/16/16
July 1, 2007
ACGME SLEEP FELLOWSHIP TRAINING
PROGRAM
Program Director: Ilene Rosen, M.D., M.S.C.E.
Associate Program Director: Alex Mason, M.D., Ph.D.
Fellowship Coordinator: Kim Battillo
EDUCATIONAL MISSION STATEMENT
The Division of Sleep Medicine is committed to excellence in sleep medicine. It conducts
high quality clinical sleep medicine with a service to patients with the whole range of sleep
disorders providing multidisciplinary care; it ensures that findings from our research and
that of others is transferred into practice; it provides training for fellows, who come from
different disciplines, in all aspects of sleep medicine. The Sleep Division Faculty is
committed to advancing knowledge in sleep medicine by conducting the highest quality
basic & clinical research.
The program is multi-disciplinary, utilizing specialists in Pulmonary Medicine, Neurology,
Psychiatry, Geriatrics, Pediatrics and Nursing. These specialists also work closely with
colleagues in Otorhinolaryngology (Ear, Nose and Throat), Oral-maxillo-facial Surgery, and
Weight Management in the treatment of obstructive sleep apnea.
The Division of Sleep Medicine Fellowship Training Program reflects the multidisciplinary
nature of sleep medicine at PENN.
Table of Contents
The Six ACGME Competencies
3
Program Goals and Objectives
5
Clinical Training
6
Sample Rotation Schedules
8
Inpatient Sleep Rotations
9
Rotation-Specific Learning Objectives
HUP Outpatient
HUP Inpatient
CHOP Sleep Medicine Rotation
Philadelphia VAMC Sleep Medicine Rotation
CHOP Pediatric Otolaryngology Rotation
11
17
22
28
34
Educational Conferences
39
PSG Scoring and Interpretation
42
Supervision Policies and Evaluation Methods
43
Evaluation Tools
44
Sick Days/Vacation Policy
45
Research
46
Important Forms
Outpatient Clinic Cancellation or Reduction Request Form
Mini-CEX Form
SAM_E Tool
Departmental Phone Lists
Chart Audit
48
49
51
52
56
2
THE SIX COMPETENCIES
Medical Knowledge
Patient Care
Practice Based Learning and Improvement
Systems Based Practice
Professionalism
Interpersonal and Communication Skills
MEDICAL KNOWLEDGE
Fellows must demonstrate knowledge about established and evolving biomedical, clinical, and
cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge
to patient care.
Fellows are expected to:
1. Demonstrate an investigatory and analytic thinking approach to clinical situations
2. Know and apply the basic and clinically supportive sciences which are appropriate to their
discipline
PATIENT CARE
Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the
treatment of health problems and the promotion of health.
Fellows are expected to:
1. Communicate effectively and demonstrate caring and respectful behaviors when interacting
with patients and their families
2. Gather essential and accurate information about their patients
3. Make informed decisions about diagnostic and therapeutic interventions based on patient
information, preferences, up-to-date scientific evidence, and clinical judgment
4. Develop and carry out patient management plans
5. Counsel and educate patients and their families
6. Use information technology to support patient care decisions and patient education
7. Perform competently all medical and invasive procedures considered essential for the area of
practice
8. Provide health care services aimed at preventing health problems or maintaining health
9. Work with health care professionals, including those from other disciplines, to provide
patient-focused care
3
PRACTICE BASED LEARNING AND IMPROVEMENT
Fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate
scientific evidence, and improve their patient care practices.
Fellows are expected to:
1. Analyze practice experience and perform practice-based improvement activities using a
systematic methodology
2. Obtain and use information about their own population of patients and the larger population
from which their patients are drawn
3. Locate, appraise, and assimilate evidence from scientific studies related to their patients’
health problems
4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies
and other information on diagnostic and therapeutic effectiveness
5. Use information technology to manage information, access on-line medical information; and
support their own education
6. Facilitate the learning of students and other health care professionals
SYSTEMS BASED PRACTICE
Fellows must demonstrate an awareness of and responsiveness to the larger context and system of
health care and the ability to effectively call on system resources to provide care that is of optimal
value.
Fellows are expected to:
1. Know how types of medical practice and delivery systems differ from one another, including
methods of controlling health care costs and allocating resources
2. Practice cost effective health care and resource allocation that do not compromise quality of
care
3. Advocate for quality patient care and assist patients in dealing with system complexities
4. Partner with health care managers and health care providers to assess, coordinate
PROFESSIONALISM
Fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to a diverse patient population.
Fellows are expected to:
1. Demonstrate respect, compassion and integrity
2. Demonstrate a commitment to ethical principles
3. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities
INTERPERSONAL AND COMMUNICATION SKILLS
Fellows must be able to demonstrate interpersonal and communication skills that result in effective
information exchange and teaming with patients, their patients’ families, and professional
associates.
Fellows are expected to:
1. Create and sustain a therapeutic and ethically sound relationship with patients
2. Use effective listening skills and elicit and provide information using effective nonverbal,
explanatory, questioning, and writing skills
3. Work effectively with others as a member or leader of a health care team or other
professional group
4
PROGRAM GOALS AND OBJECTIVES
1. Patient Care
a. Perform an adequate medical history and physical exam on patients in outpatient
sleep clinic and inpatients seen on the inpatient consultation service
b. Order appropriate diagnostic tests
c. Interpret polysomnograms and other diagnostic sleep evaluation
d. Form a clinical management plan
e. Interact with other health care providers to implement patient-focused care
2. Medical Knowledge
a. Demonstrate knowledge about established and evolving biomedical, clinical and
cognate sciences during clinical encounters including discussions with patients, other
health care providers (during office hours, in dictations to referring physicians, and
in consultation notes in inpatient charts), weekly Clinical Case conferences, and
Research conferences.
b. Attend the didactic sleep conferences held throughout the year
c. Application of medical knowledge to patient care
3. Practice-based Learning and Improvement
a. Fellows’ presentations at Clinical Case Conference
b. Fellows’ presentations at Sleep Journal Club
4. Interpersonal and Communication Skills
a. Communication and interaction with other health care providers/support staff by
participating in multidisciplinary practice meetings involving physicians, nurses,
medical assistants, respiratory therapists and clinical support staff.
b. Communication and interaction with patients and their families during outpatient
and inpatient clinical encounters
c. Fellows’ presentations at Clinical Case Conference
d. Fellows’ presentations at Sleep Journal Club
5. Professionalism
a. Intranet courses on patient privacy, good clinical practices, and patient safety
b. Encourage sensitivity to patients of diverse backgrounds
c. Carrying out professional responsibilities and adherence to ethical principles
d. Completion of assigned responsibilities including chart documentation, dictations,
and polysomnographic studies.
e. Answer pages and patient phone calls in a timely fashion.
f. Attend the minimum number of required conferences.
6. Systems-based Practice
a. Participation in quality assurance/quality improvement project
b. Participate in multidisciplinary practice meetings involving physicians, nurses,
medical assistants, respiratory therapists and clinical support staff
5
CLINICAL TRAINING
Each fellow will be expected to evaluate 200 new patients in the adult sleep medicine
outpatient practice.
Each fellow will be expected to provide continuous care to 300 follow-up patients in
the adult sleep medicine outpatient practice.
Each fellow will be expected to evaluate at least 40 new patients in the pediatric sleep
medicine outpatient practice.
Each fellow will be expected to provide continuous care to at least 40 follow-up
patients in the pediatric sleep medicine outpatient practice.
Each fellow is expected to evaluate a minimum of 10 inpatients with sleep medicine
complaints from representative demographic groups.
Each fellow will keep a log of his/her clinical activities that documents: the clinics
attended, number of patients seen in clinic and their diagnoses, the number of PSG
interpreted, and the number of PSG set-ups completed. This log will be used to
document that the fellow has fulfilled the clinical requirements set by the ACGME.
(Log form available upon request). These forms when completed must be turned
into the Program Coordinator for placement in portfolios.
OUTPATIENT SLEEP CLINICS
ADULT SLEEP TRACK
Continuity Clinic
Each fellow will be assigned a ½ day per week adult continuity clinic. The fellow
will attend this clinic throughout the year in order to learn about the chronic
management of patients with sleep disorders. The fellow’s continuity clinic will be
staffed by a faculty member of the Division of Sleep Medicine.
Continuity clinic is scheduled on a weekly basis throughout the year.
As per the policies of CPUP and the Department of Medicine, all
absences/cancellations must be scheduled 6 weeks in advance to be
considered an excused absence except for illness, family emergencies, etc.
Any absence less than 6 weeks from the time of the scheduled office
session will require an approval from the Program Director, the Faculty
Advisor and the Division Chief.
Therefore, whenever possible, any cancellations must be made 6 weeks in
advance IN WRITING to the program director, the program coordinator
and the scheduling staff of the appropriate clinic.
Pertinent phone numbers, pager numbers and email addresses are provided at the
end of the handbook.
6
Pediatric Rotation (CHOP) – 4 months scheduled in 1 block, if possible.
Each fellow will be assigned 3 ½-day per week pediatric clinics.
Adult Rotations (HUP/PVAMC) – 8 months total scheduled over the course of the year.
Each fellow will be assigned 5 ½-day per week adult clinics.
PEDIATRIC SLEEP TRACK
Continuity Clinic
Each fellow will be assigned a ½ day per week adult continuity clinic and a ½ day per
week pediatric continuity clinic. The fellow will attend this clinic throughout the year in
order to learn about the chronic management of patients with sleep disorders. The
fellow’s continuity clinic will be staffed by a faculty member of the Division of Sleep
Medicine.
Continuity clinic is scheduled on a weekly basis throughout the year.
As per the policies of CPUP and the Department of Medicine, all
absences/cancellations must be scheduled 6 weeks in advance to be
considered an excused absence except for illness, family emergencies, etc.
Any absence less than 6 weeks from the time of the scheduled office session
will require an approval from the Program Director, the Faculty Advisor and
the Division Chief.
Therefore, whenever possible, any cancellations must be made 6 weeks in
advance IN WRITING to the program director, the program coordinator and
the scheduling staff of the appropriate clinic.
Pertinent phone numbers, pager numbers and email addresses are provided at the end of
the handbook.
Adult Rotations (HUP/PVAMC) – 5-6 months total scheduled in 1-month blocks.
Each fellow will be assigned 5 ½-day per week adult clinics.
Pediatric Rotation (CHOP) – 6-7 months scheduled over the course of the year.
Each fellow will be assigned 3 -½ day per week pediatric clinics.
7
SAMPLE ROTATION SCHEDULES
Sample Rotation (HUP)
Monday
2007
Tuesday
Dr.
Gooneratne
8:00 - 12:00
Dr. Kline
12:00 - 1:00
lunch provided
Conference
1:00 - 5:00
Dr. Gehrman
Conference
1:00 - 5:00
OSA Sleep
Disorders
Clinic/
CPAP FU
Clinic
Friday
Dr. Cantor
Dr. Pien
PSG Review
Wednesday
Thursday
Friday
Sleep Disorders
Clinic/CPAP FU
Clinic
Fellows
Continuity
Clinic
CPAP FU
Clinic/
AutoCPAP
set-up clinic
Conference
OSA Sleep
Sleep Disorders
Disorders
Clinic/CPAP FU
Clinic/CPAP FU
Clinic/AutoCPAP Clinic/AutoCPAP
set-up clinic
set-up clinic
Sample Rotation (CHOP)
Monday
2007
Patient Review
8:00 - 12:00
CHOP Inpt
Conference 12:00 - 1:00
lunch provided
MKT
1:00 - 5:00
Thursday
Fellows
Continuity
Clinic
Conference
Sample Rotation (PVAMC)
Monday
Tuesday
2007
Sleep Disorders
CPAP
Clinic/
Support
8:00 Set-up
Clinic
12:00
Clinic/CPAP FU
(10am-12pm)
Clinic
12:00 - 1:00
lunch
provided
Wednesday
PSG Review
AutoCPAP
set-up
clinic
Sleep Disorders
Clinic/Sleep
Study
Interpretations
Tuesday
Wednesday
Thursday
PSG Review
Ped Sleep Clinic
Fellows Clinic
Ped Sleep Clinic
CHOP Conf
Conference –
MKT
PSG Clinic/Ped
Sleep Clinic
PSG Review
Friday
PSG Review
CHOP Inpt
PSG Review
8
INPATIENT SLEEP ROTATIONS
ADULT & PEDIATRIC SLEEP TRACKS
HUP Inpatient Consultations. Each fellow will be assigned 4-6 weeks of coverage of the
inpatient sleep medicine consultation service at HUP.
This occurs in 2 week blocks. Sleep medicine fellows perform new consultations, present
their cases to the Sleep Medicine Attending on the consult service, and then provide
management advice and follow-up as needed. As soon as possible after receiving the
request for consultation, the fellow interviews and examines the patient, gathers all
necessary information from the chart and other sources as appropriate. S/he then
presents the patient to the attending after which the fellow and attending see the patient
together at the bedside. A plan of care is developed by fellow and attending together and
then communicated by the fellow both verbally and in writing to the service requesting
the consultation within 24 hours of the request for the consultation. Thereafter, the
fellow rounds at least once daily on all active patients on the consult service and
discusses them with the attending. All patients with active issues or whose status has
changed are revisited with the attending later in the day. Of note, sleep medicine fellows
will also be continuing their outpatient responsibilities during this time as the burden of
consultations is quite low.
Additionally, all fellows will spend up to 4 weeks total on a combination of various
subspecialty inpatient consultation services including the neurology, pulmonology,
bariatric surgery and heart failure services at HUP. During these rotations, the
supervising physician will be board certified in the subspecialty of the rotation as well as
sleep medicine or have a specific interest in sleep medicine (e.g. sleep apnea and heart
failure). These inpatient experiences will serve to illustrate how sleep disorders integrate
into the differential diagnoses of various clinical questions posed to subspecialty
consultation services. Sleep medicine fellows perform new consultations, present their
cases to the attending on the consult service, and then provide management advice and
follow-up as needed. As soon as possible after receiving the request for consultation, the
fellow interviews and examines the patient, gathers all necessary information from the
chart and other sources as appropriate. S/he then presents the patient to the attending
after which the fellow and attending see the patient together at the bedside. A plan of
care is developed by fellow and attending together and then communicated by the fellow
both verbally and in writing to the service requesting the consultation. Thereafter, the
fellow rounds at least once daily on all active patients on the consult service and
discusses them with the attending. All patients with active issues or whose status has
changed are revisited with the attending later in the day. Of note, sleep medicine fellows
will have reduced outpatient responsibilities during this portion of their sleep inpatient
rotation.
Pertinent phone numbers, pager numbers and email addresses are provided at the end of
the handbook.
CHOP Inpatient Consultations. Each fellow will be expected to perform 4-5 inpatients
consults per year on pediatric sleep medicine patients admitted to CHOP during their time
on the CHOP rotation.
Inpatient consultations. The fellow will perform all inpatient consultations under the
direct supervision of an ABMS-certified physician. The sleep medicine fellow, under the
9
supervision of a sleep medicine attending, will review the patient’s medical chart and
elicit a history, examine the patient, and discuss the goals of evaluation with the hospital
team. A formal consultation note by the fellow/attending will become part of the
medical record. If a polysomnogram is deemed appropriate, the results will be reviewed
with the primary team, and the sleep fellow will offer management options accordingly.
When possible, continuity of care will be promoted by scheduling follow-up
appointments with the fellow in the outpatient sleep clinic.
Each fellow will keep a log of his/her clinical activities that documents: the
inpatients seen at either HUP or CHOP and their diagnoses. This log will be used to
document that the fellow has fulfilled the clinical requirements set by the ACGME.
(Log form available upon request). These forms when completed must be turned
into the Program Coordinator for placement in portfolios.
10
ROTATION-SPECIFIC LEARNING OBJECTIVES





HUP Outpatient Rotation
HUP Inpatient Consultation
CHOP Sleep Medicine Rotation
PVAMC Sleep Medicine Rotation
Pediatric Otolaryngology Rotation (CHOP)
Learning Objectives for HUP Outpatient Rotation:
Sleep Medicine Ambulatory Experience
Educational Rationale:
Sleep Medicine Ambulatory Experience includes three components: direct patient care, didactic
sessions and hands-on experience with sleep studies and associated tools. The approach to care in
the faculty-fellow practice is multi-disciplinary. Each site (i.e. Market Street and Radnor) works with
a practice nurse, who is available to conduct teaching visits and other focused visits such as mask
fittings and response to medications and also as an initial phone contact for patient questions.
Respiratory therapists and medical assistants work on site to facilitate the care of patients with
sleep-disordered breathing.
Disease Mix/Patient Characteristics:
Patient population in the faculty-fellow practices is quite heterogeneous, including individuals from
a wide range of socioeconomic and ethnic backgrounds. Additionally, because of the multidisciplinary nature of the specialty as well as the multi-disciplinary nature of the Penn Sleep Centers
faculty, the types of encounters range from snoring and complaints related to sleep-disordered
breathing to restless legs and nocturnal seizures.
Procedures:
Fellows can expect to review and interpret polysomnographies, both diagnostic and therapeutic,
multiple sleep latency tests, actigraphies and sleep logs on the patients they encounter in their officebased practices.
Principal Teaching Methods/Learning Venues:
A core curriculum in sleep medicine is presented in a multifaceted approach that includes the
continuity practice experience, elective faculty specific block rotations as well as a series of didactic
initiatives.
The most important component is the Sleep Medicine Continuity Practice (SMCP). Each fellow is
assigned to the Fellows’ Continuity Practice which is based at 3624 Market Street under the direction
of two clinic directors. Each fellow has their own panel of patients within the practice that they keep
throughout the clinical year of fellowship. Fellows attend their practices one half-day per week
except during vacation.
Related to their continuity based practices, trainees are also responsible for participating in a
personal quality improvement project (PQIP). This project is designed to address practice based
and systems based learning. Fellows utilize a diagnosis-specific abstraction tool developed by the
faculty and review 5-10 of their own charts with the tool. The data is summarized and an
11
intervention plan is implemented in conjunction with a faculty mentor who may be the PD,
continuity clinic preceptors or member of the faculty advisory committee. When it is fully
implemented the chart abstraction will occur in the second quarter of the clinical year and again in
the spring
In addition, ambulatory block rotations are designed to supplement the continuity practice
experience to further develop skills in sleep medicine. For an additional 4 to 5 half days per week,
each fellow will have the opportunity to experience a variety of different Faculty-Based Practices
(FBP) in ambulatory settings as well. These include faculty with various backgrounds including
internal medicine, pulmonary/critical care, neurology, psychiatry, emergency medicine and
behavioral psychology.
Furthermore, patient care is rounded out with an intensive experience in interpretations of sleep
studies, including polysomnography, multiple sleep latency tests, maintenance of wakefulness tests,
actigraphy and sleep logs. This occurs during a weekly PSG Review (PSGR) session which occurs
with all the fellows and 2 dedicated faculty preceptors. As many as 15 studies of various types are
reviewed in detail during these sessions. A pre-review session reviews the literature important to
these interpretations including the basis for the scoring of sleep stages, respiratory events, arousals,
periodic limb movements, etc. Additionally, fellows will participate in a Quality Assurance (QA)
program within the sleep laboratory whereby fellows, along with the faculty and sleep laboratory
technical staff, score a sleep study. The results are scored against a gold standard and feedback is
provided to the individual fellow by the faculty coordinator of the program.
The final component of the HUP sleep medicine educational program is the Sleep Medicine
Conference Schedule (SMCS), which include two 1-hour didactic sessions per week and the Center
for Sleep Seminar series which occurs 8-10 times per year. The twice weekly didactic sessions are
either Clinical Case Conferences (CCC), Sleep Lecture Series (SLS), Sleep Medicine Journal Club
(SMJC) or Sleep Medicine Research Conference (SMRC)
The principal teaching/learning activity of the HUP outpatient rotation occurs through Direct
Patient Care (DPC) activities. In all of the ambulatory settings mentioned above, fellows present
their cases to the supervising faculty member and a discussion of evaluation and management
ensues. Often, the fellow and faculty member return together to the examining room to expand on
the history or physical examination and to teach about interviewing and examination techniques.
The didactic programs described above complement direct patient care activities.
Principal Educational Goals by Relevant Competency:
In the tables below, the principal educational goals for the HUP outpatient rotation are listed for
each of the six ACGME competencies. The second column of the table indicates the most relevant
principal teaching/learning activity for each goal, using the legend below.
* Legend for Learning Activities (See above for descriptions)
SMCP -- Sleep Medicine Continuity Practice
FBP -- Faculty-Based Practices
QA-- Quality Assurance Program
PQIP-- Personal Quality Improvement Project
PSGR -- Polysomnography Review session
CCC -- Clinical Case Conferences
SLS -- Sleep Lecture Series
MJC -- Sleep Medicine Journal Club
SMRC -- Sleep Medicine Research Conference
12
1) Patient Care
Principal Educational Goals Learning Activities*
Effectively interview sleep medicine outpatients
Effectively examine sleep medicine inpatients
Maintain focus and timeliness in the evaluation and
management of sleep medicine problems
Order appropriate diagnostic tests
PSGR
Interpret polysomnograms and other diagnostic sleep evaluation tools
CCC
SMCP, FBP, PQIP
SMCP, FBP, PQIP
SMCP, FBP, PQIP
CCC, SLS, SMJC, PQIP,
SMCP, FBP, PSGR, QA,
2) Medical Knowledge
Principal Educational Goals Learning Activities*
Expand clinically applicable knowledge base of the biomedical,
SMJC, clinical and cognate sciences underlying the care of sleep
medicine patients
SMCP, FBP, CCC, SLS,
SMRC, PSGR
Access and critically evaluate current medical information
and scientific evidence relevant to outpatient sleep medicine
patient care
ALL
Assess the validity of original research concerning clinical
questions such as diagnosis, prognosis, treatment and prevention
CCC, SLS, SMJC, SMRC,
PSGR
3) Practice-Based Learning and Improvement
Principal Educational Goals Learning Activities*
Identify and acknowledge gaps in personal knowledge and
skills in the care of sleep medicine patients
SMCP, FBP, CCC, SMJC
PQIP, QA
Develop real-time strategies for filling knowledge gaps that
will benefit patients in a busy practice setting
SMCP, FBP, CCC, SMJC
PQIP, QA
4) Interpersonal Skills and Communication
Principal Educational Goals Learning Activities*
Communicate effectively with patients and families across a
broad range of socioeconomic and ethnic backgrounds
SMCP, FBP
Communicate effectively with physician colleagues and
members of other health care professions to assure
comprehensive patient care
SMCP, FBP
5) Professionalism
13
Principal Educational Goals Learning Activities*
Behave professionally toward towards patients, families,
colleagues, and all members of the health care team
ALL
6) Systems-Based Practice
Principal Educational Goals Learning Activities*
Understand and utilize the multidisciplinary resources
necessary to care optimally for sleep medicine patients
ALL
Collaborate with other members of the health care team to
assure comprehensive sleep medicine outpatient care
SMCP, FBP, PQIP, QA,
CCC
Use evidence-based, cost-conscious strategies in the care of
sleep medicine patients
ALL
Begin to understand the business aspects of practice
management in a variety of settings
SMCP, FBP, CCC, SLS
PQIP, PSGR
Begin to develop efficient practice patterns so patient care
PQIP,
proceeds at an acceptable rate
SMCP, FBP, CCC, SLS,
PSGR, QA
Principal Educational Goals
In addition to the above goals by competency, after 12 months of training, the fellow should
have achieved the following:








Function as an integral member of an outpatient multidisciplinary team
Evaluate 200 new adult sleep medicine patients
Provide continuous care to 300 adult sleep medicine patients
Attending a minimum number of the required departmental conferences, including
clinical case conference, sleep lecture series and journal clubs
Enhance office based time management skills
Develop telephone management skills
Develop urgent care skills
Function as role models and mentors for younger trainees within the multidisciplinary
fields that make up sleep medicine
Recommended Resources
UpToDate (available on-site in the practice)
Ahrens, E.H. (1992). The Crisis in Clinical Research. New York: Oxford University Press.
Bates, D.V. (1989). Respiratory Function in Disease (3rd edition). Philadelphia: W.B. Sanders Company.
Berry, R.B. (2003). Sleep Medicine Pearls (2nd edition). Philadelphia: Hanley & Belfus, Inc.
Carlson, R.W. & Geheb, M.A. (1993). Principles and Practices of Medical Critical Care. Philadelphia:
W.B. Saunders Company.
Chase, M.H. & Roth, T (eds.) (1990). Slow Wave Sleep. Los Angeles: Regents of the University of
California.
Chokroverty, S., Thomas, R.J., & Bhatt, M. (2005). Atlas of Sleep Medicine. Philadelphia: Elsevier, Inc.
14
Fraser, R.G. (1988). Diagnosis of Diseases of the Chest: Volume 1. Philadelphia: W.B. Saunders
Company.
Fraser, R.G. (1988). Diagnosis of Diseases of the Chest: Volume 2. Philadelphia: W. B. Saunders
Company.
Fritz, R. (1993). Sleep Disorders: America’s Hidden Nightmare. Grawn: National Sleep Alert, Inc.
George, R.B., Light, R.W., Matthay, M.A., & Matthay, R.A. (1990). Chest Medicine: Essentials of
Pulmonary and Critical Care Medicine (2nd edition). Baltimore: Williams & Wilkins.
Inlander, C.B. & Moran, C.K. (1995). 67 Ways to Good Sleep. New York: Walker Publishing
Company, Inc.
Johnson, T.S. & Halberstadt, J. (1993). Phantom of the Night. Cambridge: NTP, Inc.
Kryger, M.H., Roth, T. & Dement, W.C. (1994). Principles and Practice of Sleep Medicine (2nd edition).
Philadelphia: W.B. Saunders Company.
Kryger, M.H., Roth, T. & Dement, W.C. (2000). Principles and Practice of Sleep Medicine (3rd edition).
Philadelphia: W.B. Saunders Company.
Kryger, M.H., Roth, T. & Dement, W.C. (2005). Principles and Practice of Sleep Medicine (4th edition).
Philadelphia: Elsevier, Inc.
Marklund, M. (2001). Treatment of Obstructive Sleep Apnea with a Mandibular Advancement Device.
Umea: Umea University.
Mazzoni, P., Pearson, T., & Rowland, L.P. (2006). Merritt’s Neurology Handbook (2nd edition).
Lippincott Williams & Wilkins.
Murray, J.F. & Nadel, J.A. (1988). Textbook of Respiratory Medicine: Volume 1 (1st edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel J.A. (1988). Textbook of Respiratory Medicine: Volume 2 (1st edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel, J.A. (1994). Textbook of Respiratory Medicine: Volume 1 (2nd edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel, J.A. (1994). Textbook of Respiratory Medicine: Volume 2 (2nd edition).
Philadelphia: W.B. Saunders Company.
Ogden, T.E. (1991). Research Proposals: A Guide to Success. New York: Raven Press, Ltd.
Pack, A.I. (2002). Sleep Apnea. New York: Marcel & Dekker, Inc.
Parrillo, J.E. & Dellinger, R.P. (2001). Critical Care Medicine: Principles of Diagnosis and
Management in the Adult (2nd edition). St. Louis: Mosby, Inc.
Rechtschaffen, A. & Kales, A. (1968). A Manual of Standardized Terminology, Techniques and
Scoring System for Sleep Stages of Human Subjects. Bethesda: U.S. Department of Health,
Education, and Welfare.
Richardson, G. (ed.) (2006). Update on the Science, Diagnosis, and Management of Insomnia.
London: RSM Press, Ltd.
Shoemaker, W.C., Ayres, S., Grenvik, A., Holbrook, D.R., & Thompson, W.L. (1989). Textbook of
Critical Care (2nd edition). Philadelphia: W.B. Saunders Company.
Spriggs, W.H. (2002). Principles of Polysomnography (1st edition). Salt Lake City: Sleep Ed, LLC.
Evaluation Methods
A competency-based evaluation matrix is available at the end of the curriculum. The evaluation
methods that apply to these rotations include:
 Web enabled competency-based evaluation forms that are completed by faculty at the
end of each rotation
 360° evaluations completed quarterly by clinical support staff, nursing and sleep
laboratory technical staff
 Mini-CEXs are completed at least four times during the fellowship
 Review of PQIPs are evaluated by faculty preceptors
15



Review of QA scoring are evaluated by faculty preceptors
Procedure logs/Portfolios
ABIM sleep board summative exam results
Level of Supervision by Faculty
All fellows are supervised by the attending of record according to the institutional policy on
Attending supervision that is included in our departmental policies. Ratio of fellows to faculty in a
given practice session is no more than 4:1; faculty usually do not see their own patients during
sessions when they are precepting fellows in their continuity practice setting. When a fellow is
rotating in a faculty-based practice the ratio of fellows to faculty will not exceed 2:1; faculty may see
their own patients if the fellow to faculty ratio is 1:1. Regardless of the clinical scenario, every
patient seen is reviewed with the faculty preceptor before being released.
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Learning Objectives for HUP Inpatient Consultation:
Educational Rationale:
Sleep Medicine Inpatient Consultation experience can encompass a broad range of sleep disorders
depending on the practice setting. However, the extent and complexity of the role may be
determined by the availability of neurological, psychiatric, otolaryngological, pediatric internal
medicine and other specialists, including pediatric and internal medicine subspecialists such as
pulmonologists and cardiologists. Since sleep medicine consultation is practiced at the interface of
multiple specialties, it requires familiarity with those specialties, skill in synthesizing information
and appropriate effective communication with attending and other consulting physicians, dentists,
other health care workers, and families.
These skills are acquired via a multidisciplinary approach to sleep medicine consultation.
First of all, all clinical fellows spend up to 4-6 weeks covering the Sleep Medicine Inpatient
Consultation (SMIC) Service at HUP. This occurs in 2 week blocks. Sleep medicine fellows perform
new consultations, present their cases to the Sleep Medicine Attending on the consult service, and
then provide management advice and follow-up as needed. As soon as possible after receiving the
request for consultation, the fellow interviews and examines the patient, gathers all necessary
information from the chart and other sources as appropriate. S/he then presents the patient to the
attending after which the fellow and attending see the patient together at the bedside. A plan of care
is developed by fellow and attending together and then communicated by the fellow both verbally
and in writing to the service requesting the consultation within 24 hours of the request for the
consultation.. Thereafter, the fellow rounds at least once daily on all active patients on the consult
service and discusses them with the attending. All patients with active issues or whose status has
changed are revisited with the attending later in the day. Of note, sleep medicine fellows will also be
continuing their outpatient responsibilities during this time as the burden of consultations is quite
low.
Additionally, all fellows will spend up to 4 weeks total on a combination of various subspecialty
inpatient consultation services including the neurology, pulmonology, bariatric surgery and heart
failure services at HUP. During these rotations, the supervising physician will be board certified in
the subspecialty of the rotation as well as sleep medicine or have a specific interest in sleep medicine
(e.g. sleep apnea and heart failure). These inpatient experiences will serve to illustrate how sleep
disorders integrate into the differential diagnoses of various clinical questions posed to subspecialty
consultation services. Sleep medicine fellows perform new consultations, present their cases to the
attending on the consult service, and then provide management advice and follow-up as needed. As
soon as possible after receiving the request for consultation, the fellow interviews and examines the
patient, gathers all necessary information from the chart and other sources as appropriate. S/he then
presents the patient to the attending after which the fellow and attending see the patient together at
the bedside. A plan of care is developed by fellow and attending together and then communicated
by the fellow both verbally and in writing to the service requesting the consultation. Thereafter, the
fellow rounds at least once daily on all active patients on the consult service and discusses them
with the attending. All patients with active issues or whose status has changed are revisited with the
attending later in the day. Of note, sleep medicine fellows will have reduced outpatient
responsibilities during this portion of their sleep inpatient rotation.
Disease Mix/ Patient Characteristics:
17
The Hospital of the University of Pennsylvania is a 700-bed hospital serving a patient population
with a variety of ethnic backgrounds and socioeconomic statuses. The opportunity to round on
multiple subspecialty services in addition to interfacing with any clinical service that might call a
sleep consult allows for exposure to a diverse disease mix.
Principal Teaching Methods/Learning Venues:
Direct Patient Care (DPC) – Daily bedside rounds with the sleep medicine attending on service
seeing new consultations and follow-ups.
Consult Attending Teaching Rounds (CATR) – As patients are seen, the attending on consult
service provides focused teaching on common topics in Sleep Medicine Consultation.
The final component of the HUP sleep medicine educational program is the Sleep Medicine
Conference Schedule (SMCS), which include two 1-hour didactic sessions per week and the Center
for Sleep Seminar series which occurs 8-10 times per year. The twice weekly didactic sessions are
either Clinical Case Conferences (CCC), Sleep Lecture Series (SLS), Sleep Medicine Journal Club
(SMJC) or Sleep Medicine Research Conference (SMRC).
Principal Educational Goals by Relevant Competency
In the tables below, the principal educational goals for the General Medicine Consultation Rotation
are listed for each of the six ACGME competencies. The second column of the table indicates the
most relevant principal teaching/learning activity for each goal, using the legend below.
* Legend for Learning Activities (See above for descriptions)
DPC – Direct Patient Care
CCC -- Clinical Case Conferences
SMJC -- Sleep Medicine Journal Club
CATR – Consult Attending Teaching Rnds
SLS -- Sleep Lecture Series
SMRC -- Sleep Medicine Research Conference
1) Patient Care
Principal Educational Goals Learning Activities*
Effectively, efficiently, and sensitively interview and examine
patients hospitalized with complaints that suggest a possible sleep disorder
DPC, CATR
Obtain all necessary medical information by chart review,
discussion with the service requesting the consultation, and
through contact with the patient’s primary care internist and
other important providers
DPC, CATR
Adjust all recommendations as required by the patients
coexistent problem(s) which resulted in their admission to
another service: impending or recent surgery, pregnancy or
recent delivery, etc.
DPC, CATR
2) Medical Knowledge
Principal Educational Goals Learning Activities*
18
Expand clinically applicable knowledge base of the biomedical,
clinical and cognate sciences underlying the care of patients with
sleep related illness on non-dedicated sleep medicine services.
DPC, CCC, SLS, SMJC,
CATR
Access and critically evaluate current medical information
and scientific evidence relevant to inpatient sleep medicine
patient care
ALL
Assess the validity of original research concerning clinical
questions such as diagnosis, prognosis, treatment and prevention
CCC, SLS, SMJC, SMRC,
CATR
3) Practice-Based Learning and Improvement
Principal Educational Goals Learning Activities*
Identify and acknowledge gaps in personal knowledge and
skills in the care of patients with sleep-related illness on non-sleep
medicine services
Develop evidence-based, real-time strategies for filling gaps in
personal knowledge and skills in the care of patients with
sleep-related illness on non-sleep medicine services
DPC, CATR
DPC, CATR,
CCC, SLS, SMJC
4) Interpersonal Skills and Communication
Principal Educational Goals Learning Activities*
Communicate sensitively and effectively with patients with
sleep-related illness on non-sleep medicine services and with their
families
DPC,
Communicate effectively with residents, fellows and attending
physicians on the service requesting the consultation to be
DPC, CATR
Verbally communicate findings and recommendations to the
requesting resident and/or attending physician clearly and
concisely as soon as the consultation is completed and
assure that all questions have been satisfactorily answered
DPC, CATR
Complete a concise consultation note with clearly stated,
detailed recommendations
DPC, CATR
Communicate effectively with the nursing staff and other
members of the health care team on the patient's primary
service to assure that plan of medical care is clear
DPC, CATR
5) Professionalism
Principal Educational Goals Learning Activities*
Behave professionally toward towards patients, families,
ALL
19
colleagues, and all members of the health care team
6) Systems-Based Practice
Principal Educational Goals Learning Activities*
Work with the service requesting the consultation to assure
that care for the patient's medical needs is properly
coordinated with care being delivered by the primary service
DPC, CATR
Assist with scheduling of any tests or treatments necessary
to assure the patient's proper medical care
DPC, CATR
Use evidence-based, cost-conscious strategies in the care of
patients with sleep-related illness on non-sleep medicine services
and patients being assessed for pre-operative medical risk
ALL
Recommended Resources
All fellows are expected to read about their patients in an appropriate sleep medicine or
subspecialty text (see below for examples). Because it is frequently updated, extensively referenced,
and includes abstracts of referenced articles, the program highly recommends UpToDate as a
primary resource. UpToDate is available at all sites on the UPHS network. The reference shelf from
the Biomedical library is also available online. Additional educational resources include the didactic
conference curriculum and primary review of laboratory and sleep studies in addition to radiology.
Ahrens, E.H. (1992). The Crisis in Clinical Research. New York: Oxford University Press.
Bates, D.V. (1989). Respiratory Function in Disease (3rd edition). Philadelphia: W.B. Sanders
Company.
Berry, R.B. (2003). Sleep Medicine Pearls (2nd edition). Philadelphia: Hanley & Belfus, Inc.
Carlson, R.W. & Geheb, M.A. (1993). Principles and Practices of Medical Critical Care.
Philadelphia: W.B. Saunders Company.
Chase, M.H. & Roth, T (eds.) (1990). Slow Wave Sleep. Los Angeles: Regents of the University of
California.
Chokroverty, S., Thomas, R.J., & Bhatt, M. (2005). Atlas of Sleep Medicine. Philadelphia: Elsevier,
Inc.
Fraser, R.G. (1988). Diagnosis of Diseases of the Chest: Volume 1. Philadelphia: W.B. Saunders
Company.
Fraser, R.G. (1988). Diagnosis of Diseases of the Chest: Volume 2. Philadelphia: W. B. Saunders
Company.
Fritz, R. (1993). Sleep Disorders: America’s Hidden Nightmare. Grawn: National Sleep Alert, Inc.
George, R.B., Light, R.W., Matthay, M.A., & Matthay, R.A. (1990). Chest Medicine: Essentials of
Pulmonary and Critical Care Medicine (2nd edition). Baltimore: Williams & Wilkins.
Inlander, C.B. & Moran, C.K. (1995). 67 Ways to Good Sleep. New York: Walker Publishing
Company, Inc.
Johnson, T.S. & Halberstadt, J. (1993). Phantom of the Night. Cambridge: NTP, Inc.
Kryger, M.H., Roth, T. & Dement, W.C. (1994). Principles and Practice of Sleep Medicine (2nd
edition). Philadelphia: W.B. Saunders Company.
Kryger, M.H., Roth, T. & Dement, W.C. (2000). Principles and Practice of Sleep Medicine (3rd
edition). Philadelphia: W.B. Saunders Company.
20
Kryger, M.H., Roth, T. & Dement, W.C. (2005). Principles and Practice of Sleep Medicine (4th
edition). Philadelphia: Elsevier, Inc.
Marklund, M. (2001). Treatment of Obstructive Sleep Apnea with a Mandibular Advancement
Device. Umea: Umea University.
Mazzoni, P., Pearson, T., & Rowland, L.P. (2006). Merritt’s Neurology Handbook (2nd edition).
Lippincott Williams & Wilkins.
Murray, J.F. & Nadel, J.A. (1988). Textbook of Respiratory Medicine: Volume 1 (1st edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel J.A. (1988). Textbook of Respiratory Medicine: Volume 2 (1st edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel, J.A. (1994). Textbook of Respiratory Medicine: Volume 1 (2nd edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel, J.A. (1994). Textbook of Respiratory Medicine: Volume 2 (2nd edition).
Philadelphia: W.B. Saunders Company.
Ogden, T.E. (1991). Research Proposals: A Guide to Success. New York: Raven Press, Ltd.
Pack, A.I. (2002). Sleep Apnea. New York: Marcel & Dekker, Inc.
Parrillo, J.E. & Dellinger, R.P. (2001). Critical Care Medicine: Principles of Diagnosis and
Management in the Adult (2nd edition). St. Louis: Mosby, Inc.
Rechtschaffen, A. & Kales, A. (1968). A Manual of Standardized Terminology, Techniques and
Scoring System for Sleep Stages of Human Subjects. Bethesda: U.S. Department of Health,
Education, and Welfare.
Richardson, G. (ed.) (2006). Update on the Science, Diagnosis, and Management of Insomnia.
London: RSM Press, Ltd.
Shoemaker, W.C., Ayres, S., Grenvik, A., Holbrook, D.R., & Thompson, W.L. (1989). Textbook of
Critical Care (2nd edition). Philadelphia: W.B. Saunders Company.
Spriggs, W.H. (2002). Principles of Polysomnography (1st edition). Salt Lake City: Sleep Ed, LLC.
Evaluation Methods
A competency-based evaluation matrix is available at the end of the curriculum. The evaluation
methods that apply to these rotations include:
 Web enabled competency-based evaluation forms that are completed by faculty at the
end of each rotation
 360° evaluations completed quarterly by clinical support staff, nursing and sleep
laboratory technical staff
 Mini-CEXs are completed at least four times during the fellowship
 Review of PQIPs are evaluated by faculty preceptors
 Review of QA scoring are evaluated by faculty preceptors
 Procedure logs/Portfolios
 ABIM sleep board summative exam results
Level of Supervision by Faculty
All fellows are supervised by the attending of record according to the institutional policy on
attending supervision that is included in our departmental policies.
21
Learning Objectives for CHOP Sleep Medicine Rotation:
Educational Rationale:
Sleep Medicine Ambulatory Experience at the Children’s Hospital of Philadelphia (CHOP) includes
three components: direct patient care, didactic sessions and hands-on experience with sleep studies
and associated tools. The approach to care is multi-disciplinary, with sleep medicine attendings
from pediatric pulmonary and pediatric neurology, as well as other faculty from child psychology
and dedicated pediatric sleep medicine nurses.
Disease Mix/Patient Characteristics:
The CHOP Sleep Clinic is a weekly, full day, multidisciplinary clinic that provides medical care for
children (0-21 years of age) with any type of sleep complaint. Common conditions seen in the clinic
include, but are not limited to, sleep-disordered breathing (including obstructive sleep apnea
syndrome, central apnea and central hypoventilation syndromes, and children requiring
noninvasive nocturnal positive pressure ventilation), narcolepsy, circadian rhythm disorders
(particularly delayed sleep phase syndrome), behavioral sleep disorders, parasomnias, restless legs
syndrome and periodic limb movement disorders, and sleep problems in children with complex
medical conditions. The clinic attracts pediatric patients from all over the country with complex
sleep problems.
Founded in 1855, CHOP was the first children’s hospital established in the United States, and
the second in the world. For the past four years, The Children’s Hospital of Philadelphia has been
recognized in surveys by Child Magazine and U.S. News and World Report as the #1 children’s
hospital in the nation. This phenomenal recognition reflects the commitment of the Hospital and its
administration in providing unparalleled excellence of clinical care. CHOP is a large (373 beds),
tertiary children’s hospital where all subspecialties are represented. It handles nearly 23,000
inpatient admissions annually, 75,000 emergency department visits, and 85,000 outpatient visits
each year. The patient population draws from the greater Philadelphia tri-state region, as well as
nationally and internationally. All racial and ethnic groups are represented in the patient mix.
Procedures:
Fellows will be trained in the evaluation and interpretation of overnight polysomnograms, both
diagnostic and therapeutic, multiple sleep latency tests, actigrams and sleep logs on the children
evaluated in the Sleep Center. Pediatric sleep studies are scheduled and performed through the
CHOP sleep laboratory, a 6 bed facility accredited by the American Academy of Sleep Medicine and
located on the 7th floor of CHOP’s Main Hospital. The CHOP sleep laboratory operates at capacity 7
nights per week.
Principal Teaching Methods/Learning Venues:
1) Pediatric sleep clinics. During a typical rotation at CHOP, a fellow will attend at least three
outpatient pediatric sleep clinics in CHOP’s Wood Center per week in addition to his/her
adult continuity clinic. The sleep medicine fellow is expected to have the first contact with
new patients, to complete a comprehensive history and physical exam, to formulate an
assessment and plan, and then to discuss the case with the attending physician. The
attending physician reviews the case with the patient and appropriate family members.
There is a final discussion of the assessment and plan between the sleep fellow and
attending, and then care is undertaken. It is expected that the fellow will serve as the sleep
medicine care provider for that patient and family for the remainder of that rotation. The
22
fellow will review all laboratory test results (e.g., sleep studies) and provide further
management. Follow-up visits serve as an opportunity for the attending and sleep fellow to
review the patient’s progress and any intervening care or advice given by the fellow.
2) Polysomnography scoring and interpretation. Under the direct supervision of an ABMScertified attending specializing in pediatric sleep medicine, the fellow will review overnight
polysomnograms and Multiple Sleep Latency Tests. The fellow will be responsible for
formulating the interpretation of these data into concise clinical reports. The fellow will also
discuss results with referring physicians as needed. The fellow will lead the weekly
Multidisciplinary Patient Conference at CHOP, reviewing each patient’s medical history,
sleep issues, prior polysomnographic studies (if any), and propose an individualized plan for
monitoring. The fellow will be contacted by the sleep lab staff Monday through Thursday
nights, when necessary, for questions regarding the patients being studied at CHOP; an
attending physician will always be available for back-up support.
3) Inpatient consultations. The fellow will perform all inpatient consultations under the direct
supervision of an ABMS-certified physician. The sleep medicine fellow, under the
supervision of a sleep medicine attending, will review the patient’s medical chart and elicit a
history, examine the patient, and discuss the goals of evaluation with the hospital team. A
formal consultation note by the fellow/attending will become part of the medical record. If a
polysomnogram is deemed appropriate, the results will be reviewed with the primary team,
and the sleep fellow will offer management options accordingly. When possible, continuity
of care will be promoted by scheduling follow-up appointments with the fellow in the
outpatient sleep clinic.
4) Conferences. As noted above, the fellow will lead the lead the weekly Multidisciplinary
Patient Conference. The fellow will also actively participate in the weekly CHOP sleep
medicine lecture series, that covers a broad range of topics related to pediatric sleep
medicine, both clinical care and clinical research. The fellow will also be required to attend
the Sleep Center Administrative Meeting, where issues related to clinic and sleep laboratory
organization, educational goals, health care delivery to sleep medicine patients and other
topics will be discussed; this meeting will contribute to the fellow’s aptitude in resource
management, and foster insight into the operation and management of a pediatric sleep
center.
The principal teaching/learning activity of the CHOP sleep medicine rotation occurs through Direct
Patient Care (DPC) activities. The didactic programs described above complement direct patient
care activities.
Principal Educational Goals by Relevant Competency:
In the tables below, the principal educational goals for the CHOP sleep medicine rotation are listed
for each of the six ACGME competencies. The second column of the table indicates the most relevant
principal teaching/learning activity for each goal, using the legend below.
* Legend for Learning Activities (See above for descriptions)
PSC—Pediatric Sleep Clinics
PSI—Polysomnography Scoring and Interpretation
IC—Inpatient Consultations
CONF—Pediatric Sleep Medicine Conferences
1) Patient Care
23
Principal Educational Goals Learning Activities*
Effectively interview sleep medicine patients
PSC, IC
Effectively examine sleep medicine patients
PSC, IC
Maintain focus and timeliness in the evaluation and
management of sleep medicine problems
PSC, IC
Order appropriate diagnostic tests
PSC, PSI, IC, CONF
Interpret polysomnograms and other diagnostic sleep evaluation tools
PSC, PSI, IC, CONF
2) Medical Knowledge
Principal Educational Goals Learning Activities*
Expand clinically applicable knowledge base of the biomedical,
clinical and cognate sciences underlying the care of sleep medicine
patients
PSC, IC, CONF
Access and critically evaluate current medical information
and scientific evidence relevant to sleep medicine
patient care
PSC, IC, CONF
Assess the validity of original research concerning clinical
questions such as diagnosis, prognosis, treatment and prevention
PSC, IC, CONF
3) Practice-Based Learning and Improvement
Principal Educational Goals Learning Activities*
Identify and acknowledge gaps in personal knowledge and
skills in the care of sleep medicine patients
PSC, IC
Develop real-time strategies for filling knowledge gaps that
will benefit patients in a busy practice setting
PSC, IC, CONF
4) Interpersonal Skills and Communication
Principal Educational Goals Learning Activities*
Communicate effectively with patients and families across a
broad range of socioeconomic and ethnic backgrounds
PSC, IC
Communicate effectively with physician colleagues and
members of other health care professions to assure
comprehensive patient care
PSC, PSI, IC, CONF
24
5) Professionalism
Principal Educational Goals Learning Activities*
Behave professionally toward towards patients, families,
colleagues, and all members of the health care team
PSC, PSI, IC, CONF
6) Systems-Based Practice
Principal Educational Goals Learning Activities*
Understand and utilize the multidisciplinary resources
necessary to care optimally for sleep medicine patients
PSC, PSI, IC, CONF
Collaborate with other members of the health care team to
assure comprehensive sleep medicine outpatient care
PSC, PSI, IC, CONF
Use evidence-based, cost-conscious strategies in the care of
sleep medicine patients
PSC, PSI, IC, CONF
Begin to understand the business aspects of practice
management in a variety of settings
PSC, IC, CONF
Begin to develop efficient practice patterns so patient care
proceeds at an acceptable rate
PSC, IC
Principal Educational Goals
In addition to the above goals by competency, after 12 months of training, the fellow should
have achieved the following:









Function as an integral member of an outpatient multidisciplinary team
Evaluate at least 40 new pediatric sleep medicine outpatients
Evaluate and manage 4-5 pediatric sleep medicine inpatients
Provide continuous care to at least 40 pediatric sleep medicine outpatients
Attend pediatric sleep medicine conferences regularly
Enhance office based time management skills
Develop telephone management skills
Develop urgent care skills
Function as role models and mentors for younger trainees within the multidisciplinary
fields that make up sleep medicine
Specialty Tracks:
Additional training is available to fellows who want a concentrated experience in pediatric sleep
medicine. Fellows on the Pediatric Track will spend a total of 6 one month blocks at CHOP, in
addition to maintaining an additional year-long sleep medicine continuity clinic at CHOP.
Specifically, the Wednesday afternoon sleep clinic session will be maintained throughout the year to
allow continuity in the care of pediatric sleep medicine patients. Trainees in this track will be
expected to evaluate at least 60 new pediatric sleep medicine patients throughout the year.
Recommended Resources
25
UpToDate (available on-site in the practice)
Ahrens, E.H. (1992). The Crisis in Clinical Research. New York: Oxford University Press.
Bates, D.V. (1989). Respiratory Function in Disease (3rd edition). Philadelphia: W.B. Sanders
Company.
Berry, R.B. (2003). Sleep Medicine Pearls (2nd edition). Philadelphia: Hanley & Belfus, Inc.
Carlson, R.W. & Geheb, M.A. (1993). Principles and Practices of Medical Critical Care.
Philadelphia: W.B. Saunders Company.
Chase, M.H. & Roth, T (eds.) (1990). Slow Wave Sleep. Los Angeles: Regents of the University of
California.
Chokroverty, S., Thomas, R.J., & Bhatt, M. (2005). Atlas of Sleep Medicine. Philadelphia: Elsevier,
Inc.
Fraser, R.G. (1988). Diagnosis of Diseases of the Chest: Volume 1. Philadelphia: W.B. Saunders
Company.
Fraser, R.G. (1988). Diagnosis of Diseases of the Chest: Volume 2. Philadelphia: W. B. Saunders
Company.
Fritz, R. (1993). Sleep Disorders: America’s Hidden Nightmare. Grawn: National Sleep Alert, Inc.
George, R.B., Light, R.W., Matthay, M.A., & Matthay, R.A. (1990). Chest Medicine: Essentials of
Pulmonary and Critical Care Medicine (2nd edition). Baltimore: Williams & Wilkins.
Inlander, C.B. & Moran, C.K. (1995). 67 Ways to Good Sleep. New York: Walker Publishing
Company, Inc.
Johnson, T.S. & Halberstadt, J. (1993). Phantom of the Night. Cambridge: NTP, Inc.
Kryger, M.H., Roth, T. & Dement, W.C. (1994). Principles and Practice of Sleep Medicine (2nd
edition). Philadelphia: W.B. Saunders Company.
Kryger, M.H., Roth, T. & Dement, W.C. (2000). Principles and Practice of Sleep Medicine (3rd
edition). Philadelphia: W.B. Saunders Company.
Kryger, M.H., Roth, T. & Dement, W.C. (2005). Principles and Practice of Sleep Medicine (4th
edition). Philadelphia: Elsevier, Inc.
Marcus, C.L., Carroll J.L., Loughlin G.M. (eds.) (2000). Sleep and breathing in children. New York:
Dekker.
Marklund, M. (2001). Treatment of Obstructive Sleep Apnea with a Mandibular Advancement
Device. Umea: Umea University.
Mazzoni, P., Pearson, T., & Rowland, L.P. (2006). Merritt’s Neurology Handbook (2nd edition).
Lippincott Williams & Wilkins.
Mindell, J.A. & Owens, J.A. (2003). A Clinical Guide to Pediatric Sleep: Diagnosis and Management
of Sleep Problems. Lippincott Williams & Wilkins.
Murray, J.F. & Nadel, J.A. (1988). Textbook of Respiratory Medicine: Volume 1 (1st edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel J.A. (1988). Textbook of Respiratory Medicine: Volume 2 (1st edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel, J.A. (1994). Textbook of Respiratory Medicine: Volume 1 (2nd edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel, J.A. (1994). Textbook of Respiratory Medicine: Volume 2 (2nd edition).
Philadelphia: W.B. Saunders Company.
Ogden, T.E. (1991). Research Proposals: A Guide to Success. New York: Raven Press, Ltd.
Pack, A.I. (2002). Sleep Apnea. New York: Marcel & Dekker, Inc.
Parrillo, J.E. & Dellinger, R.P. (2001). Critical Care Medicine: Principles of Diagnosis and
Management in the Adult (2nd edition). St. Louis: Mosby, Inc.
26
Rechtschaffen, A. & Kales, A. (1968). A Manual of Standardized Terminology, Techniques and
Scoring System for Sleep Stages of Human Subjects. Bethesda: U.S. Department of Health,
Education, and Welfare.
Richardson, G. (ed.) (2006). Update on the Science, Diagnosis, and Management of Insomnia.
London: RSM Press, Ltd.
Sheldon, S.H., Kryger, M.H., Ferber, R. (2005). Principles and Practice of Pediatric Sleep Medicine.
Philadelphia: W.B. Saunders Company.
Shoemaker, W.C., Ayres, S., Grenvik, A., Holbrook, D.R., & Thompson, W.L. (1989). Textbook of
Critical Care (2nd edition). Philadelphia: W.B. Saunders Company.
Spriggs, W.H. (2002). Principles of Polysomnography (1st edition). Salt Lake City: Sleep Ed, LLC.
Evaluation Methods
A competency-based evaluation matrix is available at the end of the curriculum. The evaluation
methods that apply to these rotations include:
 Web enabled competency-based evaluation forms that are completed by faculty at least
every 60 days
 360° evaluations completed quarterly by clinical support staff, nursing and sleep
laboratory technical staff
 Mini-CEXs are completed at least four times during the fellowship
 Procedure logs/Portfolios
 ABIM sleep board summative exam results
Level of Supervision by Faculty
All fellows are supervised by the attending of record according to the institutional policy on
Attending supervision that is included in our departmental policies. Ratio of fellows to faculty in a
given clinic session is no more than 2:1; faculty do not see their own patients while precepting
fellows in pediatric sleep clinic. Every patient seen is reviewed with the faculty preceptor before
being released.
27
Learning Objectives for Philadelphia VAMC Sleep Medicine
Rotation:
Sleep Medicine Ambulatory Experience
Educational Rationale:
Sleep Medicine Ambulatory Experience includes three components: direct patient care, didactic
sessions and hands-on experience with sleep studies and associated tools. The approach to care in
the faculty-fellow practice is multi-disciplinary. The fellows work with two ABSM certified Sleep
Medicine physicians, a Neurologist specializing in sleep medicine, a Nurse Practitioner, a Registered
Nurse, two Respiratory Therapists, and a Clinic Clerk. The fellows participate in review and
interpretation of sleep studies, new patient evaluations, follow-up clinic visits, positive airway
pressure mask fittings, patient education, and patient set-up sessions for distribution of portable
monitors for home unattended testing.
Disease Mix/Patient Characteristics:
The VISN 4 Eastern Regional Sleep Center is a full service facility accredited by the American
Academy of Sleep Medicine. The patient population seen in the outpatient clinics is heterogeneous,
including individuals from a wide range of socioeconomic and ethnic backgrounds. Approximately
45% of the patients enrolled at the Philadelphia VAMC are African American. The patients have a
broad range of sleep disorders. Fellows have an opportunity to evaluate and manage veterans with
a broach range of sleep disorders. Post traumatic stress disorder, and insomnia due to psychiatric
disorders is particularly prevalent in the veterans seen in the sleep center.
Procedures:
Fellows can expect to review and interpret polysomnograms, both diagnostic and therapeutic,
multiple sleep latency tests, home unattended sleep studies, home unattended autoCPAP titration
studies, and sleep logs on the patients they encounter in the outpatient clinics.
Principal Teaching Methods/Learning Venues:
A core curriculum in sleep medicine is presented in a multifaceted approach that provides the
fellow with the opportunity to work with Staff Physicians, a Nurse Practitioner, a Registered Nurse
and two Respiratory Therapists. The Staff Physicians have a total of 4 half-day outpatient clinic
sessions (FBP) during which they supervise fellows’ evaluations of new and follow-up patients. The
Nurse Practitioner has 4 half-day outpatient clinic sessions (NPCS) during which fellows perform
supervised evaluations of new patients referred to the sleep center for suspected sleep apnea. The
Registered Nurse has several half-day outpatient clinic sessions (RNCS) throughout the week to
provide follow-up evaluation and management of patients with sleep apnea on positive airway
pressure. This includes a comprehensive CPAP adherence program to track treatment adherence
and effectiveness. Two to four weeks following initiation of CPAP treatment, patients are seen in
follow-up for education, downloads of media card technology to assess adherence and efficacy of
treatment and mask interface adjustments. Patients who have no active problems are then
scheduled for routine follow-up appointments every 6-12 months. Sleep Medicine fellows
participate in the care of these patients in a multidisciplinary approach interacting with the
registered nurse, respiratory therapists and medical assistants. The two Respiratory Therapists
conduct mask fittings during each outpatient clinic session. In addition, they implement the home
testing program by holding several clinic sessions (RTCS) during the week to set-up patients who
are scheduled for home unattended sleep testing with Type 3 diagnostic monitor or autoCPAP. The
28
fellows interact with the clinic clerk to schedule follow-up clinic visits, sleep studies and processing
of sleep study interpretations.
Under direct faculty supervision, the fellows interpret sleep studies, including polysomnography,
multiple sleep latency tests, and home unattended sleep studies. On a weekly basis, the sleep
center performs 8 polysomnograms, 6 home unattended diagnostic sleep studies, and 8 home
unattended autoCPAP titration studies. One of the sleep specialty physicians meets with the fellow
on a weekly basis for a Sleep Study Review (SSR) to discuss the scoring and analysis of the studies
and finalize the interpretations. All outpatient sleep clinics are held in the sleep center. Fellows are
encouraged to review any sleep studies that have been performed on patients they are evaluating in
follow-up clinics.
The principal teaching/learning activity of the PVAMC sleep center rotation occurs through direct
patient care activities. In all of the ambulatory settings mentioned above, fellows present their cases
to the supervising staff member and a discussion of evaluation and management ensues. During the
physician staffed outpatient clinics, the fellow and staff physician may see the patient together.
When the fellow sees the patient alone, he/she then presents the findings and proposed
management plan to the supervising faculty member. The fellow and faculty member then return
together to the examining room to expand on the history or physical examination and to teach about
interviewing and examination techniques.
The fellows use the VA electronic medical record to document their patient encounters. The VA
computer network provides fellows access to the internet, UpToDate and the New England Journal
of Medicine. A library of sleep medicine textbooks and sleep recording atlases are available in the
sleep center for fellows to study. A copy of the AASM Practice Parameters is on file with the sleep
center’s policies and procedures notebooks.
During the rotation at PVAMC, fellows are required to attend their continuity clinic and conferences
at the Penn Sleep Center.
Principal Educational Goals by Relevant Competency:
In the tables below, the principal educational goals for the PVAMC outpatient rotation are listed for
each of the six ACGME competencies. The second column of the table indicates the most relevant
principal teaching/learning activity for each goal, using the legend below.
* Legend for Learning Activities (See above for descriptions)
FBP – Faculty-Based Practices
NPCS – Nurse Practitioner Clinic Sessions
RNCS – Registered Nurse Clinic Sessions
RTCS – Respiratory Therapist Clinic Sessions
SSR – Sleep Study Review
1) Patient Care
Principal Educational Goals Learning Activities*
Effectively interview sleep medicine outpatients
FBP, NPCS, RNCS
Effectively examine sleep medicine outpatients
FBP, NPCS, RNCS
29
Maintain focus and timeliness in the evaluation and
management of sleep medicine problems
FBP, NPCS, RNCS
Order appropriate diagnostic tests
FBP, NPCS, RNCS
Interpret polysomnograms and other diagnostic sleep evaluation tools
SSR
2) Medical Knowledge
Principal Educational Goals Learning Activities*
Expand clinically applicable knowledge base of the biomedical,
clinical and cognate sciences underlying the care of sleep medicine
patients
ALL
Access and critically evaluate current medical information
and scientific evidence relevant to outpatient sleep medicine
patient care
ALL
Assess the validity of original research concerning clinical
questions such as diagnosis, prognosis, treatment and prevention
PCS, NPCS
3) Practice-Based Learning and Improvement
Principal Educational Goals Learning Activities*
Identify and acknowledge gaps in personal knowledge and
skills in the care of sleep medicine patients
ALL
Develop real-time strategies for filling knowledge gaps that
will benefit patients in a busy practice setting
ALL
4) Interpersonal Skills and Communication
Principal Educational Goals Learning Activities*
Communicate effectively with patients and families across a
broad range of socioeconomic and ethnic backgrounds
ALL
Communicate effectively with physician colleagues and
members of other health care professions to assure
comprehensive patient care
ALL
5) Professionalism
Principal Educational Goals Learning Activities*
Behave professionally toward towards patients, families,
ALL
30
colleagues, and all members of the health care team
6) Systems-Based Practice
Principal Educational Goals Learning Activities*
Understand and utilize the multidisciplinary resources
necessary to care optimally for sleep medicine patients
ALL
Collaborate with other members of the health care team to
assure comprehensive sleep medicine outpatient care
ALL
Use evidence-based, cost-conscious strategies in the care of
sleep medicine patients
ALL
Begin to understand the business aspects of practice
management in a variety of settings
ALL
Begin to develop efficient practice patterns so patient care
proceeds at an acceptable rate
ALL
Principal Educational Goals
In addition to the above goals by competency, after 12 months of training, the fellow should
have achieved the following in their rotation at PVAMC:







Function as an integral member of an outpatient multidisciplinary team
Provide care of 65 new and 100 follow-up adult sleep medicine patients
Attend the required number of departmental conferences at the University of
Pennsylvania, including clinical case conference, sleep lecture series and journal clubs
Enhance office based time management skills
Develop telephone management skills
Develop urgent care skills
Function as role models and mentors for younger trainees within the multidisciplinary
fields that make up sleep medicine
Recommended Resources
UpToDate (available on-site in the practice)
Ahrens, E.H. (1992). The Crisis in Clinical Research. New York: Oxford University Press.
Bates, D.V. (1989). Respiratory Function in Disease (3rd edition). Philadelphia: W.B. Sanders Company.
Berry, R.B. (2003). Sleep Medicine Pearls (2nd edition). Philadelphia: Hanley & Belfus, Inc.
Carlson, R.W. & Geheb, M.A. (1993). Principles and Practices of Medical Critical Care. Philadelphia:
W.B. Saunders Company.
Chase, M.H. & Roth, T (eds.) (1990). Slow Wave Sleep. Los Angeles: Regents of the University of
California.
Chokroverty, S., Thomas, R.J., & Bhatt, M. (2005). Atlas of Sleep Medicine. Philadelphia: Elsevier, Inc.
Fraser, R.G. (1988). Diagnosis of Diseases of the Chest: Volume 1. Philadelphia: W.B. Saunders
Company.
Fraser, R.G. (1988). Diagnosis of Diseases of the Chest: Volume 2. Philadelphia: W. B. Saunders
Company.
31
Fritz, R. (1993). Sleep Disorders: America’s Hidden Nightmare. Grawn: National Sleep Alert, Inc.
George, R.B., Light, R.W., Matthay, M.A., & Matthay, R.A. (1990). Chest Medicine: Essentials of
Pulmonary and Critical Care Medicine (2nd edition). Baltimore: Williams & Wilkins.
Inlander, C.B. & Moran, C.K. (1995). 67 Ways to Good Sleep. New York: Walker Publishing
Company, Inc.
Johnson, T.S. & Halberstadt, J. (1993). Phantom of the Night. Cambridge: NTP, Inc.
Kryger, M.H., Roth, T. & Dement, W.C. (1994). Principles and Practice of Sleep Medicine (2nd edition).
Philadelphia: W.B. Saunders Company.
Kryger, M.H., Roth, T. & Dement, W.C. (2000). Principles and Practice of Sleep Medicine (3rd edition).
Philadelphia: W.B. Saunders Company.
Kryger, M.H., Roth, T. & Dement, W.C. (2005). Principles and Practice of Sleep Medicine (4th edition).
Philadelphia: Elsevier, Inc.
Marklund, M. (2001). Treatment of Obstructive Sleep Apnea with a Mandibular Advancement Device.
Umea: Umea University.
Mazzoni, P., Pearson, T., & Rowland, L.P. (2006). Merritt’s Neurology Handbook (2nd edition).
Lippincott Williams & Wilkins.
Murray, J.F. & Nadel, J.A. (1988). Textbook of Respiratory Medicine: Volume 1 (1st edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel J.A. (1988). Textbook of Respiratory Medicine: Volume 2 (1st edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel, J.A. (1994). Textbook of Respiratory Medicine: Volume 1 (2nd edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel, J.A. (1994). Textbook of Respiratory Medicine: Volume 2 (2nd edition).
Philadelphia: W.B. Saunders Company.
Ogden, T.E. (1991). Research Proposals: A Guide to Success. New York: Raven Press, Ltd.
Pack, A.I. (2002). Sleep Apnea. New York: Marcel & Dekker, Inc.
Parrillo, J.E. & Dellinger, R.P. (2001). Critical Care Medicine: Principles of Diagnosis and
Management in the Adult (2nd edition). St. Louis: Mosby, Inc.
Rechtschaffen, A. & Kales, A. (1968). A Manual of Standardized Terminology, Techniques and
Scoring System for Sleep Stages of Human Subjects. Bethesda: U.S. Department of Health,
Education, and Welfare.
Richardson, G. (ed.) (2006). Update on the Science, Diagnosis, and Management of Insomnia.
London: RSM Press, Ltd.
Shoemaker, W.C., Ayres, S., Grenvik, A., Holbrook, D.R., & Thompson, W.L. (1989). Textbook of
Critical Care (2nd edition). Philadelphia: W.B. Saunders Company.
Spriggs, W.H. (2002). Principles of Polysomnography (1st edition). Salt Lake City: Sleep Ed, LLC.
Evaluation Methods
A competency-based evaluation matrix is available at the end of the curriculum. The evaluation
methods that apply to these rotations include:
 Web enabled competency-based evaluation forms that are completed by faculty at the
end of each rotation
 360° evaluations completed quarterly by clinical support staff, nursing and sleep
laboratory technical staff
 Mini-CEXs are completed at least four times during the fellowship
 Procedure logs/Portfolios
Level of Supervision by Faculty
All fellows are supervised by the attending of record according to the institutional policy on
Attending supervision that is included in our departmental policies. Ratio of fellows to faculty in a
32
given practice session is usually 1:1 and never more than 2:1; faculty usually see their own patients
during sessions when they are supervising fellows. Regardless of the clinical scenario, every patient
evaluated by the fellow is seen and examined by the faculty preceptor before being released.
33
Learning Objectives for CHOP Pediatric Otolaryngology Rotation:
Educational Rationale:
Pediatric Otolaryngology at the Children’s Hospital of Philadelphia (CHOP) includes components of
direct patient care and frequent observation of specialized procedures. Because the approach to care
is multi-disciplinary in pediatric sleep medicine, with sleep medicine attendings practicing very
closely with pediatric otolaryngologists, it is especially important for pediatric sleep medicine
trainees to understand the surgical approach to care of the pediatric patient with a sleep disorder.
Disease Mix/Patient Characteristics:
The CHOP Pediatric Otolaryngology Clinic is a daily clinic that provides medical and surgical care
for children (0-21 years of age) with ear, nose, and throat disorders. Patients seen in clinic include
those with obstructive sleep apnea secondary upper airway pathology: adenotonsillar hypertrophy,
nasal septal deviation, palate and tongue abnormalities. Patients with tracheostomies are reviewed
for possible decannulation. Other disorders seen include subglottic stenosis, vocal cord dysfunction,
and chronic inflammation (otitis media, sinusitis). In addition, more than 10,000 pediatric
otolaryngology surgical procedures are performed at CHOP each year. Common procedures
performed include, but are not limited to, tonsillectomy, adenoidectomy, palatoplasties,
tracheostomies, and diagnostic procedures such as direct laryngoscopies.
Procedures:
While not performing procedures directly, the sleep fellow will have the opportunity to monitor
multiple surgical procedures.
Principal Teaching Methods/Learning Venues:
5) Pediatric otolaryngology clinics. During a typical rotation with CHOP-based pediatric
otolaryngologists, a fellow will attend at least four outpatient pediatric ENT sleep clinics in
CHOP’s Wood Center per week. The fellow will learn the fundamentals of surgical
management of the airway. The sleep medicine fellow will evaluate patients with an ENT
attending present. Management plans will be finalized by the ENT attending.
6) Operating Room Exposure. The fellow will have several opportunities to observe surgical
procedures firsthand in the operating room, while receiving further teaching from a CHOP
ENT attending.
7) Conferences. A weekly surgical conference will be held in CHOP’s Main Hospital. The fellow
will be encouraged to attend this conference when feasible.
The principal teaching/learning activity of the CHOP pediatric otolaryngology rotation occurs
through Direct Patient Care (DPC) activities. The didactic programs described above complement
direct patient care activities. The fellow’s sleep medicine continuity clinics will continue throughout
the rotation.
Principal Educational Goals by Relevant Competency:
In the tables below, the principal educational goals for the CHOP pediatric otolaryngology rotation
are listed for each of the six ACGME competencies. The second column of the table indicates the
most relevant principal teaching/learning activity for each goal, using the legend below.
* Legend for Learning Activities (See above for descriptions)
POC—Pediatric Otolaryngology Clinics
34
OR—Operating Room Exposure
CONF—CHOP Surgical Conference, Pediatric Sleep Medicine
1) Patient Care
Principal Educational Goals Learning Activities*
Effectively interview pediatric otolaryngology patients
POC, OR, CONF
Effectively examine pediatric otolaryngology patients
POC, OR, CONF
Maintain focus and timeliness in the evaluation and
management of pediatric otolaryngology problems
POC, CONF
Order appropriate diagnostic tests
POC, OR, CONF
2) Medical Knowledge
Principal Educational Goals Learning Activities*
Expand clinically applicable knowledge base of the biomedical,
clinical and cognate sciences underlying the care of pediatric
otolaryngology patients
POC, OR, CONF
Access and critically evaluate current medical information
and scientific evidence relevant to pediatric otolaryngology
patient care
POC, OR, CONF
Assess the validity of original research concerning clinical
questions such as diagnosis, prognosis, treatment and prevention
POC, OR, CONF
3) Practice-Based Learning and Improvement
Principal Educational Goals Learning Activities*
Identify and acknowledge gaps in personal knowledge and
skills in the care of pediatric otolaryngology patients
POC, OR, CONF
Develop real-time strategies for filling knowledge gaps that
will benefit patients in a busy practice setting
POC, CONF
4) Interpersonal Skills and Communication
Principal Educational Goals Learning Activities*
Communicate effectively with patients and families across a
broad range of socioeconomic and ethnic backgrounds
POC, OR
Communicate effectively with physician colleagues and
members of other health care professions to assure
POC, OR, CONF
35
comprehensive patient care
5) Professionalism
Principal Educational Goals Learning Activities*
Behave professionally toward towards patients, families,
colleagues, and all members of the health care team
POC, OR, CONF
6) Systems-Based Practice
Principal Educational Goals Learning Activities*
Understand and utilize the multidisciplinary resources
necessary to care optimally for pediatric otolaryngology patients
POC, OR, CONF
Collaborate with other members of the health care team to
assure comprehensive pediatric otolaryngology patients care
POC, OR, CONF
Use evidence-based, cost-conscious strategies in the care of
pediatric otolaryngology patients
POC, OR, CONF
Begin to understand the business aspects of practice
management in a variety of settings
POC, OR, CONF
Begin to develop efficient practice patterns so patient care
proceeds at an acceptable rate
POC
Principal Educational Goals
In addition to the above goals by competency, after 12 months of training, the fellow should
have achieved the following:





Function as an integral member of a multidisciplinary team
Understand the fundamentals of surgical management of the pediatric airway
Attend pediatric sleep medicine conferences regularly
Enhance office based time management skills
Function as role models and mentors for younger trainees within the multidisciplinary
fields that make up sleep medicine
Specialty Tracks:
Additional training is available to fellows who want a concentrated experience in pediatric sleep
medicine. Fellows on the Pediatric Track will be required to spend one month on the Pediatric
Otolaryngology Rotation.
Recommended Resources
UpToDate (available on-site in the practice)
Ahrens, E.H. (1992). The Crisis in Clinical Research. New York: Oxford University Press.
Bates, D.V. (1989). Respiratory Function in Disease (3rd edition). Philadelphia: W.B. Sanders
Company.
36
Berry, R.B. (2003). Sleep Medicine Pearls (2nd edition). Philadelphia: Hanley & Belfus, Inc.
Carlson, R.W. & Geheb, M.A. (1993). Principles and Practices of Medical Critical Care.
Philadelphia: W.B. Saunders Company.
Chase, M.H. & Roth, T (eds.) (1990). Slow Wave Sleep. Los Angeles: Regents of the University of
California.
Chokroverty, S., Thomas, R.J., & Bhatt, M. (2005). Atlas of Sleep Medicine. Philadelphia: Elsevier,
Inc.
Fraser, R.G. (1988). Diagnosis of Diseases of the Chest: Volume 1. Philadelphia: W.B. Saunders
Company.
Fraser, R.G. (1988). Diagnosis of Diseases of the Chest: Volume 2. Philadelphia: W. B. Saunders
Company.
Fritz, R. (1993). Sleep Disorders: America’s Hidden Nightmare. Grawn: National Sleep Alert, Inc.
George, R.B., Light, R.W., Matthay, M.A., & Matthay, R.A. (1990). Chest Medicine: Essentials of
Pulmonary and Critical Care Medicine (2nd edition). Baltimore: Williams & Wilkins.
Inlander, C.B. & Moran, C.K. (1995). 67 Ways to Good Sleep. New York: Walker Publishing
Company, Inc.
Johnson, T.S. & Halberstadt, J. (1993). Phantom of the Night. Cambridge: NTP, Inc.
Kryger, M.H., Roth, T. & Dement, W.C. (1994). Principles and Practice of Sleep Medicine (2nd
edition). Philadelphia: W.B. Saunders Company.
Kryger, M.H., Roth, T. & Dement, W.C. (2000). Principles and Practice of Sleep Medicine (3rd
edition). Philadelphia: W.B. Saunders Company.
Kryger, M.H., Roth, T. & Dement, W.C. (2005). Principles and Practice of Sleep Medicine (4th
edition). Philadelphia: Elsevier, Inc.
Marklund, M. (2001). Treatment of Obstructive Sleep Apnea with a Mandibular Advancement
Device. Umea: Umea University.
Marcus, C.L., Carroll J.L., Loughlin G.M. (eds.) (2000). Sleep and breathing in children. New York:
Dekker.
Mazzoni, P., Pearson, T., & Rowland, L.P. (2006). Merritt’s Neurology Handbook (2nd edition).
Lippincott Williams & Wilkins.
Mindell, J.A. & Owens, J.A. (2003). A Clinical Guide to Pediatric Sleep: Diagnosis and Management
of Sleep Problems. Lippincott Williams & Wilkins.
Murray, J.F. & Nadel, J.A. (1988). Textbook of Respiratory Medicine: Volume 1 (1st edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel J.A. (1988). Textbook of Respiratory Medicine: Volume 2 (1st edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel, J.A. (1994). Textbook of Respiratory Medicine: Volume 1 (2nd edition).
Philadelphia: W.B. Saunders Company.
Murray, J.F. & Nadel, J.A. (1994). Textbook of Respiratory Medicine: Volume 2 (2nd edition).
Philadelphia: W.B. Saunders Company.
Ogden, T.E. (1991). Research Proposals: A Guide to Success. New York: Raven Press, Ltd.
Pack, A.I. (2002). Sleep Apnea. New York: Marcel & Dekker, Inc.
Parrillo, J.E. & Dellinger, R.P. (2001). Critical Care Medicine: Principles of Diagnosis and
Management in the Adult (2nd edition). St. Louis: Mosby, Inc.
Rechtschaffen, A. & Kales, A. (1968). A Manual of Standardized Terminology, Techniques and
Scoring System for Sleep Stages of Human Subjects. Bethesda: U.S. Department of Health,
Education, and Welfare.Richardson, G. (ed.) (2006). Update on the Science, Diagnosis, and
Management of Insomnia. London: RSM Press, Ltd.
Sheldon, S.H., Kryger, M.H., Ferber, R. (2005). Principles and Practice of Pediatric Sleep Medicine.
Philadelphia: W.B. Saunders Company.
37
Shoemaker, W.C., Ayres, S., Grenvik, A., Holbrook, D.R., & Thompson, W.L. (1989). Textbook of
Critical Care (2nd edition). Philadelphia: W.B. Saunders Company.
Spriggs, W.H. (2002). Principles of Polysomnography (1st edition). Salt Lake City: Sleep Ed, LLC.
Level of Supervision by Faculty
All fellows are directly supervised by an ENT attending through the rotation. Patients will be jointly
evaluated with the ENT attending, who will be responsible for finalizing all treatment plans.
38
EDUCATIONAL CONFERENCES
ACGME certification guidelines require that the fellows’ attendance at conference
be documented. Fellows must sign the attendance sheet at every conference.
Fellows are expected to attend 60% of the CSRN/Sleep Division conferences per
year. Compliance with this requirement will be determined by review of the
attendance sign-in sheets. Fellows who do not meet a 60% attendance level will
not be certified for the ABIM Sleep Medicine exam.
The program coordinator should be notified preferably by email if a fellow is
unable to attend a particular conference and needs to be excused.
The conferences are posted on the Sleep Center website and include:
http://www.uphs.upenn.edu/sleepctr/conferences/conf_semin_200304.htm
Sleep Summer Lecture Series (July, August, and September)
3624 Market Street – Monday, Thursday, Friday 12pm-1pm.
Sleep Clinical Case Conference (September – June)
3624 Market Street – Monday, 12pm-1pm.
Sleep Grand Rounds (September – June)
3624 Market Street – Thursday 12pm-1pm.
Sleep Journal Club (September – June)
3624 Market Street – last Thursday of the month 12pm-1pm.
CSRN Invited Speakers Research Seminar – Location TBD.
One Friday a month 12pm-1pm.
Fellows are expected to participate in weekly conferences as an essential part of their
training. Fellows present cases and discuss topics at the following conferences:
Sleep Clinical Case Conference (September through June). These
conferences will consist of clinical case presentations by fellows, followed
by a focused discussion of relevant literature. Fellows are encouraged to
select cases that they have directly encountered in their outpatient
practices. These may include common presentations of unusual
conditions, unusual presentations of a particular syndrome, a management
dilemma, etc. For guidance on appropriate cases, fellows should contact
Drs. Alex Mason or Charles Cantor one month prior to the conference.
39
Guidelines for Sleep Clinical Case Conference:
1. Try to present an interesting case. Pick cases that are interesting to
you or have interesting twist to them. However, even run of the
mill OSA or obesity-hypoventilation patients have many interesting
comorbities or novel treatments associated with them.
2. Plan your talk for no longer than 45 minutes. By the time people
arrive and you get started (plus people like to ask lots of questions
during conference), the whole hour will pass by. A good rule of
thumb is 1 slide = 1 minute. However, some slides, especially ones
with lots of graphics can take longer so you need to take that into
account.
3. Focus your presentation. Focus your clinical case conference on a
specific topic. For example, if you are presenting a patient with
narcolepsy with cataplexy, you may want to spend your conference
talking about novel medications used for narcolepsy or the value of
the MSLT in diagnosing narcolepsy, etc., rather than reviewing all
of narcolepsy in 45 minutes. People walk out with more if you
focus your discussion.
4. Make simple slides. Limit your slides to at most seven bullet
points. Don’t type a paragraph out. Don’t put tables that are
overly complicated or crammed. Use simple statements and
relatively simple figures. Don’t put five figures from a paper onto 1
slide. Otherwise, you will lose your crowd. Also, color helps keep
people’s attention. However, remember that many people are
red/green color blind so be wary of using these colors too often.
5. Use summary of history and physical during clinical case
conference. You don’t need to include every detail, just the
pertinent ones. Someone will ask you about a particular issue if
they really want to know.
6. Try to use patient’s data such as PSG data, sleep logs, actigraphy,
MSLT, etc. You don’t need to include the whole sleep study but
some interesting epochs. It is a great chance for people to learn and
discuss especially with faculty there.
7. Handouts are very useful. Your handout should include a good
review paper on that topic or at least a copy of your slides.
8. Have fun! You really learn so much doing these conferences and
the things you present will stick with you for a long time. Also,
doing presentations will help polish your public speaking skill.
40
9. THE SHOW MUST GO ON! That is, you can't cancel...you need to
find someone to cover you.
Sleep Journal Club. These conferences are held on the last Thursday of
each month. Please see guidelines below:
JOURNAL CLUB MISSION
To review influential papers in the field of sleep medicine.
To provide a forum for discussion of state of the art ideas.
To provide an opportunity for trainees to practice public speaking.
Papers Chosen
In general, every effort should be made to pick high impact papers.
Preference should be given to papers published in high impact journals
such as Nature, Neuron, Science, Sleep, The blue journal, etc. The
impact factor of journals can be found at
http://www.sciencegateway.org/impact/if03bc.htm and in most cases
an impact factor of >5 is preferred.
Papers should be current, preferably published within the last year. In
occasional cases, older literature can be presented if, for example, it
represents the current state of the art of a particular field.
Papers chosen by fellows should be approved no less than 2 weeks in
advance by a faculty mentor (see below)
Only primary articles will be presented. No Review or opinion articles.
Mentorship of Fellows
A fellow will be responsible for choosing a faculty mentor to
Approve the paper for journal club
To help in journal club preparation
To come to the presentation and help generate discussion.
For guidance on appropriate articles and/or choice of faculty mentor,
fellows should contact Grace Pien or David Raizen one month prior to
the conference.
Presentation Format
Because of the wide spectrum of expertise in the Penn sleep
community, presentations should include a detailed background and
rationale for the paper.
Though the format should be informal to encourage discussion,
PowerPoint presentations are preferred, in particular for trainees.
41
PSG SCORING AND INTERPRETATION
ADULT & PEDIATRIC SLEEP TRACK
Fellows need to learn how to perform patient set-ups, and how to score and interpret
the various sleep evaluations. They should be familiar with the PSG
amplifiers/equipment used to collect and record the data. PSG practical sessions to
review these concepts will be held every Thursday afternoon at 3624 Market Street
and will run for 8 weeks beginning in July.
Subsequent to these Thursday afternoon sessions, scoring, review and interpretation
of clinical studies including overnight PSGs, CPAP/BIPAP titrations, MSLTs/MWTs
and actigraphy performed at HUP, Sheraton, Phoenixville and Doylestown will take
place in a group setting under the direction of a faculty member.
Skills specific to interpretation of pediatric sleep studies have been incorporated into
the summer PSG series. Real time PSG review and interpretation of pediatric clinical
studies will occur in formalized settings at CHOP under the direction of a faculty
member.
Rotations at the PVAMC will incorporate PSG interpretation, both laboratory and
home based.
42
SUPERVISION POLICIES AND PROCEDURES AT ALL CLINICAL SITES
All Fellow notes must be co-signed by an attending. ALL FELLOW NOTES MUST
CONTAIN EVIDENCE OF ATTENDING SUPERVISION. THIS IS A REQUIREMENT.
Attendings must write an addendum or separate note on all initial visits and inpatient and
outpatient consults
EVALUATION METHODS
A competency-based evaluation matrix is available at the end of the curriculum. The evaluation
methods utilized during the various rotations include:
 Web enabled competency-based evaluation forms that are completed by faculty at the
end of each rotation
 360° evaluations completed at least semi-annually by clinical support staff, nursing and
sleep laboratory technical staff
 Mini-CEXs are completed at least four times during the fellowship
 Review of PQIPs are evaluated by faculty preceptors
 Review of QA scoring are evaluated by faculty preceptors
 Procedure logs/Portfolios
 ABIM sleep board summative exam results
Each fellow will receive a mid-year review with an evaluative summary of evaluations thus far by
the Program Director. An exit interview at the end of the clinical year will comprise of a more
comprehensive evaluative summary based on a review of the various aspects of the evaluation
matrix by the Program Director.
43
EVALUATION TOOLS
SAM_E (Self-Assessment Mid-Rotation Evaluation) Tool: Fellows must complete one
SAM_E in each half of the year, for a total of two for the fellowship.
Mini-CEX: Fellows must complete 3 Mini-CEX in each block, for a total of at least 6
for the year.
PQIP/Chart Audit: 5 charts should be audited after November of the academic year.
These will be reviewed and discussed at the mid-year evaluation. An action plan for
improvement will be developed. A subsequent audit of 5 additional charts (such that
10 total chart audits will be performed over the course of the year) will occur prior to
the end of the academic year.
QA Scoring: Fellows will participate in two QA scoring assessments along with
sleep technicians. Direct feedback about personal performance and how it relates to
the group will be given by the faculty supervisor for this initiative.
44
SICK DAYS/VACATION POLICIES
Fellows are excused from their continuity clinic(s) and VA clinic on holidays and
during the week of the APSS annual meeting. Fellows are also excused from their
elective clinics when the attending is on vacation or has cancelled his/her clinic.
Fellows have 4 weeks of vacation time during their clinical year.
Fellows must notify the Fellowship Director and Program Coordinator, in writing, of
dates when they plan to take vacation or administrative leave. These requests should
be submitted at least one month in advance. In addition, the
scheduling/administrative staff of the participating clinic should be notified IN
WRITING.
If a fellow is absent from clinic for administrative leave or vacation, it is the fellow’s
responsibility to notify the clinical staff and the supervising physician. If it is less
than 6weeks from the date of the scheduled clinic, it is the fellow’s responsibility to
find coverage for those hours and those patients. Patients are scheduled for these
clinics with the understanding that a fellow will be attending these clinics; the
Fellowship Program promotes good clinical practice, which includes keeping
appointments and avoiding last-minute cancellations.
If a fellow is unable to attend a continuity clinic due to a sudden illness that does not
allow arranging for a substitute, he/she should notify both the clinic attending and
the Program Coordinator at his/her earliest convenience. These patients should then
be rescheduled for an alternate time slot whenever possible. PLEASE NOTE THAT
ONLY TWO SUCH EMERGENCIES WILL BE ALLOWED. SUBSEQUENT
INFRACTIONS WILL RESULT IN AN EXTENSION OF TRAINING TO FULFILL
CLINICAL COMMITMENTS.
45
RESEARCH
While there is no formal research requirement during the ACGME clinical year, sleep
fellows are encouraged to participate in scholarly activities which are ongoing in the
Division. This may include oral or poster presentations at local and national
meetings, community outreach/education and/or participation in various forms of
patient-oriented research which is ongoing in the Division of Sleep Medicine and the
Center for Sleep and Respiratory Neurobiology.
Fellows can start to meet with Researchers Investigators 6-8 months into their clinical
year to determine which research program they might like to participate in after their
clinical fellowship.
46
Important Forms





Outpatient Clinic Reduction or Cancellation Request Form
Mini-CEX Form (Assessment Tool)
SAM_E Tool (Assessment Tool)
Departmental Phone Lists
Chart Audit (Assessment Tool)
47
OUTPATIENT CLINIC CANCELLATION OR
REDUCTION REQUEST FORM
REQUEST MUST BE RECEIVED THIRTY DAYS PRIOR TO EFFECTIVE DATE
Process for Requesting Cancellation or Reduction:
1. Sleep Fellow must first get approval from the Fellowship Director (Ilene Rosen, MD).
2. Once request has been approved, Sleep Fellow provides Practice Manager (Samantha
Cartagena), Patient Service Representative (Tiffany Brown), their Primary Attending
Physician, and the Fellowship Coordinator (Kim Battillo) this form for date of clinic
cancellation or reduction.
REQUEST MUST BE RECEIVED THIRTY DAYS PRIOR TO EFFECTIVE DATE
Today’s Date: ____________
Effective Date of Change: _______________
Name of Clinic: _________________________________________________________
Name of Provider: _______________________________________________________
Type of Change Requested:
Cancellation
Reduction
Justification for Change: _______________________________________________
______________________________________________________________________
______________________________________________________________________
“I certify that I have reviewed the IDX schedule and that the date for rescheduling of
each patient is appropriate based on the condition of the individual patient.”
__________________________________________
Sleep Fellow’s Signature
Approve/Disapprove: ________________________________________________________________
Program Director
Date
48
UNIVERSITY OF
PENNSYLVANIA
HEALTH SYSTEM
Division of Sleep Medicine
Sleep Fellowship Program
MINI-CEX FORM
Evaluator:
_______________________________
Fellow:
_______________________________
Patient Problem/Dx:
Date: __________________
______________________________________________________
Settings:
__ Ambulatory __ Inpatient __ ED __ Other
Patient:
Age: ____
Sex:
____
__ New __ Follow-up
Complexity: __ Low __ Moderate __ High
Focus:
__ Data Gathering __ Diagnosis __ Therapy __ Counseling
1.
Medical Interviewing Skills
Facilitates patient’s telling of story;
Effective use of questions and
Directions to obtain accurate,
adequate information needed;
responds appropriately to affect,
non-verbal cues.
Unsatisfactory Satisfactory Superior
N/A
1 2 3
4 5 6
7 8 9
2.
Physical Examination Skills
Follows an efficient, logical sequence;
Appropriately selective balance of
screening, diagnostic steps for problem;
alerts patient of next moves, attends to
patient’s comfort, modesty.
Unsatisfactory Satisfactory Superior
N/A
1 2 3
4 5 6
7 8 9
3.
Counseling Skills
Explains rationale for test and treatment,
obtains patient’s consent, educates/
counsels regarding management.
Unsatisfactory Satisfactory Superior
N/A
1 2 3
4 5 6
7 8 9
49
4.
Clinical Judgement
Selectively orders or performs diagnostic
studies appropriate to patient’s perspective
with medical facts, costs, risks, benefits;
informs patient of appropriate diagnostic
possibilities.
Unsatisfactory Satisfactory Superior
N/A
1 2 3
4 5 6
7 8 9
5.
Humanistic Qualities/Professionalism
Demonstrates respect, compassion,
empathy, establishes trust; attends to
patient’s needs for comfort, modesty,
confidentiality, information,
encouragement.
Unsatisfactory Satisfactory Superior
N/A
1 2 3
4 5 6
7 8 9
6.
Overall Clinical Competence
Judgement, synthesis, caring, analysis,
effectiveness, efficiency.
N/A
Unsatisfactory Satisfactory Superior
1 2 3
4 5 6
7 8 9
Total time observing: _______ minutes
Total time providing feedback:
_______ minutes
Evaluator Satisfaction with Mini-CEX
Low          High
Fellow Satisfaction with Mini-CEX
Low          High
Please forward completed form to Kim Battillo.
50
Self-Assessment Mid-Rotation Evaluation (SAM_E) Tool
(For discussion with the preceptor evaluating the fellow.)
Specific Rotation Competencies
(Learning expectations for rotation.)
Resident
Rating.*
(How I feel I
am doing.)
Attending
Rating.*
(Preceptor rates
how I’m doing.)
Ways to keep improving. (Fellow and preceptor brainstorm
ways to keep improving in given area. Fellow progress to be
reviewed during final evaluation with preceptor.)
1. Perform an adequate medical history and
physical exam on patients in outpatient sleep
clinic
2. Interpret polysomnograms and other
diagnostic sleep evaluation
3. Demonstrate knowledge about established
and evolving biomedical, clinical, and cognate
sciences for OSA
4. Demonstrate knowledge about established
and evolving biomedical, clinical, and cognate
sciences for narcolepsy
5. Application of medical knowledge to patient
care for OSA
6. Application of medical knowledge to patient
care for narcolepsy
7. Communication and interaction with other
health care providers to get CPAP ordered
8. Communication and interaction with patients
and their families
9. Sensitivity to patients of diverse backgrounds
10. Carrying out professional responsibilities
and adherence to ethical principles
11. Knowledge of practice and delivery systems
for treatment of OSA
12. Practice cost effective care
13. Use evidence from scientific studies
14. Facilitate learning of others
*Score 1-3, 1=needs improvement; 2=appropriate for level of training; 3=competent at the level expected of graduating fellow.
51
CENTER FOR SLEEP AND RESPIRATORY NEUROBIOLOGY
And DIVISION OF SLEEP MEDICINE PHONE LIST
NAME
(Includes faculty, staff and postdoctoral fellows)
LOCATION
PHONE NUMBER
(Modified: June, 2007)
EMAIL
ACCARDO, Jennifer, M.D.
3624 Market, Ste 205
590-9176
accardo@email.chop.edu
AHMED, Murtuza, M.D.
AL-SHEHABI (McGee), Erica
ANASTASI, Matthew, RPSGT
ANTONIOU, Maria, M.D.
3624 Market, Ste 205
3615 Chestnut, #236
11 West Gates
3624 Market, Ste 201
615-4199
615-0141
615-1630
615-4847
murtuza.ahmed@uphs
ericamcg@mail.med
matthew.anastasi@uphs
maria.antoniou@uphs
ASHMORE, Lesley, Ph.D.
AYENE, Anou
BARRETT, Daniel C.
BATTILLO, Kimberley
BECKETT, Barbara
BEOTHY, Elizabeth
BERGMANN, Andrea, R.N.
BLECKMAN, Inna
BRENNICK, Michael, Ph.D.
BROTHERS, Cynthia
BROWN, Tiffany
CALAMARO, Christina, Ph.D.
CANTOR, Charles, M.D.
CATER, Jacqueline, Ph.D.
CHAKRAVORTY, Subhajit, M.D.
CHI, Luqi, M.D.
CROWLEY, Colleen
FELDMAN, Andrew
FENIK, Polina
2130 TRL
971 Maloney
2119 TRL
3624 Market, Ste 205
3624 Market, Ste 205
3624 Market, Ste 205
3624 Market
991 Maloney
VA Med Ctr
972 Maloney
3624 Market, Ste.201
316 NEB
3624 Market, Ste 201
3624 Market, Ste 205
3624 Market, Ste 205
3624 Market, Ste 205
11 Gates
Ralston Penn Ctr
2111 TRL
746-4817
614-0080
746-4801
615-0980
662-3287
615-4112
662-6262
662-3189
823-5800 x6531
614-0082
615-3693
898-0761
615-4838
662-3287
823-5800 x 3405
615-4197
615-1632
573-3429
746-4821
hickman@mail.med
ayene@mail.med
dbarrett@mail.med
kim.battillo@uphs
bbeckett@biomedstat.com
eabeothy@mail.med
georenoa@uphs
bleckman@mail.med
brennick@mail.med
cynthia.brothers@uphs
tiffanyb@uphs
calamaro@nursing
crcantor@pahosp.com
jcater@mail.med
subhajit.chakravorty@uphs
luqi.chi@uphs
colleen.crowley@uphs
afeldma4@mail.med
polina@mail.med
PAGER
590-1000
x14791
314-0475
267-481-3385
(cell; no pts)
961-5267
422-5361
265-0976
403-8452
52
NAME
LOCATION
PHONE NUMBER
FERBER, Megan
FERGUSON, Karimah
FRIEDMAN, Eliot, M.D.
GALANTE, Raymond J.
GOOD, Virginia
GOONERATNE, Nalaka, M.Sc., M.D.
GURUBHAGAVATULA, Indira, MD
HACHADOORIAN, Robert
HUGHES, John
HURLEY, Sharon
JONES-PARKER, Mary, RRT, RPSGT
KIM, Eugene
KUNA, Samuel, M.D.
LIAN, Jie
MACKIEWICZ, Miroslaw, Ph.D.
MAISLIN, Greg, M.S., M.A.
MARIE, Elisabeth
MAYCOCK, Matthew
MONTOYA, Jennifer
NAIDOO, Nirinjini, Ph.D.
NKWUO, J. Emeka, Ph.D.
OTTO, Cynthia, D.V.M., Ph.D.
PACK, Allan I., M.D., Ph.D.
PACK, Frances, R.N.
PALMA, Jonathan
PATEL, Nirav, MBBS
PIEN, Grace, M.D.
PLATT, Alec, M.D.
RAIZEN, David, M.D., Ph.D.
2111 TRL
11 West Gates
3624 Market, Ste 205
2118 TRL
2111 TRL
Ralston Penn Ctr
3624 Market, Ste 205
3624 Market, Ste 205
3624 Market, Ste 205
3624 Market, Ste 205
11 West Gates
3624 Market, Ste 205
VA Med Ctr
2131 TRL
2124 TRL
3624 Market, Ste 205
309 Ralston Penn
2131 TRL
TRL
2116 TRL
3624 Market, Ste 205
2117 TRL
2120 TRL
812 East Gates
11 West Gates
3624 Market, Ste 205
3624 Market, Ste 205
3624 Market, Ste 205
2122 TRL
746-4821
615-1630
615-0954
746-4808
746-4823
349-5938
662-3301
662-3287
662-3287
615-1633
349-8980
823-4400
746-4824
746-4805
610/645-5708
746-3098
746-4824
746-4802
746-4811
615-4867
746-4810
746-4806
614-1807
615-1630
615-4198
614-0081
615-4868
746-4809
EMAIL
karimah.ferguson@uphs
eliot.friedman@uphs
galante@mail.med
vp@mail.med
ngoonera@mail.med
gurubhag@mail.med
hach@biomedstat.com
hurley@mail.med
mfjones@mail.med
keugene@sas
skuna@mail.med
jielian@mail.med
mirekmm@mail.med
gmaislin@biomedstat.com
felisa@mail.med
maycock@mail.med
jennifer.montoya@uphs
naidoo@mail.med
jnkwuo@mail.med
cmotto@vet
pack@mail.med
fmpack@mail.med
palmaj@mail.med
nirav.patel@uphs
gpien@mail.med
alec.platt@uphs
raizen@mail.med
PAGER
312-0162
812-2411
961-1072
581-8041
812-4103
265-2741
314-0981
308-4649
838-5093
53
NAME
ROBINSON, Mary
RODWAY, George, Ph.D.
ROGERS, Ann E., Ph.D., R.N.
ROMER, Micah
ROSEN, Ilene, M.D.
SANFILIPP-COHN, Benjamin
SCHARF, Matthew
SCHUTTE-RODIN, Sharon, M.D.
SCHWAB, Richard, M.D.
STACHE, Stephen
STALEY, Beth, RPSGT
VEASEY, Sigrid, M.D.
WEAVER, Terri, Ph.D., R.N.
WIELAND, William
WU, Mark, M.D., Ph.D.
ZHAN, Guan Xia, M.D.
ZHANG, Kathy
ZHANG, Lin, M.D.
ZHU, Yan
ZIMMERMAN, John, Ph.D.
ROOM NO.
2111 TRL
224 NEB
429L NEB
2111 TRL
3624 Market, Ste 205
2111 TRL
2130 TRL
3624 Market, Ste. 201
3624 Market, Ste 205
11 West Gates
11 West Gates
2115 TRL
406 NEB
11 West Gates
3624 Market, Ste 205
2111 TRL
VA Med Ctr
2111 TRL
2130 TRL
2125 TRL
PHONE NUMBER
746-4819
898-0761
573-7512
746-4821
615-4719
746-4821
746-4816
615-4841
349-5477
615-1630
615-1634
746-4812
898-2992
615-1630
615-4199
746-4821
823-5800
746-4821
746-4818
746-4804
EMAIL
marobins@vet
rodway@nursing
aerogers@nursing
mromer@mail.med
irosen@mail.med
mscharf@mail.med.
sharon.rodin@uphs
rschwab@mail.med
stephen.stache@uphs
beth.staley@uphs
veasey@mail.med
tew@nursing
william.wieland@uphs
marknwu@mail.med
guanz@mail.med
kzhang3@mail.med
zhanglin@mail.med
zhuy@mail.med
johnez@mail.med
PAGER
812-3457
308-1268
980-1934
401-8333
577-1130
All “uphs” and “mail.med” email addresses end with “.upenn.edu”
Sleep Lab, Market Street, Suite 201
Sleep Outpatient Practice – Market Street, Ste 201
Sleep Outpatient Practice – Radnor
Center for Sleep/Market Street, Ste 205
Center for Sleep/TRL
Clinical Research Center for Sleep - HUP
PHONE
FAX
662-7772
615-3669
610-902-5600
662-3305
746-4813
615-1630
349-8038
615-3671
610-902-5609
662-7749
746-4814
615-1635
54
CHOP SLEEP MEDICINE PHONE LIST
Name
Position
Email
Phone
Pager
Beck, Suzanne E., M.D.
Attending
becksu@email.chop.edu
(215) 590-6918
18788
Brooks, Lee J., M.D.
Attending
brooksl@email.chop.edu
(856) 435-1300
(x. 31495)
(215) 819-6516
Brown, Larry M.D.
Attending
brownla@email.chop.edu
(267) 426-5842
14829
Secretary, Sleep Center
cornaglia@email.chop.edu
267.426.5842
(215) 590-3500 (fax)
DiFeo, Natalie
Nurse Practitioner
difeo@email.chop.edu
(267) 426-5842
Elliott, Joanne
Sleep Lab Manger
elliott@email.chop.edu
(215) 590-3703
Attending
Director, Sleep Center
marcus@email.chop.edu
Cornaglia, Mary Anne
Marcus, Carole L., M.B.B.Ch.
masont@email.chop.edu
(215) 590-4406
(215) 905-0325
(215) 590-0810
(215) 980-0495
Mason, Alex, M.D., Ph.D.
Attending
Lisa Meltzer, Ph.D.
Attending
meltzerl@email.chop.edu
(267) 426-5842
Mindell, Jodi , Ph.D.
Associate Director,
Sleep Center
mindell@email.chop.edu
(267) 426-5842
Sleep Lab Technician Area
Tate, Mary
19337
15411
(215) 590-9176
Sleep Lab
Office Coordinator
tate@email.chop.edu
(215) 590-3703
(215) 590-2632 (fax)
VA SLEEP MEDICINE PHONE LIST
Name
Amy Sawyer
Khena Hin
Les Gellis
Raj Gupta
Jackie Ferguson
Sam Kuna
VA Telephone
2574
4299
3450
pending
4435 or X2771
4400
Email
asawyer@nursing.upenn.edu
sakhena.hin@va.gov
leslie.gellis2@va.gov
s0538655@monmouth.edu
jacqueline.ferguson@med.va.gov
skuna@mail.med.upenn.edu
55
56