Adult Sleep Medicine Clinic
Daily half-day adult sleep medicine clinics provide the bulk of the clinical experience for fellows in the program. In these core clinics fellows perform the initial and follow up evaluations of patients assigned to them with a wide array of sleep disorders including obstructive sleep apnea, narcolepsy, insomnia, parasomnias and sleep related breathing disorders in patients with co morbid COPD and congestive heart failure. The Fellow will attend these daily clinics when not on an elective rotation. A continuity clinic will continue on all elective months as well. The fellow will learn to assess, diagnose, and treat patients with sleep disturbances, under the direct supervision of board-certified sleep medicine physicians from the Division of Pulmonary, Critical Care and Sleep Medicine. There will also be experience with pulmonary patients and the interpretation of arterial blood gas and pulmonary function testing. Fellows will write orders for all sleep specific and non-specific evaluation and management plans. They will also write follow-up orders for treatment, such as treatment with positive airway pressure, appropriate medications and behavioral therapy.
Sleep Laboratory Rotation
Fellows will work with attending physicians in the sleep laboratory when the fellow is not attending clinic. Attending physicians will instruct fellows in the interpretation of the polysomnogram. Registered sleep technologists will function to teach the fellow how to properly monitor a patient during a sleep study, including proper calibration and acquisition of data signals, perform CPAP/BIPAP titrations and set up home sleep studies.
There is no “in-house” or night call for sleep fellows. Fellows are expected to observe the hook-up and performance of sleep studies in the sleep laboratory 3 – 4 times throughout the year. They are given the next day off following these nights.
Adult Neurology/EEG Elective
The fellow will spend 2 months rotating through Adult Neurology and EEG., under the supervision of board-certified attending physicians. The fellow will attend Tuesday AM clinic with Dr. Bell, and Friday AM clinic with Dr. Motamedi. Afternoons will be spent in the electrophysiology laboratory to familiarize fellows with the principles of electrophysiological recording. Fellows will learn proper lead placement for EEG monitoring, and to read and interpret EEG's and video-EEG monitoring. The fellow will continue to attend their continuity clinics and be required to interpret polysomnograms when not in clinic. During these rotations, one on one didactic sessions on various sleep topics as they relate to Neurology will occur once a week. These will be given by the attending physicians, and are informal.
Pediatric Sleep Medicine/Pediatric Neurology
The sleep fellow will spend 2 months rotating in Pediatric Neurology and Pediatric Sleep Medicine with attendings who are board-certified in Sleep Medicine. During that time, he/she will spend Monday mornings in clinic with Dr. Santos, and Thursday mornings in clinic with Dr. Bautista. When not in these clinics, the fellow will continue to attend their continuity clinic, and interpret polysomnograms. Emphasis will be placed on assessment and treatment of pediatric sleep apnea, sleep disturbance in patients with pulmonary disorders, pediatric narcolepsy and behavioral sleep disorders in children.
ENT/Oral Maxillofacial Surgery (OMFS)/Dental Medicine
The fellow will spend two months rotating through ENT/OMFS/Dental clinics. One morning or afternoon each week during those months the fellow will attend OMFS clinic with Dr. Stephen Baker) and Dental Medicine with Dr. Ramin Razavi) The fellow will attend a half day ENT clinic with Dr. Suzette Mikula on Tuesdays, and spend time in the OR either on Mondays or Wednesdays when there are sleep related surgeries. Emphasis will be on the appropriate treatment of patients with obstructive sleep apnea. The fellow will become familiar with both the various surgical interventions and dental devices.
Psychiatry/Cognitive Behavioral Therapy
The fellow will rotate through the Department of Psychiatry for one month, and have clinics one day per week, i.e. either one full day, or 2 mornings per week. There will be at least one session during the month that will cover cognitive behavioral therapy with Meredith Cary, PsyD. During the month, there will be some weekly informal didactic sessions, one on one with the supervising attendings, on sleep related topics, such as interpreting psychological and psychometric testing, mental status testing, anxiety/depression as related to sleep, and effects/use of psychiatric drugs on/for sleep.