Rotation Summary

Clinical Year
Rotation Experiences

OTO=Adult Otolaryngology Sleep Disorders Clinic
AN=Adult Neurology Sleep Disorders Clinic
PSG=Sleep lab
Pul=Adult Pulmonology Sleep Disorders Clinic
PedPul=Pediatric Pulmonary Sleep Disorders Clinic

Rotation 1: AN / Pul / OTO / IP / PSG / RES
Institution / site: FH
Duration: 2 months

Rotation 2: PedPul / OTO / PSG / IP / RES
Institution / site: CHW
Duration: 2 months

Rotation 3: Pul / IP / RES
Institution / site: VAMC
Duration: 2 months

Rotation 4: AN / Pul / OTO / IP / PSG / RES
Institution / site: FH
Duration: 2 months

Rotation 5: PedPul / IP / OTO / PSG / RES
Institution / site: CHW
Duration: 2 months

Rotation 6: Pul / IP / RES
Institution / site: VAMC
Duration: 2 months

Throughout the year, the fellows’ work with faculty in specialty based sleep medicine clinic in 4-7 half day sessions per rotation depending on the site.

At the FH Site (Site #1) rotation, the fellow works with board certified sleep specialists in their department clinics including Otolaryngology, pulmonology and adult neurology sleep clinics. Together this provides 7 half day sessions of sleep clinics. These clinics are primarily hospital based but there is a half-day a week that the fellow attends clinic at one of the community based clinics. This provides the fellow with a depth of patients from those with complex co-morbidities who are being referred to the tertiary center at FH to those that one would encounter in a community setting. The fellow is responsible for reviewing sleep studies and other sleep related testing under faculty mentorship for 3 half days.

At the CHW Site (Site #2) rotation, the fellow works with board certified sleep specialists in the pediatric pulmonology clinics. This is again a tertiary referral center and the fellows are exposed to a complicated patient population. This site also has community based clinics and here again the fellow attends clinic one-half day a week in this setting allowing them to see a more typical community pediatric population in addition to those see at the main hospital based clinic. Together, the fellow attends clinic 6 half-day sessions each week. They also read sleep studies with the faculty 4 half-days a week. Consultations for inpatients are handled as part of the day to day operation of the practice.

At the VAMC Site (Site #3) rotation, the fellow works with board certified sleep specialists in adult pulmonology. In addition to sleep clinics held 4 half-days a week, CPAP desensitization and cognitive behavioral clinics are each held twice a month. The fellows also participate in inpatient consultations as they arise throughout the week on a day by day basis. The ambulatory practice at the VAMC is unique in providing the fellows with exposure to providing care in a limited resource setting through their work triaging consultations. This requires a thorough chart review to determine the first step in the patient’s care (sleep study, home study, physician clinic visit, CPAP clinic, etc.). The fellows also review sleep studies (portable monitoring studies) and downloads of the CPAP and BiPAP equipment during their non-clinic time. Telemedicine is an occasional opportunity at the VAMC site that the fellow will participate in under the direction of faculty supervisor.

The Friday afternoon block across all three rotations is used by the fellows and faculty for education and practice development as well as research. Depending on the week during the month, there are 1-3 hours of activities that the fellow participates in with one or more faculty present. The fellow is assigned a continuity clinic ½ day/week for 6 to 12 month blocks at one of the three sites.

The fellows are required to do a competency based self-review of their portfolio with the goal of assessing for any gaps or areas requiring strengthening in their training that will require improvements prior to the end of the year. The fellow uses the goals and objectives as a guide for this review and also is given a copy of the self review report at the start of the year. At the mid-year review and again at the end of the year review with the program director, the fellow completes this self-review report. This self directed activity requires the fellow to reflect on their current progress through review of their portfolio (research and scholarly activities and patient and procedure logs) as well as the global evaluations from the faculty, multisource evaluations, patient surveys and grand rounds speaker feedback provided by the program director at these meetings in context that allows them to identify those aspects of their training that are in need of further development. This self-review is completed by the fellow and discussed with the program director who provides additional recommendations regarding improvement methods and implementation of changes to ensure the goals are met by the end of the fellow’s training. Once this is completed it placed in the fellow’s personnel folder.

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Page Updated 12/02/2015