Program Address:
Beth Israel Deaconess Medical Center
330 Brookline Avenue
KS-B23 (Pulmonary Office)
Boston, MA 02215
Phone: (617) 667-5864
Fax: (617) 754-8619
Program E-mail: jchang4@bidmc.harvard.edu
Program Director: Jacqueline Chang, M.D.
Associate Program Director: Robert Joseph Thomas, M.D.
Program Contact:
Andrea Allen
Divisions of Pulmonary, Critical Care and Sleep Medicine
Beth Israel Deaconess Medical Center
330 Brookline Avenue
KS-B23
Boston, Massachusetts 02215
Phone: (617)667-4195
Fax: (617) 754-8619
aallen10@bidmc.harvard.edu
Program History
Since 1985, the Sleep Medicine Training Program at Beth Israel Deaconess Medical Center (BIDMC) has provided superb, multidisciplinary training in all aspects of Sleep Medicine. The fellowship is accredited by the Accreditation Council for Graduate Medical Education (ACGME), and our Sleep Disorders Center is accredited by the American Academy of Sleep Medicine. Our program combines resources from Neurology and Pulmonary Medicine at BIDMC, Boston Children’s Hospital (BCH), and Massachusetts General Hospital (MGH), and is administered through the Department of Medicine at BIDMC. We usually train 4 fellows each year, but we can accommodate more when funding permits. Over 100 fellows have completed training in the BIDMC program and gone on to successful careers in academic medicine and clinical practice.
Program Vision
The program targets comprehensive training for the whole spectrum (across age and co-morbid diseases) of sleep disorders. There is substantial emphasis on critical thinking and introspection, in preparation for a rapidly changing sleep and health care environment. We aim to train future leaders of the field.
Training Tracks
We offer an adult sleep medicine track and a pediatric sleep medicine track. Both tracks are run through the Department of Medicine at BIDMC but are listed as separate tracks in the NRMP match system.
Adult Sleep Medicine Track
Fellows on the adult track spend about 75% of their time caring for adult sleep medicine patients and interpreting sleep studies at BIDMC and MGH. The remaining 25% time is spent caring for children and reading sleep studies at BCH. In a typical year, 3 out of 4 fellows will be on the adult track.
Pediatric Sleep Medicine Track
Fellows on the pediatric track spend the majority of their time, about 60-70% in clinical care of children at BCH, and the remaining 30-40% of time in caring for adults at BIDMC. Exposure to sleep studies is similarly shifted to the pediatric population. Typically 1 fellow each year is in the pediatric track. More information can be found about the Boston Children's Hospital Pediatric Sleep Disorders Center here.
Program Duration
The sleep medicine clinical fellowship lasts 1 year. Additional options are available for individuals interested in additional training in clinical or basic sleep research.
Prerequisite Training / Selection Criteria
Applicants must be board eligible or certified in Internal Medicine, Neurology, Family Medicine, ENT, Anesthesiology, or Psychiatry through an ACGME accredited program. Those who have additional boards are also eligible (e.g., Pulmonary and Critical Care Medicine, Clinical Neurophysiology). Fluency in English is required, and the applicant must be eligible for a Massachusetts state license. Candidates who have shown prior academic interest and potential are preferred, including prior sleep related research. Selection is not based on the primary certification of the prospective candidate – our program trains individuals from a variety of backgrounds.
The program uses the National Residency Matching Program, please refer to the NRMP match calendar for specifics on ranking deadlines and match dates. Applications are accepted only through the Electronic Residency Application Service (ERAS).
Goals and Objectives for Training
- Training in the full spectrum of adult and pediatric sleep medicine.
- Training in sleep laboratory technology (including hand-on management of complex patients), sufficient to run an independent sleep laboratory and technician training program.
- Training in sleep medicine skills needed to treat complicated adult and pediatric sleep apnea syndromes, hypersomnia conditions, parasomnias, restless legs syndrome/periodic limb movements, insomnia, circadian rhythm disorders, and other sleep disorders.
- Training in sleep research methodology adequate to prepare a poster, review article, or original research paper.
- Exposure to, and use of, cutting edge analysis methods for sleep signals
- The opportunity to work in a highly integrated care environment, as sleep medicine is truly multi-disciplinary.
- Continued development of individual candidates as physicians and healers.
Program Resources
Teaching Staff
The sleep fellowship program benefits from faculty across a wide variety of backgrounds and training, including internal medicine, neurology, pulmonary, pediatric neurology, pediatric pulmonary, and psychiatry.
Faculty at Beth Israel Deaconess Medical Center include: Robert J. Thomas, MD, Thomas Scammell, MD, Ina Djonlagic, MD, Anjali Ahn, MD, Jacqueline Chang, MD, Monica Makhija MD and Layola Lunghar MD.
Faculty at Boston Children’s Hospital include: Kiran Maski, MD, PhD, Umakanth Khatwa MD, Seyni Gueye Ndiaye MD, Jonathan Lipton, MD, PhD, Eric Zhou, MD, Robert Stowe, MD, and Po-Yang Tsou MD
Faculty at MGH include: Aleks Videnovic, MD and John Winkelman, MD
Additional supporting faculty includes Vicki Cohn, DDS (Dental Sleep Medicine), Christopher Brook, MD (ENT) and Lisa Strauss, PhD (Psychology)
Facilities
Training sites are:
Beth Israel Deaconess Medical Center
Massachusetts General Hospital
Educational Program – Basic Curriculum
Clinical component
Fellows will be exposed to the full spectrum of adult and pediatric sleep disorders. In addition to continuity sleep clinics, they will work in sleep subspecialty clinics focusing on circadian medicine and/or assisted ventilation. Fellows will rotate through the inpatient consult service at BIDMC. Additionally, there are elective rotations including maxillofacial surgery, neuropsychiatry, ENT, dental sleep medicine, neurostimulation and EEG. Direct instruction is provided for scoring polysomnograms, Multiple Sleep Latency and Maintenance of Wakefulness Tests, Actigraphy, home sleep testing, use of various wearable devices, sleep quality tracking, salivary melatonin/cortisol assays and use of sleep logs. Fellows read an average of 250+ sleep studies, each reviewed with a Board Certified sleep physician, and integrate laboratory with clinical data for optimal patient management.
Sleep lab requirements
Fellows must demonstrate proficiency in: i) Scoring of polysomnograms, MSLT, and MWT; ii) Set-up of polysomnographic recordings; iii) Set-up and interpretation of actigraphy; iv) management of complex breathing disorders in the sleep laboratory.
Didactic components
The program includes an extensive, high-quality didactic component. The training year begins with an immersive bootcamp series in July, to get fellows readily versed with basics of sleep medicine. Subsequently, a multi-disciplinary sleep conference is held weekly at BIDMC, including sleep journal club, case conferences, core lectures and emerging sleep topics. Educational lectures are shared across the greater Boston / New England network (MGB, Yale, Tufts, Boston Medical, Brown) on a bimonthly basis. There is an additional monthly pediatric sleep conference held at BCH. Harvard Clinical Sleep Grand Rounds are held quarterly and offers an opportunity to engage with nationally recognized figures in sleep medicine. Fellows interpret polysomnograms with attendings 2-3 times each week. In addition, fellows spend most of the night at the sleep lab with an attending approximately once a month, either on-site or remotely, to learn hands on management of complex breathing disorders.
Participant’s supervisory and patient care responsibilities
Fellows are responsible for the comprehensive management of their patients, under the supervision of an Attending Physician. This includes clinical evaluation and follow-up, arranging sleep laboratory investigations, and interpretation and reporting of sleep studies.
Evaluation
A detailed evaluation program is modeled around the “General Competencies in Sleep Medicine” and Milestones as applied to sleep medicine. Fellows are evaluated every 3 months by their Attending Physicians, and in turn, Fellows provide feedback on the program to improve the training experience. The program is dynamic and responsive to changes in health care and sleep medicine and thus is continuously innovating and evolving. There is continuous feedback and guidance and deep faculty engagement with the goal of maximizing learning in a minimally stressful environment.
Research component
Fellows are expected to prepare a poster, primary research paper, or review article/chapter. These are highly focused topics and efforts, designed to not adversely compete with clinical training. Fellows can engage with faculty at the BIDMC or across the Boston area.
For trainees who wish to establish a long-term career in academic sleep medicine, there are many options available through the more than 100 faculty at Harvard University conducting research on sleep, circadian rhythms, or mechanisms of sleep apnea. This option usually requires a commitment beyond the clinical training year. Fellows interested in research are strongly encouraged to select a research mentor and begin design of their project during the first 3-6 months of their clinical year to leave ample time for obtaining funding and preparing for the research. Research funding sources include the Harvard Research Training Program in Sleep, Circadian and Respiratory Neurobiology, the American Academy of Sleep Medicine, the American Heart Association, and the National Institutes of Health. As sleep medicine is a relatively young field, there are many exciting and unanswered questions to pursue.
Prior fellows have conducted research in:
- Human and animal hypoxia, hemodynamics, vascular effect
- Central and peripheral autonomic regulation and hypoxia
- Restless legs syndrome
- Circadian rhythm disorders, including melatonin/cortisol mapping
- Functional brain imaging of sleep
- Clinical laboratory database analysis
- Signal analysis using large public datasets (Sleep Heart Health Study, CHIME)
- Phenotyping of sleep apnea
- Sleep epidemiology including at the Framingham Heart Study (FHS) and Korean Genome and Epidemiology Study (KoGES)
- Data available at the National Sleep Research Resource https://sleepdata.org/
- Mouse models to understand the causes of sleepiness and cataplexy in narcolepsy
- Neuropathological studies of narcolepsy and traumatic brain injury
- Basic research to define the neural circuitry that regulates sleep and circadian rhythms
- Biomarkers for diagnosis of pediatric narcolepsy