Program Address:

Beth Israel Deaconess Medical Center
330 Brookline Avenue
KS-B23 (Pulmonary Office)
Boston, MA 02215
Phone: (617) 667-5864
Fax: (617) 667-4849
Program E-mail: eheckman@bidmc.harvard.edu

Program Director: Eric Heckman, M.D. 

Associate Program Director: Robert Joseph Thomas, M.D.

Program Contact:

Joanna Pires
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)667-4849
jpires@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 3 fellows each year, but we can accommodate more when funding permits. Over 50 fellows have completed training in our 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.  

Adult and Pediatric Sleep Medicine Tracks

Fellows on the adult track spend about 75% 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. Typically 2 of 3 fellows each year are in the adult track. It is anticipated that the adult and pediatric track will be listed as separate tracks in the NRMP match system for the 2019-2020 application cycle.

Pediatric Sleep Medicine Track

Fellows in the pediatric track spend the majority of their time (about 70%) in clinical care of children at BCH, and 30% of time in caring for adults in BIDMC. Exposure to sleep studies is similarly shifted to the pediatric population. Typically 1 of 3 fellows each year is in the pediatric track. The pediatric track is anticipated to be listed as a separate track in the NRMP match system for the 2019-2020 application cycle. 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.  Many 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). Other requirements include fluency in English, a MA state full license (limited license is not sufficient), and full federal DEA certificate. Licensing and DEA is required to adequately handle the large number of controlled substance prescription in and out of state. The program uses the National Residency Matching Program. 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 with a variety of backgrounds.
 

Goals and Objectives for Training
  • Training in the full spectrum of adult and pediatric sleep medicine.
  • Training in sleep laboratory technology, 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, and other sleep disorders.
  • Training in sleep research methodology adequate to prepare a poster, review article, or original research paper.
  • 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

Dr. Robert Joseph Thomas is key to the education experience at BIDMC, supported by Drs. Thomas Scammell, Jacqueline Chang, Melanie Pogach, Eric Heckman, Ina Djonlagic, Monica Makhija, and  Jean Matheson; all are certified in Sleep Medicine. Training in pediatric sleep medicine is provided by Drs. Judith Owens, Kiran Maski, Umakanth Khatwa, and Eric Zhou. Training at MGH is with Drs. John Winkelman and Aleksandar Videnovic. Additional supporting faculty includes Dr. Edward Lahey (Maxillofacial Surgery), Dr. David Caradonna (ENT), Dr. Vicki Cohn (Dental Sleep Medicine), Dr. Albert Galaburda (Behavioral Neurology, Neuropsychiatry), Dr. Peter Zimetbaum (Cardiology), Dr. Donald Schomer (EEG) and Dr. Lisa Strauss (Psychology).

Facilities
Training sites are: 

  • Beth Israel Deaconess Medical Center
  • Boston Children’s Hospital
  • Massachusetts General Hospital
     
Educational Program – Basic Curriculum

Clinical component
Fellows will be exposed to the full spectrum of adult and pediatric sleep disorders. Sleep medicine relevant outcomes and milestones form the core of the training program. Elective rotations include maxillofacial surgery, neuropsychiatry, ENT, dental sleep medicine, and EEG.  Some of these such as EEG are optional, based on the past training of the Fellow. Direct instruction is provided for scoring polysomnograms, Multiple Sleep Latency and Maintenance of Wakefulness Tests, Actigraphy, home sleep testing, sleep quality tracking, and use of sleep logs. Fellows read an average of 300 + sleep studies, each reviewed with a Board Certified sleep physician, and integrate laboratory with clinical data for optimal patient management.

Research component
Fellows are expected to prepare a poster, primary research paper, or review article/chapter.

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.

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. Fellows interpret polysomnograms with Attendings 2-3 times each week.  A multi-disciplinary sleep conference is held weekly. There is an additional monthly to bi-monthly pediatric sleep conference held at BCH. Sleep journal club, a research meeting, and mini-sleep board review sessions supplement didactics throughout the year. Harvard Clinical Sleep Grand Rounds are held quarterly and offers an opportunity to engage with nationally recognized figures in sleep medicine. In addition, fellows spend most of the night at the sleep lab with an attending to learn management of complex breathing disorders once each month.

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 year(s)

Many options are available for trainees who wish to establish a career in academic sleep medicine as more than 90 faculty at Harvard University conduct research on sleep, circadian rhythms, or mechanisms of sleep apnea. 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 can often be obtained from the Harvard Research Training Program in Sleep, Circadian and Respiratory Neurobiology, the American Academy of Sleep Medicine, the American Heart Association, the NIH, or other sources. 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
  • 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
  • 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