Exposure to Sleep Medicine Education Is Low in Parent ACGME Training Programs

Shannon S. Sullivan, MD

Using the peer-reviewed Sleep Education Survey, researchers recently found that there is limited and/or absent sleep medicine training in most parent specialty programs and suggest a consequent narrowing of the pipeline of sleep medicine providers and researchers.

To understand the sleep medicine educational exposure among parent specialties of sleep medicine fellowships, lead author Shannon S. Sullivan, MD, clinical professor of pediatrics, Stanford University, and colleagues contacted 1228 programs of family medicine, otolaryngology, psychiatry, neurology, pediatrics, and pulmonary and critical care medicine (PCCM), of which 479 (39%) responded.

Neurology and PCCM programs reported the highest percentages of association with an Accreditation Council of Graduate Medical Education (ACGME) sleep-medicine fellowship program within their institutions, followed by otolaryngology, pediatrics, family medicine, and psychiatry (52.4%, 46.3%, 42.0%, 43.7%, 33.3%, and 33.0%, respectively).

PCCM reported the highest number of programs (75.4%) that required sleep medicine rotation, while requirement varied widely among all specialties (0% to 73.8%). Sleep medicine electives were made available to trainees across all specialties, ranging from 18.2% in otolaryngology to greater than 90% in neurology. Notably, 85.7% and 90.8% of PCCM and neurology offered sleep medicine rotation as an option for house staff, the highest among any program.

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"In addition to great variability in exposure and content between specialties, exposure to sleep medicine is generally quite limited across the board. This could arguably influence the low percentages of trainees reported to pursuing further training in sleep medicine specialty,” Sullivan et al wrote.

At least some programs in all specialties reported affiliation with a sleep center (12.3% to 87.9%) or a sleep laboratory (13.7% to 90.8%) within their own institutions. Sullivan and colleagues noted, however, that this affiliation does not translate to house staff rotation through the center or laboratory.

PCCM and neurology reported having the highest number of faculty specializing in sleep medicine, most of which had at least 2 sleep medicine faculty members. On the other hand, more than half of family medicine, psychiatry, and otolaryngology programs reported having no faculty with sleep medicine expertise.

The types of sleep medicine education varied, with a mixture of didactic lectures, sleep center and/or sleep laboratory exposure, and care reports as the methods used. Didactic lectures were the most commonly used teaching format, with a mean duration of lectures of 4.75 hours/year for all respondent programs. Notably, PCCM and neurology reported the highest hours at 7.4 and 5.8 hours/year, respectively, and pediatrics with the lowest at 3 hours/year.

A total of 236 trainees across the 479 programs that responded entered sleep medicine fellowships over the 5 years surveyed, with the highest being PCCM, reporting 114 trainees (from 41 programs), followed by neurology with 41 trainees (from 33 programs).

The investigators also questioned program directors on whether house staff was pursuing sleep medicine-related research or grants. Overall, the responses varied, but a minority of programs had at least 1 trainee who participated in a sleep-focused scholarly project at a professional meeting within the 5 years surveyed.

"More work is needed to understand how exposure and content in early training years may directly or indirectly affect specialty choice and career trajectories, but it is possible that this may have important implications for the pipeline of the future sleep medicine clinical and research workforce,” the study authors wrote.

REFERENCE

Sullivan SS, Cao MT. Sleep medicine exposure offered by United States residency training programs. J Clin Sleep Med. Published online April 1, 2021. doi: 10.5664/jcsm.9062