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Vocational Training
Respiratory
and Sleep Medicine (cont...)
SLEEP
MEDICINE
Definition of Specialty
Paediatric sleep medicine has evolved from paediatric respiratory medicine. Paediatric
sleep medicine encompasses congenital and acquired disorders of breathing during,
disorders of daytime somnolence, insomnias, parasomnias, disorders of chronobiology,
and neurological and behavioural disorders affecting sleep. Sleep medicine is
a cohesive blend of: clinical knowledge of sleep disorders; knowledge of the basic
sciences of normal and disordered sleep processes; experience with specialised
diagnostic techniques, tests and procedures employed in clinical assessment; and
expertise in the management of all clinical sleep disorders.
The essential
element of paediatric sleep medicine which distinguishes it from adult sleep medicine,
is the need to understand the normal changes that occur during growth and development.
Core knowledge should include changes in the development in: respiratory control
and respiratory mechanics; neurophysiology, especially with regard to sleep-wake
states; and interactions between the respiratory system and sleep state.
Levels of Training
There
are 2 levels of training in sleep medicine that lead to qualification to practise
sleep medicine:
| Level
1: | Twelve months core training in sleep medicine
for advanced trainees to enable them to have a proportion of clinical practice
in sleep medicine and to report sleep studies (this may include 3 months concurrent
training achieved during the course of a general respiratory core year). | | Level
2: |
Three years training (2 core years plus an approved
complementary year) for advanced trainees to enable them to have clinical practice
predominantly or solely in sleep medicine, and to pursue a full time career
in the speciality of sleep medicine to direct a clinical sleep disorders
service. |
Advanced
Training Program in Sleep Medicine - LEVEL 1
General
Principles- Completion of level 1 advanced training in sleep medicine
qualifies advanced trainees to have a substantial clinical practice in sleep medicine
(e.g. manage sleep apnoea syndromes and more complex sleep-related breathing problems),
and is also required to apply for credentialling for reporting sleep studies (as
required by the Health Insurance Commission).
- Twelve months of training
in clinical sleep medicine is necessary.
- For respiratory medicine trainees
this may be undertaken as an approved complementary year within the 3 years of
advanced training in respiratory medicine, although 3 months of the 12 months
may be undertaken during the 2 years of core training in clinical respiratory
medicine (as the recommended 3 months of training in sleep medicine).
- Advanced
trainees from non respiratory medical disciplines may be eligible to undertake
level 1 training, provided there is a clear demonstration of at least one year
of relevant background advanced training in an appropriate complementary discipline
(e.g. neurology) and that the proposed program involves a substantial component
of respiratory sleep disorders. Where an advanced trainee has no complementary
training, a period of 2 years of core training may be required.
- Training
may be undertaken as post FRACP supervised training in sleep medicine.
- It
may be undertaken in Australia or overseas.
- Successful completion of level
1 training will enable trainees to reach a satisfactory level of competence to
have a proportion of clinical practice in sleep medicine and to report sleep studies.
- No more than 20% of core clinical training towards Level 1 Sleep Medicine
may be spent in research activities.
Core Training
Clinical Sleep Medicine
Quality
training should include a broad exposure to all common sleep disorders including
sleep breathing disorders, disorders of daytime somnolence, and other non respiratory
sleep disorders. Trainees will be expected to have a detailed practical knowledge
of:- sleep physiology, including development, mechanics and control;
- the
instrumentation, recording, scoring techniques and interpretation of polysomnographic
studies.
They will need to obtain detailed experience and skill in the
management of sleep breathing disorders (including CPAP and non invasive ventilation).
They should also be familiar with the diagnosis and management of non respiratory
sleep disorders.
It is desirable that training should be undertaken in
a multi-disciplinary sleep disorders service.
Procedural Skills
Essential Procedural Skills
Full polysomnography, MSLT, overnight oximetry and transcutaneous CO2 monitoring,
CPAP and non invasive ventilation.
Other Specific Requirements- The trainee's
supervisor/s will confirm in their written report/s that a full 12 months of training
has been spent in the clinical areas of sleep medicine outlined in the program,
or 9 months, if 3 months are undertaken during the 2 core years of training in
respiratory medicine.
- A sufficient number of procedures must be performed
to allow the trainee to develop competence in these procedures. Competence will
be assessed on the basis of the written assessment by supervisors, and by interview
to assess the trainee's experience and competence. A logbook of procedures should
be maintained to support the assessment of experience.
- Modules are proposed
to be developed between 2002 and 2005 and may be required as part of the overall
assessment of training and competence.
Training
Sites
See "Training Sites"
section under Advanced Training Program in Sleep Medicine - Level 2.
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