Mission

Our mission is to provide evidence-based sleep medicine education and military unique curriculum to maintain a ready medical force to applicants from a variety of prior training settings including family medicine, internal medicine, pulmonary/critical care, pediatrics, neurology, psychiatry, otolaryngology, or anesthesiology. Upon completion of this fellowship, our trainees will be well-rounded, excellent clinicians who treat the full spectrum of sleep disorders seen in our active duty, veteran, and dependent population.

Vision

Fellows will participate in research and quality improvement projects during training that will improve our ability to treat sleep disorders in Military Service Members and maintain a ready medical force.

Aims

The NCC Sleep Medicine fellowship aims to:

• Educate and mentor military physicians who will treat sleep disorders for military personnel, veterans and their dependents in an empathetic, intelligent and efficacious manner.
• Serve as force multipliers for their parent medical specialty and military branch of service.
• Graduates will be able to serve as subject matter experts that can provide guidance and leadership for all aspects of clinical and operational sleep medicine.

Tuesday afternoon weekly conferences which includes lectures from our faculty as well as esteemed experts in Sleep Medicine from all over the country. Didactics include formal lectures, journal club, review of clinical practice guidelines, board review, challenging case discussions, abstract and primary literature discussion.

Initial didactics for fellowship will also include a 2-day Sleep Medicine introductory boot camp at the University of Maryland.

The majority of the rotations will be based at the Sleep Disorders center at Walter Reed National Military Medical Center (WRNMMC):

• One day per week of Pediatric Sleep Clinic
• One day per week of Behavioral Sleep Clinic with a focus on Cognitive Behavioral Therapy for Insomnia
• Two day per week of Adult Sleep Clinic
• One half day a week of Sleep Academics
• One half day a week dedicated time for research

Throughout the academic year, there are 12 days of Sleep Medicine Clinic seen at Children’s National Medical Center and 2-4 days at University of Maryland’s Amyotrophic Lateral Sclerosis (ALS) Clinic.

• Children’s National Medical Center: Sleep Medicine Clinic
• University of Maryland ALS Clinic
• Walter Reed Army Institute of Research

Fellows alternate being on call from home and discuss cases with the staff physician. Occasional inpatient consults would be addressed in person during business hours.

Operational aspects of sleep, sleep deprivation, and fatigue mitigation are discussed during weekly conference. Fellows are trained to be well versed in how sleep disorders effect operational readiness. These areas of expertise may include, but not limited to: guiding consulting physicians and command on clinical sleep disorders that may be duty limiting as well as understanding how sleep deprivation and fatigue mitigation strategies are operationally relevant.

There are no required courses in our program.

Fellows have the opportunity to join hospital committees, American Academy of Sleep Medicine fellows leadership council, and participate in Uniformed Services University of the Health Sciences (USUHS) Faculty Development.

Fellows are required to be actively engaged in a research project throughout their training period. The project will preferably be completed prior to graduation but ongoing projects will be acceptable if the fellow maintains active involvement during the training period. The minimum research requirement is presentation of an abstract (case report or research) at the National Sleep Medicine Meeting (Associated Professional Sleep Studies/American Academy of Sleep Medicine) in June of the Fellowship year. Abstract submissions for these conferences are typically due in November/December. Each fellow should seek to have at least one publication prior to graduation.

Fellows are required to develop a performance improvement project during the training period. The project will preferably be completed prior to graduation but ongoing projects will be acceptable if the fellow maintains active involvement during the training period. Fellows are encouraged to identify an aspect of the Sleep Center's procedures that may benefit from this type of initiative. In conjunction with a faculty member, the fellow should identify the need, develop and initiate a course of action, and assess the outcomes and benefits from that initiative.

The program encourages fellows to pursue committee assignments, American Academy of Sleep Medicine fellowship leadership roles and GME leadership roles. Fellows may not pursue additional degrees such as Master of Public Health or Master of Business Administration concurrently during their fellowship unless cleared by local GME and the clinical faculty.

• WRNMMC Sleep Disorders Clinic
• Children’s National Medical Center: Sleep Medicine C;inic
• University of Maryland ALS Clinic
• Walter Reed Army Institute of Research

Rotators are assigned to shadow/observe as well as interview, examine, and evaluate patients in the Sleep Disorders Center at WRNMMC under faculty supervision. The full range of sleep disorders are addressed at the WRNMMC Sleep Disorders Center to include adult and pediatric insomnia disorders, sleep related breathing disorders, central disorders of hypersomnolence, circadian rhythm disorders, rapid eye movement (REM) and non-rapid eye movement (NREM) parasomnias, and sleep-related movement disorders. Rotators are also exposed to a variety of sleep medicine procedures to include polysomnography, positive airway pressure titrations, multiple sleep latency tests, maintenance of wakefulness tests, and actigraphy. Rotators can view these studies alongside faculty and fellow physicians.

• Demonstrate an interest in Sleep Medicine.
• Maintain appropriate board certification and accomplish academic requirements for graduation from residency program.
• Reach out to NCC Sleep Medicine fellowship program director and associate program director.
• Consider rotation with WRNMMC Sleep Medicine Clinic
• Consider research or academic literature in the field of sleep.

Program graduates take the American Board of Sleep Medicine. This exam is offered annually. To become fully board certified, applicants are eligible to take board certification exam in October/November following graduation. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the American Board of Sleep Medicine by June 30th. Pre-requisites for graduation include scoring interpretation of: 40 pediatric polysomnograms (PSG), 200 adult PSGs, 25 multiple sleep latency/maintenance of wakefulness tests, set number of actigraphy and HSAT interpretations. Fellows must also accomplish at least 400 patient encounters during their fellowship year.

Fellows get an opportunity to teach medical students/residents, patients in a group setting, and operational units. Fellows have the opportunity to work and teach sessions with Uniformed Services University medical students as part of Integrated clinical Reasoning and Integrated Clinical Skills sessions.

Fellows get an opportunity to teach and present at local and national conferences, including platform presentations if their research is selected to be showcased at the respective conferences. Fellows have the opportunity to present fatigue management training to GME programs.

Our faculty disciplines include Pediatrics, Internal Medicine, Neurology, Pulmonary/Critical Care Medicine, Psychiatry, Otolaryngology and Family Medicine.

We mentor USUHS medical students, residents across several programs and fellows interested in pursuing sleep medicine.

Fellows have networking opportunities with monthly-bimonthly District of Columbia Sleep Society. Fellowship dinner meetings occur sporadically during the year as well.