Mission

The mission of the SAUSHEC Sleep Medicine Fellowship Program is to provide the clinical experience, educational resources, and mentorship support that produces exceptional sleep medicine physicians who deliver the highest quality of safe, ethical, and compassionate sleep medicine. Fellows are prepared to provide the highest level of clinical care with a focus on patient safety and the individual needs of their patients. In addition, the SAUSHEC sleep medicine fellowship includes a military unique curriculum designed to provide fellows with the clinical and leadership skillset necessary to care for active-duty service members with the full range of sleep disorders.

Vision

The vision of the SAUSHEC sleep fellowship program is to be the premier sleep training and sleep research program in the Department of Defense. 

Aims

• Develop the next generation of military sleep physician leaders, researchers, and scholars. 
• Produce sleep medicine physicians who possess the requisite sleep medicine knowledge, clinical and academic skills, and leadership abilities to function as an independent practitioner in the field of sleep medicine, advance the science of sleep medicine, manage a sleep laboratory, and provide state-of-the-art sleep advice to military leaders.  
• Ensure that all fellows are prepared to provide the highest level of clinical care with a continuous focus on patient safety and quality improvement.  
• Teach fellows to become proficient with the administrative actions required in all branches of the military for treating the full spectrum of sleep disorders that afflict service members, ensuring that active-duty members are returned to duty when possible and to a deployable status with minimal delay.  
• Provide a comprehensive, holistic, multi-disciplinary approach to sleep and sleep disorders in military personnel, their families, and retirees.
• Teach novel and innovative diagnostic and therapeutic techniques for sleep disorders including military unique sleep disorders.

• Weekly sleep medicine didactics on Tuesday afternoons covering full spectrum of sleep medicine
• Weekly reading sessions on Wednesdays for one hour
• Weekly board review and book review on Thursdays for one hour beginning in the fall
• Monthly Pediatric sleep multi-disciplinary conference (participants include pediatric neurology, pulmonology, and otolaryngology)
• Monthly multi-disciplinary Clinical Health Psychology conference
• Monthly journal club
• Fellows virtually attend a monthly American Academy of Sleep Medicine Webinar

The rotation schedule is based out of the sleep disorders center at Wilford Hall for the entire year with the following clinical and academic schedule:

• Two half days of adult sleep clinic per week
• One half day of pediatric sleep clinic per week
• One half day of obstructive sleep apnea (OSA) treatment group per week
• One half day of dedicated time for research per week
• Monthly half day of neuromuscular multi-disciplinary clinic
• On approximately 2 nights per year, fellows will come to the sleep lab with staff at night to become proficient with titrating and caring for complicated sleep patients in real time
• The remainder of the time is spent on polysomnography (PSG) interpretation 

There are no elective rotations during this one-year fellowship. However, time is spent intermittently with otorhinolaryngology (in clinic with sleep surgery patients and operating room for sleep surgeries), prosthodontics (fabrication of mandibular advancement device), and clinical health psychology (observing and learning behavioral treatments for sleep disorders).

Fellows split call for the year with a very low burden of acute consults or sleep lab concerns.

Fellows learn the military specific diagnosis, treatment, operational, and career sequelae of the different sleep disorders. This may include appropriate diagnosis, treatment, and disposition of the entire spectrum of sleep disorders in military members to include pilots and deployment-related preparations and concerns. Importantly, the central disorders of hypersomnolence are recommended to be ultimately evaluated and diagnosed at an American Academy of Sleep Medicine accredited military treatment facility per the US Air Force Medical Standards Directory. The SAUSHEC sleep fellowship and sleep center also have an established history of treating and publishing on military unique topics to include sleep and sleep disorders in military women and men and trauma associated sleep disorder (TSD).

Fellows complete the American Academy of Sleep Medicine (AASM) Inter-Scorer Reliability (ISR) scoring course during the first weeks of training.

There is no active sleep related simulation curriculum, however Brooke Army Medical Center (BAMC) boasts a fully staffed and equipped simulation lab.

As part of the didactic and curricular schedule throughout the year, there are focused sessions on leadership and professionalism topics through case study review, books, research, and expert commentary. Additionally, our sleep fellows gain experience running an accredited sleep lab in preparation for their next duty assignment and eventual civilian practice.

There are also numerous opportunities for fellows to hold leadership positions within our program to include organizing didactics and the multi-disciplinary conferences, becoming involved with SAUSHEC GME as a house staff officer or GME subcommittee member.

• As part of SAUSHEC GME graduation requirements, all fellows are expected to produce a manuscript ranging from a case report to novel research. Fellows are generally able to meet and exceed this requirement due to the diverse patient population and pre-existing, simultaneously running research protocols. Fellows can join these existing projects or are supported in pursuing their own. 
• Fellow travel to conferences is supported and encouraged. Fellows consistently attend the annual Sleep Medicine “SLEEP” conference, often being selected for podium presentation. They also typically attend multiple other conferences through the year depending on their interest.
• Fellows are encouraged to attend research training meetings and courses held by SAUSHEC GME and the 59th Medical Wing.

As part of SAUSHEC GME graduation requirements, all fellows participate in quality improvement and patient safety (QIPS). The program’s Associate Program Director is the designated QIPS champion, who can help generate original ideas, or support fellow participation in a QIPS elective rotation, A3 training, yellow and green belt training, and root cause analysis (RCA) course and participation.

Professional development is an important aspect of the SAUSHEC sleep medicine fellowship training. It is incorporated into the Leadership Curriculum. All committees at SAUSHEC have GME representatives and fellows are encouraged to serve in these roles.

The primary training site is at Wilford Hall Ambulatory Surgical Center (WHASC). Fellows also attend neuromuscular multi-disciplinary clinic and see occasional inpatient consults at Brooke Army Medical Center (BAMC).

Rotators are assigned to shadow/observe as well as interview, examine, and evaluate patients in the WHASC Sleep Disorders Center under faculty or fellow physician supervision. The full range of sleep disorders are addressed at the WHASC Sleep Disorders Center to include adult and pediatric insomnia disorders, sleep related breathing disorders (obstructive and central sleep apnea, hypoventilation, and hypoxemia disorders), central disorders of hypersomnolence (narcolepsy, idiopathic hypersomnia, and periodic par Kleine-Levin syndrome), 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 (including advanced interventions such as adaptive servo-ventilation - ASV), multiple sleep latency tests, maintenance of wakefulness tests, and actigraphy. Rotators can view these studies alongside faculty and fellow physicians.

Medical students interested in scheduling a rotation should contact: usarmy.jbsa.medcom-bamc.mbx.saushec-clerkship@health.mil. 

If you would like to schedule an interview with our program, please contact dha.jbsa.brooke-amc.list.saushec-sleepmed@health.mil. Interviews are scheduled during the open application cycle, typically from July to early October. Applicants are welcome though not required to visit our program to engage with our staff and fellows. Virtual interviews are offered if unable to come in person. Each applicant will be interviewed by the Program Director and Associate Program Director, hear more about our program, and be given the opportunity to ask questions.

Program graduates take the Sleep Medicine Board Certification exam. This exam is offered every other year.  To become fully board certified, applicants are eligible to take board certification exam at the first available testing opportunity. To be eligible to take specialty board exams, graduates must complete all pre-requisites. The pre-requisite is a prior board certification in another approved specialty, most commonly internal medicine, family medicine, pediatrics, neurology, psychiatry, otolaryngology, or anesthesiology.

Fellows have a plethora of teaching opportunities. The sleep disorders center has weekly resident and fellow rotators from other programs, allowing our fellows ample opportunity to teach. Fellows also give lectures to the department throughout the year during our didactic sessions.

Additionally, our fellows are frequently invited to do guest lectures at other GME departments, medical institutions, community locations, and even DOD commands.

Faculty have subspecialty training in internal medicine, neurology, pediatrics, pulmonary & critical care, anesthesia, and otolaryngology.

All fellows will select a mentor in the first half of the year. Additionally, the program prides itself in having staff that are always willing to provide mentorship.

Well-being is important in our fellowship. In addition to boasting an excellent work-life balance for fellows during the entire year, the sleep fellowship also encourages at least quarterly wellness events.