Curriculum and competency assessment tools for sleep disorders in pulmonary fellowship training programs.

Syndromes of respiratory disorders of sleep as well as nonpulmonary disorders of sleep are common and amenable to treatment (1). Obstructive sleep apnea hypopnea syndrome is the most common diagnosis found in the laboratory assessment of patients with sleep-related complaints (2). Anecdotal reports suggest that between 10 and 40% of a community outpatient practice of pulmonary medicine involves assessment for and management of sleepdisordered breathing. In addition, nonpulmonary disorders of sleep often present as comorbid conditions in patients with pulmonary disorders. In the many areas where access to expertise in sleep medicine is limited, the pulmonary physician with actual or perceived expertise in sleep-disordered breathing usually is the principal resource to whom patients and other physicians turn for advice or consultation on patients with sleep problems. Because there is considerable overlap of the cardinal signs and symptoms across a wide range of sleep disorders, including sleep apnea, the pulmonary specialist may be asked to appropriately identify, manage, or refer patients with nonpulmonary problems of sleep. Knowledge of sleep disorders and circadian rhythm is not only relevant to clinical practice but also is a seminal element of the pulmonary fellowship experience (3, 4). In addition, for all physicians, adequate sleep and recovery sleep are important for professionalism, learning, and personal relationships (5, 6). Some education in sleep medicine and chronobiology occurs in undergraduate medical education (7, 8), and additional curricular efforts to expand this exposure are underway at these levels of training (9). Hence, the pulmonary trainee of the future will likely have experienced such basic instruction. Competency domains related to sleep and chronobiology have been partially articulated for undergraduate medical education (10) and to some degree for residency training (8). Competencies in these areas have been suggested (10–12), but have not been systematically incorporated within pulmonary fellowship training and do not incorporate viewpoints from directors of