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International Mini-Fellowship Training Program in Sleep Medicine
12.06.2002
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1) Abstract
Sleep health care is a relatively new clinical discipline and is a grossly under served area of medicine in most countries. As such, the AASM International Affairs Committee (IAC) has enormous opportunities to provide a global leadership role to improve sleep health knowledge and sleep health care. Programs like this will enhance the Academy’s standing in the global sleep community. The IAC proposes to launch an International Mini-Fellowship in Sleep Medicine. This initiative is primarily aimed to facilitate and organize mini fellowships (4 weeks training) in clinical sleep medicine for international physicians and other qualified health care providers. The aim of this program will be to provide hands on training experience to prospective participants so that they can initiate and establish clinical sleep programs/centers in their home countries and improve sleep health care.
The fellowship core program will include 3 weeks visiting rotation at an established sleep center where fellows will be provided an opportunity to attend supervised sleep clinic, sleep conferences, observe and score sleep diagnostic studies. The program will also include didactic lectures on certain selected sleep topics and practical workshops. The last week of this 4-week fellowship program will be spent at the annual APSS Meting, which will allow the fellows to interact with Academy members and its leadership and meet with sleep industry leaders. Initially, the proposed program will be offered for three consecutive years and will be evaluated on annual basis. It is envisioned that this program will be supported through non-governmental & governmental organizations of recipient countries, and other key players in the private sectors such as international pharmaceutical companies and sleep technology industry. The Academy will play a facilitator role for this initiative, and as such will be requested provide logistical and operative support for this program (see detail in operation). In addition to improving sleep health in many parts of the world, it is expected that the proposed international sleep education initiative will provide huge opportunities for clinical research in sleep disorders, epidemiology and a greater understanding of sleep-health care practices in other parts of the world.
2): Background:
In the last 20 years or so, significant progress has been made in the field of Sleep Medicine. Improved understanding of the mechanism of sleep disorders and better appreciation of its consequences on health & health economics have transformed the obscured field of clinical sleep medicine into one of the most vibrant specialties. In the United States, it is estimated that 30 million Americans suffer from some form of the more than 80 identified sleep disorders. For example, it is estimated that 2-4% of general population has underlying obstructive sleep apnea syndrome (OSAS). Incidence of OSAS is even much higher in certain higher risk population. Similarly, the incidence of chronic insomnia is pervasive and 10% of the general population is inflicted with this crippling condition. Over the last two decades, sleep apnea care has been transformed by modern technology into a sophisticated and highly effective clinical discipline, resulting in the improvement in the quality of life and life expectancy itself.
Similarly, better understanding of sleep-wakefulness mechanisms are creating new clinical paradigms to manage and treat sleep disorders associated with pathological sleepiness and insomnia conditions.
Despite the increased recognition of the facts that sleep disorders are pervasive and that they are associated with serious health consequences and can be easily treated, the majority of the sleep sufferers, even in this country, continue to remain undiagnosed and untreated. Lack of public awareness and lack of sleep education and physician’s training in sleep medicine are two of the important reasons for this state of affairs. This situation is far worse in many other parts of the world, even in those countries that do not necessarily face the severe fiscal constraints. For example, Kuwait with population of 800,000 and where per-capita income is among one of the highest in the world have only one sleep program with a 2-bed sleep laboratory. What can a physician do to improve the conditions described above? To better describe it, I may simply take the privilege to re-narrate a wonderful paragraph by Dr Solomon Banter, published in a recent article: “Respiratory Health in A Globalizing World. Am J Respir Crit Care Med, 163: 1064-1067, 2001. ”
“ First, we have an obligation to know about and understand the impact of the global forces on health. Second all of us we should become more introspective about our privileged lives. Third we should appreciate that our personal skills, developed on the basis of labor and investment by previous generations, represent social capital and involve social obligations for us. Fourth, we should become a force in coupling excellent treatment of individual patients to national programs that improve public health within nations. Finally, we need to locate our activities within the global context described above and promote new ways of thinking about local and international activities that have the potential to improve the well being and health at the global level.”
From a personal perspective, I may add that I believe many of us, who left our countries of origin for better medical training opportunities, have an extra obligation to help those whom we left behind. Our home countries have invested in us, both emotionally and financially in form of our expensive graduate medical education that we acquired back in our countries of origin, and as such we owe something back to them. Educating the others, through the creation of International Mini-Fellowship in Sleep Medicine will be a small step in that direction. I speak for others on our committee, when I say that we indeed feel heartened by the warm endorsement of this initiative by the AASM leadership, particularly Dr John Shepard who has assured us with his personal support.
3: Specific Goal:
· To provide practical training in clinical sleep medicine to international physicians so that they can develop/improve sleep health care in their respective countries.
4: Program Description
In summary, this will be a 4-week training program and include 3-weeks experience at an established clinical sleep program, which will have teaching and training resources. The last week of the fellowship duration will be spent at the APSS Annual Meeting where the prospective fellows have an opportunity to attend the desired courses, academic sessions, etc. This gathering will also allow the fellows to meet and network with the AASM members, and faculty as well as sleep industry leaders. During this meeting training certificates will be issued to the fellows and a future communication module will be established. Initially, the proposed program will be offered for 3 consecutive years and will be evaluated on annual basis.
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