We believe the strengths of our program are its focus on fellowship education and diversity of both patients and faculty.
Sleep Medical School is a prime example of our focus on fellow education. During much of July fellows focus on the basics of sleep medicine without primary clinical responsibilities. This includes our unique PSG curriculum which emphases learning all aspects of PSG interpretation in a graduated fashion. Fellows spend time learning each component of a PSG such as sleep staging, scoring respiratory events, scoring movements, etc. as they gradually learn to interpret a full PSG. Once the initial phase of the PSG curriculum is completed, fellows have a gradual increase in numbers of PSGs they are responsible for interpreting each week culminating in 10-15 per week in the final quarter which prepares them for eventual independent practice which requires both completeness and efficiency in PSG interpretation. Fellows also spend a night in the sleep lab learning how the sleep technicians set up and run a sleep study; fellows have the following day free to recover and study independently.
Fellows rotate in faculty clinics at the VA, OHSU and Doernbecher Children’s Hospital. We have general sleep clinics and subspecialty sleep clinics focused on Insomnia, OSA/OHS, Neurology Sleep, RBD, Pediatric Pulmonary Sleep, and CHF/CSA clinics. OHSU has clinics both at the main university and also in community-based clinics.
Fellows see the full gamut of sleep patients from infants to geriatric patients with the full array of sleep disorders. Our VA population reflects the younger population in Portland with many young veterans from recent conflicts enrolled in the VA for their health care. Fellow logs demonstrate an almost equal number of patients < 65 years of age as >65 years of age in the adult clinics. Many of our patients are in their 30s-40s. Portland VA also has a significant transgender population followed in a transgender clinic as well as an increasing population of women cared for in Women’s Health primary care clinics.
At the pediatric sleep clinics at OHSU and Doernbecher Children’s Hospital, fellows will see patients from infants to teens with the majority being in the school age years. There is also clinical experience with more medically complex pediatric patients who have significant sleep disorders.
We have a diverse faculty. We have faculty with primary background in Internal Medicine, Pediatrics, Neurology, Psychiatry, Psychology, Pulmonary/CC, Pediatric Pulmonary, and Anesthesiology with regular didactic sessions and clinical experience options with our ENT colleagues at OHSU.
At the VA we provide all the DME needs for our patients. Fellows spend time in CPAP clinic with our sleep technologists setting up CPAP for new patients and doing follow up with troubleshooting for established CPAP patients. We utilize both ResMed and Respironics devices. There are also didactic sessions led by our Chief Sleep Technologist on practical clinical management of sleep patients on PAP therapy.
VA ENT physicians do implant HNS and follow up of those patients happens in fellow and faculty clinics. There are also opportunities to visit the OR to observe implantation of HNS.
The VA has recently started a Remede program and these patients will be followed in the sleep fellows’ clinic.
In a one-year fellowship most fellows do QI/QA projects to fulfill their research requirement. These are fellow driven projects answering questions they formulate. We also have several funded faculty with large research programs and during Sleep Medical School fellows meet with all these faculty for a roundtable discussion of their research programs and opportunities for fellow engagement.
Yes, our fellows have no issues with getting enough patient care visits and sleep study interpretations to meet all ACGME requirements.
At the Portland VA, Nihon-Koden’s Polysmith software is used for in lab polysomnography. At OHSU, Cadwell is used for in lab PSGs. At the Portland VA home sleep studies are done using either Noxturnal or WatchPAT. At OHSU, home sleep studies are done using G3.
We have a rolling 3 year pass rate (how ACGME tracks this) of 100%. Looking even further back, we have a 100% board pass rate since 2016.
Recent graduates have an almost 50:50 split between joining an academic practice and joining a community based practice.
29 fellows to date
16 women (55%)
11 internal medicine
10 pulmonary/critical care
1 critical care
Since Dr. Mukundan’s tenure as PD AY 2020-2021:
2 university academic jobs (including one division chief!)
1 community/university affiliate practice jobs
2 private practice jobs
Fellowship totals since 2007:
8 University jobs
21 community jobs
Yes, fellows are on call one week per month covering both the VA and OHSU sleep labs overnight. This is home call and there is always an attending back up. Fellows only take call M-F with no weekends and no holiday call for fellows.