AIRE Pilot Programs

The path to sleep medicine

The American Academy of Sleep Medicine is seeking the participation of interested sleep medicine fellowship training programs in an Accreditation Council for Graduate Medical Education (ACGME)-sponsored pilot program to develop and test innovative models of graduate medical education that emphasize competency-based training methods. Selected institutions will test AASM developed training and assessment tools and novel fellowship pathways including a part-time model and a model blending sleep training with additional specialty training. The required additional training slots will be funded by the AASM.

Currently, sleep training occurs predominantly in a time-based model with a focus on process and structure as fellows are required to score a fixed number of polysomnograms, interpret a set number of sleep studies and manage a pre-determined number of patients. This is counter to the trend in medical education for competency-based training. In addition, despite success in establishing > 80 fellowship training programs since recognition of sleep medicine in 2005, current workforce projections show the number of new board-certified sleep medicine physicians is unlikely to keep up with projected losses from retirement much less increase the number of sleep specialists. A major barrier to training additional sleep physicians is the added time required for training on top of other specialty and subspecialty training. Novel training pathways are needed to lower barriers to obtaining sleep medicine training.

ACGME established the Advancing Innovation in Residency Education (AIRE) program in an attempt to catalyze innovation in graduate medical education (GME). The AASM is submitting a proposal to develop alternate training pathways utilizing a competency-based curriculum and uniform evaluation tools. Education committees within the AASM have developed a standardized competency-based curriculum for training sleep medicine fellows to allow comparison of achievement of curricular-based milestones of clinical competency across training programs. Competency-based assessment tools will be provided to participating programs to accomplish the comparisons. A component of the proposal is exploration of the feasibility of alternate training pathways, including a part-time model and a blended model allowing concurrent training in sleep medicine and another related subspecialty.

The overall goal is to improve the quality and safety of delivered health care through innovation in fellowship training. Specifically, participants in this pilot will implement alternate training pathways utilizing a competency-based curriculum that allows it to be blended with other fellowship training programs with overlapping knowledge and skills (i.e. pulmonary diseases, pulmonary critical care medicine, pediatric pulmonology) or accomplished on a part-time basis and compare these pathways with a traditional time-based sleep medicine fellowship model. A second goal will be to validate standardized competency assessment tools, based on the ACGME Milestones Report framework, that have been developed and disseminated by AASM.

Participating programs must meet the following eligibility criteria

  • An ACGME accredited sleep medicine fellowship program in good standing
  • Division/Department willingness to utilize AASM-provided standardized competency assessment tools for fellows in both innovative pathways and standard pathway.
  • Ability and capacity to add an additional fellow slot
  • For participation in part-time model, agreement to allow variable completion dates, not to exceed 2 years from the starting date.
    • Fellows participating in part-time model must have board certification or board eligibility through the American Board of Internal Medicine, American Board of Pediatrics, or the American Board of Psychiatry and Neurology
  • For participation in the blended model
    • Related ACGME accredited fellowship program (pulmonary diseases, pulmonary critical care medicine, pediatric pulmonology) in good standing

Agreement from related subspecialty to participate and adjust fellow’s schedule to allow completion of both fellowships.

Interested programs should provide the following:

  • Completed application form
  • Support letter from sleep medicine Program Director and Division/Department Chief
  • For programs applying for the blended model, a support letter from the Program Director and Division/Department Chief of the related fellowship program (pulmonary diseases, pulmonary critical care medicine, pediatric pulmonology) will be required before completion of the selection process.
  • Support letter from Institution’s Graduate Medical Education leadership/Designated Institutional Officer (DIO)
  • CV of sleep medicine Program Directors and, for programs applying for the blended model, of the Program Director of the related fellowship program (pulmonary diseases, pulmonary critical care medicine, pediatric pulmonology)

Applications will be submitted to the AASM’s Innovative Fellowship Model Implementation Committee, which will oversee this program. This group is composed of program directors, former program directors or persons with needed educational leadership experience from nonparticipating sleep medicine fellowship programs. The AASM’s Board of Directors will give final approval to the Committee’s selections.

The AASM will provide a total of $4 million dollars for 5 years to cover fellow salary and benefits, and the costs of development and implementation of the competency-based assessment tools across all participating programs. Total award for each participating institution will defray the salary and fringe for one full year of fellowship training.

  • Ten fellows will be recruited as part of the pilot, 5 in each of the two pathway models.
  • Recruitment will occur in the first 3 years of the pilot, with 2-3/arm each year.

The AASM plans to execute this project over the next 5 years. Programs are eligible to re-apply if not selected as a participating site for the initial phase of the project in AY2019-20.