On November 15, Pell Ann Wardrop, MD, walked into a testing center, where she sat down at a computer and took an exam. On that date, she and 77 other otolarygnologists across the nation were among the first doctors to take the new American Board of Medical Specialties (ABMS)-approved Sleep Medicine certification examination.
This new subcertification is offered through the American Board of Otolaryngology (ABOto), and is administered by the newly established ABMS conjoint board of Sleep Medicine. The conjoint board consists of the ABOto, the American Board of Internal Medicine (ABIM), the American Board of Pediatrics (ABP), the American Board of Neurology and Psychiatry (ABNP), and the American Board of Family Medicine (ABFM).
Dr. Wardrop, a member of the Sleep Disorders Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), has been helping get the word out about the certification program. She is in private practice in Lexington, KY and is also a clinical faculty member at the University of Kentucky School of Medicine. She encourages otolaryngologists to pursue the subcertification for a number of reasons.
For one, many otolaryngologists are already working with patients who have sleep disorders, and getting the subcertification provides doctors with a wider knowledge base about sleep conditions and their various causes. It’s not always about apnea, she reminded readers of ENT Today.
Another reason is that otolaryngologists need to be part of the wider community of sleep medicine, and make sure that issues from their specialty are heard. This can include subjects such as third-party payer decisions, patient access to a variety of treatment options for sleep-related breathing disorders, and ensuring that research includes otolaryngology-related aspects of sleep conditions.
Our participation adds to our ability to influence the training of all sleep medicine physicians, Dr. Wardrop said. Right now, many sleep medicine programs include very little on the otolaryngologist’s role in managing patients with sleep-related breathing disorders.
Genesis of the Program
So, how did the subcertification program evolve? Robert H. Miller, MD, MBA, Executive Director of the ABOto, provided ENT Today with some of the background. He explained that three of the boards within the ABMS (internal medicine, pediatrics, and psychiatry/neurology) started the process to develop a conjoint board to subcertify in sleep medicine a few years ago. The ABOto was invited to join this group, and, after careful consideration, it did.
The American Board of Sleep Medicine (ABSM, which is not an ABMS member), which once administered a certification exam for its own members, will no longer be administering that exam. The ABSM, however, will continue with its programs relating to education and international certification.
Obtaining the subcertification is optional for otolaryngologists. But for those who have an interest, there are a number of requirements. One is to be an ABOto-certified otolaryngologist-head and neck surgeon with an unrestricted license. Candidates must have completed an Accreditation Council for Graduate Medical Education (ACGME)-accredited sleep medicine residency program or fellowship.
However, Dr. Miller noted that the ACGME accreditation began only about three years ago, which means that many doctors who did fellowships did not have the ACGME accreditation available to them. Taking this into account, otolaryngologists may quality if they meet alternate pathway criteria. And through the alternate pathway, otolaryngologists can qualify to take the exam through three possible ways.
First, if the individual is currently certified by the non-ABMS Board of Sleep Medicine, then they’re eligible to take the exam, Dr. Miller said.
The second way is if the otolaryngologist has done 12 months of full-time post-graduate training in sleep medicine. This doesn’t have to be ACGME-accredited, since for many this was a program that didn’t exist for many doctors while they were getting their training.
The third path is having self-trained and practiced sleep medicine for a significant amount of time. These people have to demonstrate that over a maximum of a five-year period they have practiced the equivalent of 12 months of sleep medicine, Dr. Miller said.
This is not easy to demonstrate. Doctors will need to show that they have evaluated a minimum of 400 sleep medicine patients. Dr. Miller pointed out, however, that because sleep problems are so common, that’s not been much of a stumbling block for many otolaryngologists.
The other part of that requirement is that otolaryngologists must have interpreted the data from 200 polysomnograms and 25 multiple sleep latency tests, he said. Related to this final pathway, the ABOto has the right to audit some of the charts and related information. The alternate pathway is an option that will be open for only five years.
Preparing for the Test
Once a doctor has met the qualifications, it becomes a matter of applying to take the test, preparing for it, and going to a computer test center on the appropriate date. Details for all this are on the ABOto Web site.
Dr. Wardrop pointed out that physicians who are considering taking the test do need to do a fair amount of preparation. For many otolaryngologists, sleep-related problems are largely a surgical problem-yet surgery is barely addressed in the exam. Doctors need to brush up on several areas that are related to other specialities, she advised. The exam covers the basic science of sleep, including neuroanatomy, neurophysiology, and neuropharmacology. All aspects of sleep medicine, from diagnosis to treatment, need to be known.
Otolaryngologists need to know about sleep-wake disorders, sleep in psychiatric and neurologic disorders, biologic rhythms, dreaming and behavior issues, endocrinology as it relates to sleep, and more. And, of huge importance, is polysomnogram (PSG) interpretation.
In fact, Dr. Wardrop suggested that the otolaryngologist team up with a sleep medicine specialist for a few months prior to the exam to get the PSG reading experience. Find a mentor, she recommended.
During the examination, candidates will be tested on the basic science of sleep, clinical disorders of sleep, and the use of clinical and PSG data. Questions will emphasize sleep-stage scoring, artifact recognition, interpretation of sleep studies, diagnosis of sleep disorders and patient management skills, Dr. Wardrop said.
Another hugely valuable way to prepare is to sign up for an introductory sleep medicine course. These typically are five- to seven-day courses, and should provide a good introduction to sleep medicine and PSG interpretation. Sleep medicine review courses are useful as well, she said.
Joining the American Academy of Sleep Medicine (of which fewer than 1% of current members are otolaryngologists) and attending sleep specialty conferences may also be beneficial.
In addition, otolaryngologists should consider sharing their surgical expertise by giving talks to groups in other medical specialities. This is something that helps keep the otolaryngological aspects of sleep disorders alive in the wider field of sleep medicine, and allows for a sharing of expertise.
Test Administration
While physicians must prepare for the test on their own, the test is administered at several community-based computer testing facilities.
Dr. Wardrop found that the arrangement when she took the exam was convenient because there is a testing center near where I work. And it was comfortable because you could work at your own pace, she said. As with any testing center, she had to present identification and be photographed and fingerprinted-good mechanisms to ensure that people taking the test are who they say they are.
A total of 78 of the doctors taking the exam that day were otolaryngologists. Overall, 1882 physicians from various specialties took the exam, with the largest group being in internal medicine.
To prepare, the most important thing is to work on training yourself, Dr. Wardrop said.
Sleep Certification Exam- The Results
The first examination for subcertification in sleep medicine was administered on two days in November 2007. A total of 1882 physicians took the examination, including 78 otolaryngologists (4% of all candidates). The examination, administered at several computer-based testing centers around the country, covered the full spectrum of sleep disorders. The content was the same for all test-takers regardless of specialty.
The examination was divided into a total of 12 categories:
- Normal sleep and variants
- Disorders related to sleep-wake timing
- Sleep-related movement disorders
- Organ system physiology in sleep
- Insomnia
- Sleep-related breathing disorders
- Sleep evaluation
- Hypersomnolence unrelated to sleep-related breathing disorders
- Sleep in other disorders and considerations unique to childhood
- Pharmacology
- Parasomnias
Of the 78 otolaryngologists who took the examination, 49 passed and are now subcertified in sleep medicine by the American Board of Otolaryngology.
We congratulate these individuals for their hard work in preparation for the exam and have listed their names on our Web site (www.aboto.org ), said Robert H. Miller, MD, MBA, Executive Director of the American Board of Otolaryngology.
The next examination in sleep medicine will be administered in 2009. Individuals interested in learning more about this subcertification should contact the ABOto office at 713-850-0399, or check the ABOto Web site.
©2008 The Triological Society