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Position Identification: Sleep Fellow

Position Summary: The Sleep Medicine Fellowship is an integrated 12-month longitudinal clinical training experience. Through clinical activities and didactics fellows acquire knowledge and clinical experience in the diagnosis and management of a broad range of sleep disorders, including sleep-disordered breathing, insomnia, central hypersomnia, circadian rhythm disorders, parasomnias, and sleep-related movement disorders. Training occurs across four primary sites: Harborview Medical Center (HMC), University of Washington Medical Center (UWMC), Seattle Children’s Hospital (SCH), and the Veteran’s Administration Puget Sound Health Care System (VAPSHCS).

For the purpose of this document, the term “Resident” includes medical and dental residents and fellows, including those in ACGME, CODA and non-ACGME accredited programs.

General Overview of the Resident Role

A resident’s responsibilities include patient care responsibilities within the scope of their clinical privileges commensurate with level of training and other responsibilities required of all members of the medical staff. Under the supervision of attendings, general responsibilities of the resident may include:

  • Initial and ongoing assessment of patients’ medical, physical and psychosocial status
  • Performing history and physical examination
  • Developing assessment and treatment plan
  • Performing rounds
  • Recording documentation, including progress notes, admission notes, procedure notes and discharge summaries
  • Ordering tests, examinations, medications and therapies
  • Arranging for discharge, referral and after care.
  • Providing patient education and counseling about health status, test results, disease processes and transition of care planning
  • Performing procedures
  • Assisting in surgery
  • Teaching and evaluating junior learners, such as medical students

UW GME Expectations for Professional Behavior

Essential Functions

Essential functions are the fundamental job duties of the position that cannot be eliminated or substantially modified without changing the nature of the position.

A job function may be considered essential for the following reasons:

  • The reason the position exists is to perform that function
    • Resident educational requirements and patient care responsibilities
  • A limited number of available residents can perform that function
  • Varies by program, rotation, year, risk pools, etc.
  • The function may be highly specialized so that the trainee in the position is hired for their expertise or ability to perform the particular function
    • Cannot easily hire more trainees, especially of a specific R level
  • The percentage of time spent on a function does not determine whether or not it is essential.

Essential functions for GME residents must include consideration of:

  • ACGME program requirements
  • Specialty board requirements
  • UW program requirements
    • Unique to each UW training program and must consider:
      • Complexity of rotations/service requirements
      • Size of program
      • Structure and depth of risk pools
      • Please refer to the program’s Clinical Coverage Policy
    • Inclusive of the hospital system requirements:
      • Rotations dependent on residents’ service for patient care
      • Coverage options available

A resident must perform the position’s essential job functions with or without an approved reasonable accommodation. Reasonable accommodation means modifying or adjusting practices, procedures, policies, job duties, or the work or application environment so that a qualified individual with a disability can still perform a position’s essential functions. Approved reasonable accommodations are determined via an interactive process involving the resident, DSO/HR/GME and the program.

Essential functions ensure the safe and smooth delivery of education and patient care and are identified in alignment with program aims to facilitate trainee readiness for independent practice across an appropriate range of clinical settings for that specialty. Transparent documentation of a program’s essential functions is also an important resource for applicants evaluating the training program during recruitment.

Essential Program Administrative Functions

Onboarding

The Resident must:

  • comply with all program and institutional tasks required for credentialing and onboarding by the requested deadlines
  • Other functions/details specific to the program:
    Fellows must coordinate with the Sleep Medicine Fellowship Administrator for the onboarding process and site-specific credentialing.

Program Tasks and Documentation

The Resident must:

  • participate in all requests for schedule preferences, requests for absence or schedule changes of requests for clinical coverage on the requested timelines or deadlines.
  • complete in a timely manner all evaluations requested for medical students, peer residents, faculty or other members of the team
  • complete MedHub clinical and educational hour logs
  • complete case or procedure logs
  • complete the annual ACGME Resident Survey
  • complete the program’s annual confidential internal survey
  • complete required examination preparation and/or testing requirements, to include USMLE or COMLEX Step 3, in-training examinations and program-specific guidelines for national board certification
  • attendance at all required program meetings, including semiannual meetings, mentorship meetings, program retreats, etc.
  • Other functions/details specific to the program:
    • MedHub: Maintain daily clinical and educational hour logs and procedure logs for consults and sleep study interpretations.
    • Milestones: Complete the AASM Sleep ISR scoring course and competency assessment within the first month of training. 
    • Absences: Submit vacation requests at least 3 months in advance and shorter scheduled absences at least 6 weeks in advance. 

Essential Program Core Educational Functions

Didactics

The Resident must:

  • Comply with all standards for attendance at didactics or other core educational activities
  • Adhere to the preferred mode of attendance (in-person, virtual, hybrid)
  • Other functions/details specific to the program:
    • Present at least 4 formal lectures at Sleep Medicine Grand Rounds. 
    • Present at 2 journal club conferences and provide 5 clinical case presentations annually.
    • Present at least one case at Seattle Area Chest Grand Rounds
    • Attend mandatory weekly didactics at SCH (Mondays), HMC (Tuesdays), and the VA (Wednesdays).

Scholarship

The Resident must:

  • Comply with all program or specialty requirements for research or scholarship, quality improvement, national or regional conference presentation, publication or scholarly writing or teaching and presentations internal to the program (e.g. journal club, didactics, case conference, M&M, etc.)
  • Other functions/details specific to the program:
    • Complete at least one scholarly activity suitable for peer-reviewed publication or national presentation.
    • Identify a research mentor and project by August 30 and present a preliminary plan to faculty in September.

Essential Patient Care Functions

Presence and preparedness

The Resident must:

  • present to work as physically, mentally and emotionally fit for duty
  • arrive at the patient care setting on schedule
  • arrive at work in attire appropriate for the professional and safe delivery of patient care
  • meet expectations for chart review or pre-rounding
  • satisfy expectations that precede sign-out and/or departure from the clinical setting, including an appropriate handoff and follow up on all patient assessments/data/studies that will alter care in the near term.
  • Other functions/details specific to the program:
    • Be physically present onsite for all clinics, including those with Telemedicine appointments, unless otherwise instructed. 
    • Coordinate morning clinic starts by ensuring slots are correctly blocked or managed with front desk staff by 4:30 pm the prior day

Administrative

The Resident must:

  • complete patient health record documentation on the schedule prescribed by the program or medical center. (Examples include but are not limited to progress notes/visit summaries, discharge summaries, operative or procedure notes, perioperative records)
  • comply with expectations for EHR inbox management, including timely responses to messages from patients, medical staff and tracking and patient follow up of expected results
  • Other functions/details specific to the program:
    • Complete patient health record documentation on the same business day as the visit to ensure accurate billing and attending co-signature. 
    • Route Epic notes for signature and close encounters immediately following the patient visit.

Patient Care Communication

The Resident must:

  • respond in a timely manner to pages, phone calls and Epic Secure Chat
  • remain within the program-prescribed geographic range while on call or eligible for coverage
  • Other functions/details specific to the program:
    • Follow the standardized I-PASS format for verbal handoffs during clinical transitions.

Patient Care Volumes

The Resident must:

  • work toward (with supervision) or meet benchmarks for patient care volumes in all clinical settings
  • appropriately request and utilize supervision
  • work toward or ultimately meet procedure certification standards
  • Other functions/details specific to the program:
    • Interpret at least 300 total sleep studies (minimum 150 lab-based) by graduation.
    • Complete at least 15 MSLT/MWT and 40 pediatric sleep study interpretations. 

Consultation

The Resident must:

  • appropriately respond to, triage, and staff consultations in a timely manner
  • document findings and recommendations in a timely manner
  • communicate with the requesting service directly (e.g. in-person, phone) in advance of and following the assessment
  • ensure that consultations are staffed and finalized with a faculty member in a timely manner
  • Other functions/details specific to the program:
    • Manage and log at least 12 inpatient consults per year.

Essential Shift and Schedule Functions

Settings

  • complete assigned shifts in settings deemed essential by the program, such as inpatient units, NICU, PICU, emergency department, and outpatient specialty and primary care clinics
  • complete assigned away rotations deemed essential by the program
  • Other functions/details specific to the program:
    • Clinical rotations occur at four regional sites: HMC, UWMC, SCH, and VAPSHCS.
    • Pediatric clinical work is conducted at SCH main campus and SCH Sleep Center at Overlake Hospital in Bellevue.

Shift length and timing

The Resident must:

  • complete shifts of all lengths deemed essential by the program, which may include daytime, swing, nights, weekends, and holidays
    • Shifts must not exceed ACGME limits of up to 28 hours per shift, and up to 80 hours per week averaged over a 4 week period
  • where appropriate, comply with designated break lengths (to meet personal needs and not impact patient care)
  • Other functions/details specific to the program:
    • Typical clinical shifts are 8 a.m. – 5 p.m. on weekdays

Call Responsibilities

The Resident must:

  • complete assigned shifts of overnight call, as deemed essential by the program
  • complete assigned shifts of home call, as deemed essential by the program
  • remain within the prescribed geographic range while on call or eligible for coverage
  • Other functions/details specific to the program:
    • Assigned to up to one week of home call per month for the HMC sleep laboratory.
    • Must remain within a geographic range allowing for arrival at the sleep center within 30–60 minutes for urgent patient safety issues. 

Essential Cognitive Functions

Physiological Data Synthesis: Fellows must possess the ability to synthesize complex, multi-channel physiological data to accurately diagnose sleep disorders.  Critical Appraisal: Fellows must critically appraise scientific literature to implement evidence-based treatments.

Differential Diagnosis: Ability to perform complex differential diagnoses. 

Clinical Decision-Making: Formulating and adjusting multi-disciplinary treatment plans. 

Essential Communication Functions

Professional Reporting: Providing clear, concise written and verbal reporting of diagnostic results to referring physicians and multi-disciplinary teams. 

Patient Counseling: Conducting patient-centered counseling and motivational interviewing to support long-term adherence to chronic therapies. 

Standardized Handoffs: Utilizing the I-PASS format for verbal handoffs and comprehensive "Transfer of Care" emails to ensure patient safety during clinical transitions . 

Team Coordination: Effectively communicating with sleep team members to manage patient care. 

Essential physical functions

Visual/Sensory Perception: Fellows must have the visual acuity to recognize and analyze minute variations in high-resolution digital waveforms (EEG, EOG, EMG, ECG) over long periods during study interpretation.

Fine Motor Skills: Ability to perform or supervise precise patient "hook-up" procedures, including the manual placement of electrodes and respiratory sensors.

Mobility and Stance: Ability to move between multiple regional clinical sites (HMC, UWMC, SCH, and VA) and navigate hospital settings to provide bedside inpatient consultations. 

Technical Manipulation: Proficiency in operating and troubleshooting diagnostic software and durable medical equipment, including PAP machines and interface masks.

Statement Of Nondiscrimination

The University of Washington prohibits discrimination, harassment and sexual misconduct in any education program or activity that it operates. Individuals may report concerns, make complaints, or direct inquiries to the Civil Rights Compliance Office. View the Statement of Nondiscrimination.

Key Principles for ADA-Compliant Language:

  • Focus on results, not methods
  • Essential function is a completed task, not how that task is completed
More Inclusive Term Example of Physical Demand
Move/traverse Walk, run
Ascend/descend Climb
Transport Carry
Relocate Lift
Stationary position Sit, stand
Position, detect, operate Feel, handle
Maneuver Pull, push
Attain Reach
Retrieve from ground level Squat
Repetitive movement Performing a task repeatedly
Communicate Speak, talk, hear
Communicate in written language Write
Input data Use keyboard
Position self (to move) Crouching, stooping, crawling
Work atop Balance
Determine, identify, assess, recognize See
Assess Hear
Review Read
Adhere Remember
Apply Think

This document reflects requirements, established practices, policies, procedures, and resources as of the date of publication; however, parts of this document may be updated from time to time in accordance with changes in the law and applicable requirements, established practices, policies, procedures, and resources. Continued participation by a resident in the program will demonstrate agreement by the resident to adhere to the updates. The program will communicate changes to this document or established practices to residents via program leadership (Drs. Kapur, Palen, or Chan).