The German Sleep Society professionalized its services by introducing a number of quality improvements in sleep medicine. The first one was sleep center accreditation. This aims to set criteria for high and standardized quality for sleep centers. This relates to equipment, room settings, and structural components. The second quality issue was education. This aims to establish criteria and tests for sleep physicians and sleep technicians. More details are given here. The third quality issue aims at procedural and results of patient care. The assessment of this is done by a review of patient records and by questionnaires given to the patients diagnosed and treated in sleep centers.

            For education in sleep medicine the German sleep society has set educational curricula for three branches of qualifications. Qualifications can be given to a) physicians, b) psychologists and academic scientists, and c) medical technicians. To achieve the qualification each group has to spend a reasonable time in a sleep center being employed as a full-time person. This time period is two years or more for the three groups and has to be documented by a submission of the corresponding work contracts. During this time a fixed number of clinically relevant investigations has to be done (e.g. polysomnography, MSLT, sleep scoring, respiration scoring). These numbers are certified by the head of the sleep center. After the training phase an examination has to be passed by a board of the German sleep society. This face-to-face examination consists of a theoretical part and a practical part. During the theoretical part many aspects of sleep medicine and sleep research are tested. The questions are linked to standard text books for sleep medicine in Germany and cover the educational curricula as specified for the three groups.

            The practical exams test the ability set up a cardiorespiratory polysomnography on a volunteer under the eyes of the examiner. All sensors and electrodes have to be attached and tested by the examinee including a test of electrode impedance. The characteristics of sensors and electrodes must be explained in addition. The second part of the practical exam is actual sleep scoring, respiratory event scoring and PSG reporting. Also an MSLT has to be scored. The curricula were designed in an analogous way to curricula of other medical subspecialties, such as child cardiology, intensive care medicine, or sports medicine, which can be added to a primary medical specialty. From the beginning the German sleep society was seeking official recognition of sleep medicine as a medical subspecialty by the Chamber of Physicians in Germany. In 2005 this application was finally accepted by the General Assembly of Physicians. Now Sleep Medicine can be obtained as a certificate by the German sleep society or as an official subspecialty the Chamber of Physicians. The Chamber of Physicians copied the largest part of the curricula of the German sleep society and also the exams. Unfortunately they did not implement the practical examination part.

            We expect that the certificate of the German Sleep Society will become obsolete for the physician group, and will be important only for the psychologists and medical technician group. Importantly, the health insurances are beginning to recognize this specialty. In order to run an accredited sleep center the medical head must hold either the certificate of the German sleep society or the subspecialty sleep medicine issued by the Chamber of Physicians. There are over 320 accredited sleep centers in Germany, and about 400 holders of the certificate given by the German Sleep Society.

            Beside this success to establish Sleep medicine as a medical discipline in the German health care system, education at the university level is a little bit behind. At the universities with medical faculties there are only few dedicated sleep courses which are run by sleep centers. There are no departments and no professors for sleep medicine. Several professors have sleep medicine as one topic of their education in order to compensate this lack of official education.

            The German society for neurophysiology has also established a certificate to carry out polysomnography. This certificate is only available for physicians and is so far not recognized by the Chamber of Physicians or by the health care insurances. It is more a certificate of personal qualification within this medical society.

Thomas Penzel, Berlin, Germany