Competency-Based
Classification for Sleep Medicine
A. Competency-Based Classification
There exists a variety
of approaches for classifying Individuals as sleep specialists. Some
classifications provide hierarchical classification based on professional group
while others cede most of the certification to the local licensing authorities. In general, certification can be based on
credentials, professional discipline, licensing, experience, training, testing,
or a combination of these elements. It is WASMs Standard of Practice Committee
position that certification should be based on competency vis-à-vis expertise.
This is especially true because tremendous variation exists in both resources
and expertise across geo-political regions.
With sleep disorders
becoming increasingly recognized by the medical community, public health
officials, and the general population, demand for sleep care services are
outpacing available expertise in many localities. While local licensing and credentialing
policies cannot be ignored, a step-wise, competency-based approach is offered
here for guidance. It should be
emphasized that the classification here concerns the requirements for
designation as a sleep specialist
and does not provide any permission to practice clinically. All medical and
clinical licensing requirements remain with local practice authority. Nonetheless,
this classification can be used as a guideline for the knowledge and expertise
needed to understand and treat sleep disorders.
To meet patient health
care needs, the best arrangement is for individuals certified as sleep
specialists to have extensive knowledge about sleep and sleep disorders. The
WASM curriculum can be used for guidance concerning subject-area content and
level of detail. In general content areas include sleep physiology,
epidemiology, clinical diagnosis, laboratory assessment, treatment, and
experience performing follow-up for longer-term clinical sleep care.
Professional level clinical expertise is needed in both behavioral and
pharmacological therapeutics.
The schema here defines
four sleep specialist classification levels and ranks them as satisfactory for
limited practice, good for limited practice, good for full practice, and
superior for full practice (see table 1). In a simplified form, this system can
be viewed as a hierarchy of adequate, good, better, and best.
B. Description of Sleep Specialist Classifications
1. Requirements to Attain “Superior” Rating for
Full Sleep Practice
Realizing that sleep
medicine did not suddenly burst into existence but rather evolved with the
support of pioneering individuals focused on sleep science, epidemiology,
diagnostics, treatment, clinical outcomes, and education. Moreover, many
clinicians were treating sleep disorders decades before the nosological
entities were systematically defined or recognized by the medical community or
third-party payers. Thus, true sleep specialists have existed long before this
classification of their expertise was even conceived. These experts served as
teacher-mentors in some of the earliest and current sleep medicine training
programs. For this reason, there are two sets of criteria for the top level of
sleep specialists.
Criteria I- Founders of the Field
This group subsumes the
founders of the field and recognizes their expertise. To qualify, individuals
must have a decade or more involvement in sleep research, clinical practice,
and sleep medicine education. Documentation includes a track record of
publication, teaching, and involvement in the broader sleep community. In localities that had pre-existing certification
examinations, these individuals should be board certified as sleep specialists.
Criteria II- Sleep Medicine Fellowship Trained
This group includes
those individuals that graduated from a 1-year (or longer) accredited sleep
medicine fellowship training program and have passed their examination to be
board certified in sleep medicine.
2. Requirement to Attain a “Good” Classification
for a Full Sleep Practice
This classification
includes clinicians competent in a specialty area that includes sleep disorders
as a subspecialty. Their professional training included diagnosis and treatment
of sleep disorders. To further their expertise in sleep medicine, these
clinicians either completed a subspecialty course or elective in sleep medicine
and acquired experience recognizing and treating sleep disorders. Their
experience should include seeing individuals with a wide spectrum of sleep
disorders under the supervision of a sleep specialist. Alternatively, for
individuals in an active clinical sleep practice that predates the existence of
formal fellowship or elective training programs, the practitioner should have
(for one year, or more) a documented minimum of one week for each two months
(i.e., and average of 2.5 days per month) training with a sleep
specialist. This mentorship and
supervision should include didactic training, case review, and polysomnographic reading.
3. Requirement to Attain “Good” Classification
for a Limited Sleep Practice
To qualify for this
classification, the individual should have documented competencies in a
specialty area that includes sleep disorders as a subspecialty (for example,
a neurologist diagnosing, treating, and
following patients with narcolepsy).
They should have, as part of their training, some specific focus
concerning the relevant sleep disorders and experience treating sleep disorders
typically encountered in their specialty practice (for example, a psychologist
performing cognitive behavioral therapy for insomnia). To further and widen
their education, these specialists should have documented attendance at
accredited professional-level educational programs covering the spectrum of
sleep disorders (for example, officially sanctioned continuing medical or
clinical educational courses offered at national meetings or reputable private
schools of sleep medicine). Additionally, the individuals should have a minimum
of a year’s experience in a clinical sleep practice with consultation available
from a sleep specialist.
4.
Minimum Satisfactory Requirement for a Limited Sleep Practice
The minimum requirement
for recognition as a sleep specialist for a limited practice is recognition of
competent in a specialty area that includes sleep disorders as a subspecialty
(for example, pulmonologist with experience diagnosing and treating sleep
apnea). This entry-level sleep specialist should have some professional
training, coursework, and a minimum of 6-months experience treating sleep
disorders typically encountered in specialty practice. Such individuals are
strongly encouraged to acquire additional training in order to move up the
hierarchy outlined in this classification.
Exam
Logistics
Existing sleep
societies may request having the WASM Examination administered to candidates
wishing for WASM certification. When the WASM Governing Board approves a site
for examination, an Examination Joint Operations Committee is formed. The WASM
Exam Committee with submit an overview of the proposed summary content and this
will be reviewed and modified (if needed) by the Joint Operations Committee.
Once the overall content summary is agreed upon then a draft exam will be
extracted and constructed from the Question Bank. If necessary, the exam will
then be translated (and back-translated) and the results will be reviewed. The
examination will be administered with verification locally that the test taker
is the certified candidate. Test results will be blinded and scored. Problem
questions will be identified by the WASM Examination Committee and the actual
questions and translations (when appropriate) will be sent to the joint
committee for adjudication.