Periods	Pre-requisite	Sites & Slots	Hours	Weeks
1,2,3,4,5,6,7,8,9,10,11	BCC 7144 BCC 7184	2@T-VAH 2@TGH	FT, 44 hr wk	2,4

Drs. William Anderson, Robert Geck, and Daniel Schwartz

This elective is designed to introduce students to the practice of sleep medicine in an outpatient and inpatient setting. Under the supervision of clinical faculty, students will have the opportunity to practice in a university or hospital clinic setting. Students will also round with the preceptors in the hospital. The student will have exposure to interpretation of sleep studies and observation of the overnight recordings.

Objectives

List the clinical findings that are associated with a high pre-test probability of obstructive sleep apnea.
Compare and contrast central from obstructive sleep apnea.
Evaluate the business systems that are necessary for successful outcomes in the treament of patients in #1 & #2 above.
Describe the various presentations of a patient that may be referred for the clinal evaluation of insomnia.
Compare and contrast behavioral versus medication treatment for insomnia.
List the most common abnormal behaviors that occur during sleep (parasomnias).
Compare and contrast jet lag and shift work sleep disorder with advanced and delayed sleep phase syndromes (circadian rhythm disorders) in adults and children.

Methods

The trainee will see patients at the USF, VA and TGH Sleep clinics as well as in-patient consults. Trainees will participate in the Sleep Medicine conferences during their rotations. Trainees will be provided with the introduction to scoring of a sleep study as well as direct observation of a nocturnal recording. Upon completion of this elective, the trainee will have an understanding of the various things that can go wrong with patient's sleep in the middle the night. Furthermore, they will have a plan developed as to the diagnostic and therapeutic approach to each of these disorders.

Evaluation

The trainee will be evaluated by the course director or his designee, at the end of the course, based on the clinical evaluations completed by all fellows and faculty who work with them. An in-service exam will assess some of the ACGME six core competencies.

Grades are determined by: 75% clinical evaluations and 25% by final examination.

Learn to evaluate patients in rheumatology clinic and perform an appropriate history and physical examination, design an appropriate differential diagnosis, and diagnostic and therapeutic plans for the more common systemic rheumatic and musculoskeletal diseases
Recognize the clinical, laboratory, and radiographic features of the more common rheumatologic, and musculoskeletal diseases
nderstand the pathophysiology of the common rheumatologic, and musculoskeletal diagnoses
Learn to perform knee and shoulder aspiration injection on simulation models, and have the opportunity to perform on patients in a clinical setting

Didactics

Rheumatology Blackboard Website includes PowerPoints , links and interactive didactics for students, weekly Rheumatology conference with faculty and trainees, and Joint Injection Workshop with simulators.

Clinical experience

The student will have the opportunity to rotate with a variety of rheumatology faculty at sites including; USF Morsani Medical clinic, the James A. Haley VA Hospital Outpatient rheumatology clinic and inpatient rheumatology consult service, Tampa General Hospital rheumatology consult service, and 30th Street clinic. The students will be assigned to sites and faculty members in order to maximize the breadth of their clinical experience. The faculty will mentor the student during clinic sessions providing clinical teaching of rheumatologic differential diagnosis, evaluation, and management, and giving feedback on clinical skills. There are additional opportunities to have exposure to musculoskeletal ultrasound in the clinical setting.

Evaluation

The student will receive a final evaluation from the faculty preceptor with which they were assigned for the majority of their clinical experience. The student will also be evaluated on their PowerPoint presentation to faculty and trainees during the weekly rheumatology conference on a topic relevant to a patient seen in the clinical setting.

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