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Rebuttal From Dr Fleishman et alRebuttal From Dr Fleishman et al

Sam A. Fleishman, MD; Nancy A. Collop, MD, FCCP; Amy J. Aronsky, DO, FCCP; Kathleen M. McCann
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From the American Academy of Sleep Medicine (Drs Fleishman, Collop, and Aronsky and Ms McCann); The Sleep Center (Dr Fleishman), Cape Fear Valley Health System; Emory University (Dr Collop); and Comprehensive Sleep Associates (Dr Aronsky).

Correspondence to: Sam A. Fleishman, MD, Cape Fear Valley Health System, Fayetteville, NC 28304; e-mail: safleishman@capfearvalley.com

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;144(1):13-14. doi:10.1378/chest.13-0361
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The concept that primary care providers and physicians trained in other specialties with limited sleep medicine training possess the expertise to diagnose and treat patients suffering with sleep disorders merely because they are common is very alarming and based on a weak premise. As Dr Simon1 acknowledges, the interpretation of sleep studies is complicated and requires intensive training. Less than 2 hours of total teaching time in US medical schools, however, is allocated to sleep and sleep disorders on average.2 As reported by Rosen and colleagues,2 37 of 126 surveyed medical schools indicated no structured teaching time related to sleep. And although sleep medicine is included as part of the curriculum for fellowship training programs in neurology, otolaryngology, pediatrics, psychiatry, and pulmonary medicine, the exposure resident physicians receive is extremely limited. This limited knowledge of the pathophysiology of sleep disorders, diagnostic tools for patient testing, interpretation of sleep studies, and long-term management of patients is not sufficient to qualify as “expertise.” The training program proposed by Dr Simon is also lacking in sufficient education and training. Although he states that a recent study suggests competency in interpretation is obtained after scoring 20 to 30 tests, he does not include the full finding of the study, which also calls for 4 months of dedicated training in sleep medicine.3 Furthermore, it is unclear how his program defines appropriate training as category 1 continuing medical education in sleep disorders. Is training in the interpretation of polysomnographic data or the pathophysiology of sleep disorders required training?

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