title: How many polysomnograms must sleep fellows score before becoming proficient at scoring sleep?
abstract: OBJECTIVE
  In the field of sleep medicine, there is a paucity of evidence-based curriculum development strategies in the literature. We chose to determine the number of polysomnograms (PSG) necessary to be scored by sleep fellows in order to reasonably approximate sleep scoring by a Diplomate of the American Board of Sleep Medicine (DABSM).
  
  
  METHODS
  The fifth PSG scored by two sleep fellows during the 12 consecutive months of training was chosen for analysis. A DABSM not involved in the training of fellows scored sleep on each of the selected PSG with replication of montage and filter settings. Epoch by epoch comparison of sleep stage scoring is described as the frequency of concordance between fellow and DABSM (f correct).
  
  
  RESULTS
  The mean (SD) f correct for all PSG for each fellow was 0.83 (0.06) and 0.83 (0.08) (p = 0.93). Concordance between sleep fellow and DABSM approached 0.8 after scoring between 20-30 PSG. This milestone was reached after the fourth month of training. F correct was highest for stage 2 sleep and REM sleep and most variable for slow wave sleep and stage 1 sleep. The variability in f correct for these stages was in part related to the relative paucity of these sleep stages.
  
  
  CONCLUSIONS
  Scoring of sleep becomes reasonably proficient after scoring approximately 20-30 PSG and/or four months of dedicated sleep disorders training. A standard measure of concordance that corrects for epoch sample size may be helpful for use in future similar investigations.
authors.affiliation: Miami Sleep Disorders Center, 7029 SW 61 Avenue, Miami, FL 33143, USA. MiamiSleep@BellSouth.net
authors.forename: Alejandro
authors.initials: A
authors.lastname: Chediak
authors.forename: Belen
authors.initials: B
authors.lastname: Esparis
authors.forename: Richard
authors.initials: R
authors.lastname: Isaacson
authors.forename: Luis
authors.initials: L
authors.lastname: De la Cruz
authors.forename: José
authors.initials: J
authors.lastname: Ramirez
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Rodriguez
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abreu
mesh_terms: D000068:Accreditation / Q000331:legislation & jurisprudence / Q000592:standards* / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine / Q000458:organization & administration; D008875:Middle Aged; D017286:Polysomnography / Q000706:statistics & numerical data*; D011214:Practice, Psychological; D011361:Professional Competence; D012894:Sleep Stages / Q000502:physiology; D012893:Sleep Wake Disorders / Q000175:diagnosis*; D013038:Specialization; D013044:Specialty Boards / Q000458:organization & administration; D014481:United States