Certification of specialists in respiratory sleep medicine for the purposes of continuing professional developmen

Bonsignore M.R.

Cooper B.

De Backer W.

Mitchell S.

Penzel T.

Randerath W.J.

Riha R.L.

Rohde C.

Simonds A.K.

English

PubMed

Riha R. L.

Simonds A. K.

Bonsignore M. R.

Randerath W. J.

Archivio istituzionale della ricerca - Università di Palermo

Continuing professional development: Introducing the ERS international certificate in respiratory sleep medicine

Certification of specialists in respiratory sleep medicine for the purposes of continuing professional development http://ow.ly/4uX9309g3Hs.</p

Mitchell, Sharon

Riha, Renata L

Rohde, Gernot

Simonds, Anita K

Edinburgh Research Explorer

     Edinburgh Research Explorer                                      Continuing professional developmentCitation for published version:Mitchell, S, Riha, RL, Rohde, G & Simonds, AK 2017, 'Continuing professional development: introducing theERS International Certificate in Respiratory Sleep Medicine', Breathe, vol. 13, no. 1, pp. 11-14.https://doi.org/10.1183/20734735.001617Digital Object Identifier (DOI):10.1183/20734735.001617Link:Link to publication record in Edinburgh Research ExplorerDocument Version:Publisher's PDF, also known as Version of recordPublished In:BreathePublisher Rights Statement:Breathe articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.General rightsCopyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s)and / or other copyright owners and it is a condition of accessing these publications that users recognise andabide by the legal requirements associated with these rights.Take down policyThe University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorercontent complies with UK legislation. If you believe that the public display of this file breaches copyright pleasecontact openaccess@ed.ac.uk providing details, and we will remove access to the work immediately andinvestigate your claim.Download date: 11. May. 2020http://doi.org/10.1183/20734735.001617 Breathe | March 2017 | Volume 13 | No 1 11Continuing professional development: introducing the ERS International Certificate in Respiratory Sleep Medicinesharon.mitchell@ersnet.orgSharon Mitchell1, Renata L. Riha2, Gernot Rohde3,4, Anita K. Simonds5and the ERS Education Sleep Working Group61ERS Education, European Respiratory Society, Lausanne, Switzerland. 2Dept. of Sleep Medicine, Edinburgh Royal Infirmary, Edinburgh, UK. 3Dept. of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands. 4Network of Excellence in Community Acquired Pneumonia (CAPNETZ Stiftung), Medizinische Hochschule Hannover, Hannover, Germany. 5National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK. 6A full list of the ERS Education Sleep Working Group members and their affiliations can be found in the Acknowledgements section.What is the greatest challenge in the delivery of quality care to respiratory disease patients? Is it lack of resources, avoidable harm to patients, or more complex disease presentation? Healthcare delivery has been in the media spotlight in recent months across many countries and the question of how to deliver safe, effective and efficient care to patients remains at the forefront of political agendas at a national level. Education is the passport to the future and the European Respiratory Society (ERS) is in the unique position of being able to work with the most respected respiratory experts internationally in order to design and deliver educational activities to raise standards of training for our respiratory health practitioners.The challenge of delivering high quality care for patients is also true of respiratory sleep medicine. Inconsistencies in the diagnosis, treatment and management of sleep-related conditions emphasise the need for standards in practice and harmonised training and certification for medical practitioners managing respiratory sleep patients [1].In 2014 key medical education and respiratory medicine experts came together to plan the future of education within the ERS. The result of this seminar underpins the new direction of ERS education and the decision to move towards more comprehensive educational programmes using a blend of online learning materials, self-assessment multiple-choice questions, a mini-portfolio with personal mentoring and skills-based workshops and assessments. Such a programme has the intended purpose of bringing us one step closer to the overall aim of our healthcare systems: the enabling of medical professionals to deliver high quality healthcare to their patients.The ERS International Certificate in Respiratory Sleep MedicineThis training programme is designed to allow the ERS to consolidate and organise the delivery of education in respiratory sleep medicine. It will provide a framework for training, at a national and a local level, especially to address those countries where no structured training or certification exist [2]. Additionally, it has been discussed that this programme will, in the future, link key training centres together across Europe and allow specific sleep centres to become part of a network to share best practice in training and delivery of care to patients.Organised in a modular format, this continuing professional development programme in respiratory sleep will provide learners with the opportunity to @ ERSpublicationsCertification of specialists in respiratory sleep medicine for the purposes of continuing professional development http://ow.ly/4uX9309g3HsCite as: Mitchell S, Riha RL, Rohde G, et al. Continuing professional development: introducing the ERS International Certificate in Respiratory Sleep Medicine. Breathe 2017; 13: 11–14.Continuing professional development12 Breathe | March 2017 | Volume 13 | No 1follow core modules in key topic areas (figure 1). For knowledge-based modules it is intended to develop online materials with self-assessment. For skills-based modules (e.g. polysomography) future participants will have the option to access interactive online teaching materials, to attend a skills-based workshop and to complete a portfolio of tests with mentoring support from an expert. On successful completion of a module, participants will receive their certificate of competence in each specific topic area.All healthcare professionals working within respiratory sleep are eligible to partake in this training and the curriculum may be described as an inter-profession educational programme. It defines three specific target groups: 1) medics: those healthcare professionals who provide patient care by diagnosing, treating and managing respiratory sleep disorders; 2) advanced practitioners: those healthcare professionals who initiate and lead clinical practice, education and the development of services for respiratory sleep patients; 3) practitioners (allied health professionals): those healthcare professionals who provide patient care for the treatment and management of respiratory sleep disorders.How do I register for a specific module in respiratory sleep medicine?Participants can register to attend the European Respiratory Society/European Sleep and Research Society (ERS/ESRS) conference Sleep and Breathing 2017 in Marseille (April 6–8, 2017). A limited number of modules will be available for completion, allowing certification in polysomography, assessment of daytime sleepiness, continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV), respiratory conditions, and medicolegal aspects of sleep disorders. To obtain these certificates, participants will be required to attend specific sessions during Sleep and Breathing 2017 and to complete some follow-up learning objectives post-conference (those who register will receive continued learning support during the training period). Each module will require participants to continue through a learning programme consisting of several parts, each of which provide the opportunity to gain or update knowledge and basic skills in a specific topic or technique (key guidelines, reading materials and learning resources have been identified). To complete part one and move on to the next part of training participants will be asked to successfully complete an online multiple-choice test (a link will be sent to participants after attending Sleep and Breathing 2017). Part two of the training programme is important as it offers participants the opportunity to put theory into practice. The online portfolio will help participants build competence in respiratory sleep as they will be requested to complete a case portfolio as well as a few short assignments. During this process participants will be asked to propose a mentor to guide them and, if both parts of the training programme are successfully completed, the participant will receive the ERS module or technique certification in respiratory sleep medicine.Enrolment is open to all those attending Sleep and Breathing 2017. You do not have to be a member of the ERS to take part in this initiative but simply need to register for the sessions outlined above. Those who register for the skills-based workshops will be guided by a mentoring programme. As a prerequisite it is expected that all participants are working in the field of respiratory sleep medicine and have the necessary qualifications for their target group: 1) medics: must have medical specialist certification recognised in their country of practice; 2) advanced practitioners: must have a university Bachelor’s or Master’s diploma in an allied health field; 3) practitioners: must have a university Bachelor’s or Master’s diploma in an allied health field. An example of an educational programme can be found in figure 2.Target audienceDefining the target audience to ensure the best design and organisation of an educational programme fit for purpose has been the single most important development to come from the Anatomy andphysiology ofsleep andbreathingPaediatricsRespiratoryconditionsMedicolegalaspects ofsleep disordersCPD inrespiratorysleep medicineNon-respiratory sleep disordersTreatment andfollow-up Clinical assessmentDiagnostictechniques#Figure 1 Elements of continuing professional development (CPD) in respiratory sleep medicine. #:polysomography, continuous positive airway pressure (CPAP) treatment, assessment of daytime sleepiness.Continuing professional developmentBreathe | March 2017 | Volume 13 | No 1 13ERS Respiratory Sleep Task Force. For the first time within ERS education the curriculum modules are designed for all medical practitioners and allied health professionals working with respiratory sleep patients [3]. While this may pose a challenge across different countries depending on the legal requirements and allocation of tasks, the intention of this international framework for training is to improve practice and raise standards of care [1]. The second crucial development is the consideration and organisation of topics within ERS education (figure 3). This organisational structure guarantees the organisation and delivery of training at this tertiary level in a flexible way and considers two specific target groups: 1) respiratory medicine practitioners approaching a specific topic area (such as sleep) for the first time to develop a specialty; 2) respiratory medicine practitioners who would like to remain up to date and test their competence in specific topic areas. For the purpose of continuing professional development, trained specialists may choose which module or modules they wish to follow within a given timeframe according to their individual needs.Recognition of this qualificationWe hope that in the future any national- and local-level training programmes that wish to deliver standardised modules in respiratory sleep medicine will fully support this international educational initiative. For those who employ candidates from other countries, this training programme should be recognised as a high-quality qualification. Furthermore, as a high-quality programme, it should be recognised for raising standards of practice performance in those working in respiratory sleep medicine.The future of respiratory sleep trainingTo support the overall growth and true potential of this initiative, it is foreseen that ERS partners together with local training institutions will offer the tools for standardised training and assessment for those wishing to partake in the programme. The importance of the collaboration with the ESRS cannot go unnoticed as both societies work together to try and achieve a common framework for mutual recognition of modules. This will be particularly important for the ERS module in non-respiratory sleep disorders as the ERS will depend on guidance from the ESRS. While the ERS will certainly take a lead in the delivery of some of the modules, the primary goal will be to assist local training institutions to improve training and certification of their respiratory sleep training programmes by offering educational tools and strategies for implementation.Medical education has evolved from a didactic lecture-based training system to a more interactive learning process involving simulation and real-life experience. With the focus on high-quality patient care and safeguarding practice, lifelong learning and continuing professional development are crucial. For the first time a training framework has been assembled and published which emphasises both the essential Registration Knowledge Knowledge and skillsCertificate of competence in polysomographyRegister for polysomography skills workshop at Sleep and Breathing 2017Complete the background readingfor polysomographyAttend the skills-based workshop at sleep and breathing 2017Complete the online self-assessment multiple choice testComplete your mini-portfolio with guidance from an ERS faculty memberFigure 2 How to obtain a certificate of competence in a specific skills-based respiratory medicine module.Continuing professional development14 Breathe | March 2017 | Volume 13 | No 1elements required for the delivery of high-quality care to respiratory sleep patients (accounting for knowledge, skills and attitudes) [1] and how these may be attained in the setting of the ERS respiratory sleep medicine continuing professional development programme. To register for the programme, visit the Sleep and Breathing 2017 website (www.sleepandbreathing.org).AcknowledgementsWe would like to sincerely thank W. De Backer who has led this project, guided us through many questions and challenges in the development of the sleep curriculum, and helped make plans for its implementation. He is an integral part of the success in standardising training for respiratory sleep specialists in Europe. The collaborating members of the ERS Education Sleep Working Group are Maria R. Bonsignore (University of Palermo, Palermo, Italy); Brendan Cooper (Queen Elizabeth Hospital, Birmingham, UK); Thomas Penzel (Charité-Universitätsmedizin Berlin, Berlin, Germany); Winfried J. Randerath (Krankenhaus Bethanien, Solingen, Germany); Wilfried De Backer (University Hospital of Antwerp, Antwerp, Belgium).Conflict of interestSharon Mitchell is an employee of the European Respiratory Society. Further disclosures can be found alongside this article at breathe.ersjournals.comReferences 1. Mitchell S, Simonds A, Andreas S, et al. Introducing a core curriculum for respiratory sleep practitioners. Breathe 2015; 11: 50–56. 2. De Backer W, Simonds A, Horn V, et al. Sleep HERMES: a European Core Syllabus in respiratory disorders during sleep. Breathe 2011; 8: 61–68. 3. De Backer W, Mitchell S, on behalf of the respiratory Sleep HERMES Task Force. Respiratory Sleep HERMES: new considerations in project development. Breathe 2012; 9: 85–87.Trainedspecialistsin coretopic areasSleep OncologyOtherIntensive careSurgeryOccupationalPulmonary vacular diseases Paediatric respiratory medicineAirway diseasesRespiratoryinfectionsOtherTrainedspecialists(adult respiratory medicine)Other topicareasOther topicareasAdult curriculum contentPaediatricians with a special interest in respiratory medicineAdult curriculum contentOther topicareasGeneral paediatrics contentIn-training(adult respiratory medicine)Medical traineesInternal medicine etcBasic medical trainingFigure 3 How to define the target audience for continuing professional development in respiratory sleep medicine.

Continuing professional development:introducing the ERS International Certificate in Respiratory Sleep Medicine

Sharon Mitchell

Renata L. Riha

Gernot Rohde

Anita K. Simonds

Crossref

Breathe

Continuing professional development: introducing the ERS International Certificate in Respiratory Sleep Medicine

Certification of specialists in respiratory sleep medicine for the purposes of continuing professional development http://ow.ly/4uX9309g3Hs

Riha, Renata L.

Simonds, Anita K.

NARCIS 

Directory of Open Access Journals

Mitchell, S

Riha, RL

Rohde, G

Simonds, AK

Spiral - Imperial College Digital Repository

http://doi.org/10.1183/20734735.001617 Breathe | March 2017 | Volume 13 | No 1 11Continuing professional development: introducing the ERS International Certificate in Respiratory Sleep Medicinesharon.mitchell@ersnet.orgSharon Mitchell1, Renata L. Riha2, Gernot Rohde3,4, Anita K. Simonds5and the ERS Education Sleep Working Group61ERS Education, European Respiratory Society, Lausanne, Switzerland. 2Dept. of Sleep Medicine, Edinburgh Royal Infirmary, Edinburgh, UK. 3Dept. of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands. 4Network of Excellence in Community Acquired Pneumonia (CAPNETZ Stiftung), Medizinische Hochschule Hannover, Hannover, Germany. 5National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK. 6A full list of the ERS Education Sleep Working Group members and their affiliations can be found in the Acknowledgements section.What is the greatest challenge in the delivery of quality care to respiratory disease patients? Is it lack of resources, avoidable harm to patients, or more complex disease presentation? Healthcare delivery has been in the media spotlight in recent months across many countries and the question of how to deliver safe, effective and efficient care to patients remains at the forefront of political agendas at a national level. Education is the passport to the future and the European Respiratory Society (ERS) is in the unique position of being able to work with the most respected respiratory experts internationally in order to design and deliver educational activities to raise standards of training for our respiratory health practitioners.The challenge of delivering high quality care for patients is also true of respiratory sleep medicine. Inconsistencies in the diagnosis, treatment and management of sleep-related conditions emphasise the need for standards in practice and harmonised training and certification for medical practitioners managing respiratory sleep patients [1].In 2014 key medical education and respiratory medicine experts came together to plan the future of education within the ERS. The result of this seminar underpins the new direction of ERS education and the decision to move towards more comprehensive educational programmes using a blend of online learning materials, self-assessment multiple-choice questions, a mini-portfolio with personal mentoring and skills-based workshops and assessments. Such a programme has the intended purpose of bringing us one step closer to the overall aim of our healthcare systems: the enabling of medical professionals to deliver high quality healthcare to their patients.The ERS International Certificate in Respiratory Sleep MedicineThis training programme is designed to allow the ERS to consolidate and organise the delivery of education in respiratory sleep medicine. It will provide a framework for training, at a national and a local level, especially to address those countries where no structured training or certification exist [2]. Additionally, it has been discussed that this programme will, in the future, link key training centres together across Europe and allow specific sleep centres to become part of a network to share best practice in training and delivery of care to patients.Organised in a modular format, this continuing professional development programme in respiratory sleep will provide learners with the opportunity to @ ERSpublicationsCertification of specialists in respiratory sleep medicine for the purposes of continuing professional development http://ow.ly/4uX9309g3HsCite as: Mitchell S, Riha RL, Rohde G, et al. Continuing professional development: introducing the ERS International Certificate in Respiratory Sleep Medicine. Breathe 2017; 13: 11–14.Continuing professional development12 Breathe | March 2017 | Volume 13 | No 1follow core modules in key topic areas (figure 1). For knowledge-based modules it is intended to develop online materials with self-assessment. For skills-based modules (e.g. polysomography) future participants will have the option to access interactive online teaching materials, to attend a skills-based workshop and to complete a portfolio of tests with mentoring support from an expert. On successful completion of a module, participants will receive their certificate of competence in each specific topic area.All healthcare professionals working within respiratory sleep are eligible to partake in this training and the curriculum may be described as an inter-profession educational programme. It defines three specific target groups: 1) medics: those healthcare professionals who provide patient care by diagnosing, treating and managing respiratory sleep disorders; 2) advanced practitioners: those healthcare professionals who initiate and lead clinical practice, education and the development of services for respiratory sleep patients; 3) practitioners (allied health professionals): those healthcare professionals who provide patient care for the treatment and management of respiratory sleep disorders.How do I register for a specific module in respiratory sleep medicine?Participants can register to attend the European Respiratory Society/European Sleep and Research Society (ERS/ESRS) conference Sleep and Breathing 2017 in Marseille (April 6–8, 2017). A limited number of modules will be available for completion, allowing certification in polysomography, assessment of daytime sleepiness, continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV), respiratory conditions, and medicolegal aspects of sleep disorders. To obtain these certificates, participants will be required to attend specific sessions during Sleep and Breathing 2017 and to complete some follow-up learning objectives post-conference (those who register will receive continued learning support during the training period). Each module will require participants to continue through a learning programme consisting of several parts, each of which provide the opportunity to gain or update knowledge and basic skills in a specific topic or technique (key guidelines, reading materials and learning resources have been identified). To complete part one and move on to the next part of training participants will be asked to successfully complete an online multiple-choice test (a link will be sent to participants after attending Sleep and Breathing 2017). Part two of the training programme is important as it offers participants the opportunity to put theory into practice. The online portfolio will help participants build competence in respiratory sleep as they will be requested to complete a case portfolio as well as a few short assignments. During this process participants will be asked to propose a mentor to guide them and, if both parts of the training programme are successfully completed, the participant will receive the ERS module or technique certification in respiratory sleep medicine.Enrolment is open to all those attending Sleep and Breathing 2017. You do not have to be a member of the ERS to take part in this initiative but simply need to register for the sessions outlined above. Those who register for the skills-based workshops will be guided by a mentoring programme. As a prerequisite it is expected that all participants are working in the field of respiratory sleep medicine and have the necessary qualifications for their target group: 1) medics: must have medical specialist certification recognised in their country of practice; 2) advanced practitioners: must have a university Bachelor’s or Master’s diploma in an allied health field; 3) practitioners: must have a university Bachelor’s or Master’s diploma in an allied health field. An example of an educational programme can be found in figure 2.Target audienceDefining the target audience to ensure the best design and organisation of an educational programme fit for purpose has been the single most important development to come from the Anatomy andphysiology ofsleep andbreathingPaediatricsRespiratoryconditionsMedicolegalaspects ofsleep disordersCPD inrespiratorysleep medicineNon-respiratory sleep disordersTreatment andfollow-up Clinical assessmentDiagnostictechniques#Figure 1 Elements of continuing professional development (CPD) in respiratory sleep medicine. #:polysomography, continuous positive airway pressure (CPAP) treatment, assessment of daytime sleepiness.Continuing professional developmentBreathe | March 2017 | Volume 13 | No 1 13ERS Respiratory Sleep Task Force. For the first time within ERS education the curriculum modules are designed for all medical practitioners and allied health professionals working with respiratory sleep patients [3]. While this may pose a challenge across different countries depending on the legal requirements and allocation of tasks, the intention of this international framework for training is to improve practice and raise standards of care [1]. The second crucial development is the consideration and organisation of topics within ERS education (figure 3). This organisational structure guarantees the organisation and delivery of training at this tertiary level in a flexible way and considers two specific target groups: 1) respiratory medicine practitioners approaching a specific topic area (such as sleep) for the first time to develop a specialty; 2) respiratory medicine practitioners who would like to remain up to date and test their competence in specific topic areas. For the purpose of continuing professional development, trained specialists may choose which module or modules they wish to follow within a given timeframe according to their individual needs.Recognition of this qualificationWe hope that in the future any national- and local-level training programmes that wish to deliver standardised modules in respiratory sleep medicine will fully support this international educational initiative. For those who employ candidates from other countries, this training programme should be recognised as a high-quality qualification. Furthermore, as a high-quality programme, it should be recognised for raising standards of practice performance in those working in respiratory sleep medicine.The future of respiratory sleep trainingTo support the overall growth and true potential of this initiative, it is foreseen that ERS partners together with local training institutions will offer the tools for standardised training and assessment for those wishing to partake in the programme. The importance of the collaboration with the ESRS cannot go unnoticed as both societies work together to try and achieve a common framework for mutual recognition of modules. This will be particularly important for the ERS module in non-respiratory sleep disorders as the ERS will depend on guidance from the ESRS. While the ERS will certainly take a lead in the delivery of some of the modules, the primary goal will be to assist local training institutions to improve training and certification of their respiratory sleep training programmes by offering educational tools and strategies for implementation.Medical education has evolved from a didactic lecture-based training system to a more interactive learning process involving simulation and real-life experience. With the focus on high-quality patient care and safeguarding practice, lifelong learning and continuing professional development are crucial. For the first time a training framework has been assembled and published which emphasises both the essential Registration Knowledge Knowledge and skillsCertificate of competence in polysomographyRegister for polysomography skills workshop at Sleep and Breathing 2017Complete the background readingfor polysomographyAttend the skills-based workshop at sleep and breathing 2017Complete the online self-assessment multiple choice testComplete your mini-portfolio with guidance from an ERS faculty memberFigure 2 How to obtain a certificate of competence in a specific skills-based respiratory medicine module.Continuing professional development14 Breathe | March 2017 | Volume 13 | No 1elements required for the delivery of high-quality care to respiratory sleep patients (accounting for knowledge, skills and attitudes) [1] and how these may be attained in the setting of the ERS respiratory sleep medicine continuing professional development programme. To register for the programme, visit the Sleep and Breathing 2017 website (www.sleepandbreathing.org).AcknowledgementsWe would like to sincerely thank W. De Backer who has led this project, guided us through many questions and challenges in the development of the sleep curriculum, and helped make plans for its implementation. He is an integral part of the success in standardising training for respiratory sleep specialists in Europe. The collaborating members of the ERS Education Sleep Working Group are Maria R. Bonsignore (University of Palermo, Palermo, Italy); Brendan Cooper (Queen Elizabeth Hospital, Birmingham, UK); Thomas Penzel (Charité-Universitätsmedizin Berlin, Berlin, Germany); Winfried J. Randerath (Krankenhaus Bethanien, Solingen, Germany); Wilfried De Backer (University Hospital of Antwerp, Antwerp, Belgium).Conflict of interestSharon Mitchell is an employee of the European Respiratory Society. Further disclosures can be found alongside this article at breathe.ersjournals.comReferences 1. Mitchell S, Simonds A, Andreas S, et al. Introducing a core curriculum for respiratory sleep practitioners. Breathe 2015; 11: 50–56. 2. De Backer W, Simonds A, Horn V, et al. Sleep HERMES: a European Core Syllabus in respiratory disorders during sleep. Breathe 2011; 8: 61–68. 3. De Backer W, Mitchell S, on behalf of the respiratory Sleep HERMES Task Force. Respiratory Sleep HERMES: new considerations in project development. Breathe 2012; 9: 85–87.Trainedspecialistsin coretopic areasSleep OncologyOtherIntensive careSurgeryOccupationalPulmonary vacular diseases Paediatric respiratory medicineAirway diseasesRespiratoryinfectionsOtherTrainedspecialists(adult respiratory medicine)Other topicareasOther topicareasAdult curriculum contentPaediatricians with a special interest in respiratory medicineAdult curriculum contentOther topicareasGeneral paediatrics contentIn-training(adult respiratory medicine)Medical traineesInternal medicine etcBasic medical trainingFigure 3 How to define the target audience for continuing professional development in respiratory sleep medicine.

Continuing professional development:introducing the ERS International Certificate in Respiratory Sleep Medicine

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