Curriculum / Core Rotations
Inpatient Medicine / Family Practice
Rigorous and holistic training in adult inpatient medicine is the goal of these rotations. At the FMI, our inpatient service is an integrated family practice service, caring for all patients from our practice that require hospitalization – including pediatrics, obstetrics, newborns, and intensive care patients. Residents also care for inpatients in collaboration with attendings from a nearby rural health center, Sheepscot Valley Health Center. Supervision on inpatient medicine is from a team of two family medicine residency faculty as well as from local specialists in consultation.
All residents have an additional month of ICU experience, working directly with our intensivists, covering all patients in the ICU. This rotation provides not only experience with the medical management of ICU patients, but also in performing related procedures such as central line placement and intubation. The hospitalist elective provides additional experience managing patients from community practices with the MaineGeneral hospitalist team, made up of family physicians and internists, several of whom are alumnae of Maine-Dartmouth. Our local specialists are also enthusiastic teachers, and block rotations in many specialties (including cardiology, pulmonology, nephrology, and oncology) are also available as electives for all residents.
At MDFMR we are committed to the belief and practice that obstetrics is an integral part of the work of family doctors. The broad knowledge base of the family physician and the relationship enjoyed between the physician and the family informs unique and continuous relationships that enhance the provision of routine obstetric and gynecologic care. The addition of a new family member is one of the most significant events in the life cycle of a family and one of the more exciting and pleasurable aspects of the work of family doctors.
Our training program aims to develop highly skilled practitioners in the art and science of obstetrics and gynecology with emphasis on family centered maternity care. We provide 3 blocks of required training in Obstetrics and one block in Gynecology. In addition, during the Maternal Child Health month in Augusta, residents cover OB and Pediatric patients and have opportunities to expand their skills in obstetrical ultrasound and breast-feeding support. OB electives offers the interested resident the potential for additional experience with local obstetricians, midwives or family physicians. Our residents provide obstetric services at both the Augusta and Waterville campuses, and have additional training in Nashua, NH with a focus on high risk obstetrics.
Our OB Faculty includes a range of provider types. Almost all of the residency’s family physicians provide obstetrical care, and we have one OB-GYN physician within the residency faculty. Residents also learn from numerous OB-GYNs and family physicians in the community, as well as local nurse midwives.
The specialty of Family Medicine is well situated to provide education in all aspects of pediatric and adolescent care. We are particularly interested in normal growth and development and fostering the critical clinical skills essential to the rapid identification of the seriously ill child. Additionally, we believe that the family physician is uniquely able to care for infants, children, and adolescents in the context of the family system in which they live.
Residents in our program have 4 blocks of required pediatric rotations with opportunity for further training in elective time. Rotations occur in both inpatient and outpatient settings with broad exposure to various pediatric specialties and support services. Residents round on the newborn and pediatric wards of the Waterville campus, and inpatient care of babies and children is an integral part of the family medicine service in Augusta. An intensive away Pediatric rotation is also required. Presently, residents are rotating on the inpatient pediatric services at Memorial Hospital in South Bend, Indiana. This rotations is designed to further develop residents’ abilities in the management of high volumes of ill children and highlight the importance of the family, community, and culture in promoting pediatric health.
Outpatient care of children is a part of each resident’s family practice office hours. In addition, we have a full time pediatrician on our faculty based in the Fairfield office. Dr. Beressi offers decades of experience in general pediatrics, and now works side by side with residents in the office setting. All residents, regardless of their home outpatient site, will work with Dr. Beressi during their outpatient pediatric rotation. This rotation also includes time in pediatric specialty clinics such as orthopedics, behavioral medicine, and developmental evaluation. In Augusta, residents also work in school based clinics at a local high school and in the busy offices of local general pediatricians. Further concentrated exposure to pediatric patients occurs within the FMI with focus on pediatric acute visits. Important technical skills such as the evaluation of the septic child are emphasized in both the inpatient and outpatient settings.
[ top of page ]
With three residency physicians certified in geriatrics, another in hospice and palliative care, and an ongoing geriatric fellowship, the geriatric experience for MDFMR residents is quite rich and comprehensive. Residents work directly with faculty and fellows in the care of geriatric inpatients as well as elders in nursing homes and the outpatient setting. On a daily basis, they participate in our multidisciplinary geriatric consultation team; evaluating patients from the community for dementia and other geriatric syndromes alongside colleagues in nursing, social work, physical therapy, psychiatry and neurology. Once weekly, residents participate in home visits and home safety assessments in the community. Patient care is supplemented with didactic lessons from fellows and faculty, made more memorable with patient videos from Dr. Gershman’s extensive collection. Residents leave this rotation not only with tools for geriatric assessment but also the knowledge of how to access community resources to facilitate the independence of their patients.
The provision of emergency medicine is a critical skill to the family doctor who may well, depending on practice location, be called upon to provide frequent emergency evaluation and stabilization to patients. Additionally, the family doctor often becomes the point of entry for people with emergent problems to the medical system. Every community served by our graduates will have an existing emergency medical system with unique strengths and weaknesses and the role of the family doctor within that system will vary. We aim to provide our residents with the critical skills of assessment, evaluation, diagnosis and stabilization required in the provision of emergency care. Family doctors need to provide these services while simultaneously providing comfort and reassurance to the family and patient in fearful and potentially dangerous medical situations. Numerous technical skills are developed while on emergency room rotations with emphasis on those most frequently encountered by the practicing doctor such as fracture and dislocation evaluations, lacerations (both simple and complex) and resuscitation. The resident will learn primary evaluation and management strategies for medical, psychiatric, and surgical emergencies involving all age groups.
[ top of page ]
Gynecology training is broad based and covers the full spectrum of primary gynecologic care including colposcopy, contraceptive options, and training in pregnancy termination if desired by the resident. Residents work one on one with a variety of providers including OB-GYNs who work within each of our resident practices as well as physician and physician assistant faculty with special skills and interest in gynecologic care and procedures.
Our educational approach is best exemplified by our daily work in the family medicine centers. In Augusta, the Family Medicine Institute (FMI), and in Fairfield, the Maine Dartmouth Family Medicine Center (MDFM) serve as the two outpatient sites for our residents. Residents are assigned to one of these sites for their three years and build their own practices, managing and caring for their panel of patients. A strong commitment to this outpatient training is evidenced by the considerable time residents spend in the family medicine centers: 2 half days/week minimum in the first year, 3 half days/week minimum in second year, and 4 half days/week minimum in the final year of training. While outpatient work always poses challenges for residents during in-hospital rotations, we believe the mix provides the best background for the realities of practice following residency. Several rotations in the second and third years provide even more intense exposure to outpatient medicine, involving broader responsibilities within the practice.
Opportunities to become skilled in the administrative complexities of practice management occur in the required practice management block in the third year and in the opportunity to serve on practice team committees.
Our two family medicine centers serve, in their respective communities, as the major source of medical care for a significant population of uninsured, underinsured, and Medicaid patients. As such, our residents care for high volumes of sick patients often with major comorbid illness and complex medical and psychiatric problems. We are deeply committed, as a residency, to the care of underserved populations and believe that the challenges provided by this population contribute enormously to our teaching and learning. In addition, we believe we provide excellent medical care to a population that often has had difficulty obtaining it.
[ top of page ]
Osteopathic Principles and Practices
Maine-Dartmouth educates both allopathic (MD) and osteopathic (DO) residents, and is dually approved by the ACGME and AOA. This provides an exciting opportunity for dialogue and mutual education between these two philosophies of education and practice. The osteopathic philosophy emphasizes a holistic approach to medicine as well as the fundamental relationship of anatomic structure to the pathophysiology and healing of any given disease. This perspective is easily compatible with the field of family practice.
The primary goal of our osteopathic curriculum is to integrate osteopathic manipulative medicine (OMM) and osteopathic philosophy into day to day practice. This is done through integration of OMM appointments into the clinic schedules of osteopathic residents, and bi-weekly "D.O. Doc Time." This time is divided between reserved patient seeing time for OMT with D.O. preceptors and hands on workshops. The didactic curriculum is two tiered: partly designed to include allopathic residents and faculty and partly for furthering the technical education of osteopaths. There are also regular noon lectures by the faculty of Maine-Dartmouth and the University of New England College of Osteopathic Medicine, through our association with the Northeast Regional Osteopathic Medical Education Network (UNECOM's OPTI).
Student and resident electives are available with community osteopaths and residency faculty who both specialize in NMM/OMM and integrate it into their primary care practices. We are also looking forward to developing clinical research in OMM and have a close relationship with UNECOM and the other residencies in Maine interested in research collaboration.
Integrative Medicine is incorporated longitudinally into the first two years of training. In year three, residents are assigned an integrative medicine block rotation. A variety of topics within integrative medicine are incorporated into the longitudinal curriculum. For example, discussions about alternatives to HRT, the management of hyperlipidemia, hypertension, and diabetes, wellness, and other topics are an integral part of the outpatient medicine curriculum. A popular case presentation series occurs bimonthly where local healers are invited to participate in a multi-disciplinary consultation with one of our patients. Residents meet local practitioners and learn how to develop collaborative relationships with them.
We are excited to begin our third year in a collaborative relationship with the University of Arizona to pilot a three year curriculum of integrative medicine for all residents. Through this program we hope to address many crucial elements of holistic care that are traditionally overlooked in medical school – including nutrition and self-care, in addition to an introduction to herbal medicine, acupuncture, homeopathy, etc.
Dr. John Woytowicz is leading our partnership with the University of Arizona and has authored several of the IMR online curricular modules. He completed a 7 month apprenticeship in 2004 with herbalist Rosemary Gladstar and is a reliable resource for practitioners and patients interested in herbal alternatives for common conditions. Dr. Woytowicz has also begun serving as an herbal consultant with the Alfond Center for Cancer Care here in Augusta. Residents also have the opportunity to collaborate with Dr. Richard Hobbs, a retired residency faculty member, who is now practicing exclusively acupuncture in the Waterville area.
[ top of page ]
Residents have a block curriculum in community medicine which is made up of a series of seminars that include such topics as social and mental health services and resources, public policy, epidemiology, developing world medicine, and occupational and environmental health.
In addition, both residents and faculty are expected to participate in one or more community activities of their choosing throughout their time at Maine-Dartmouth. As a group, faculty, staff and residents participate in an annual service “work retreat” typically offering time and physical labor at shelters, soup kitchens or other local service agencies.
Over the decades, resident community projects have been quite creative and widely varied. Some examples of current individual resident projects are listed below.
An ongoing partnership the residency is proud to maintain is with the Maine Migrant Health Association. Both faculty and residents volunteer time in monthly clinics and can schedule full-month electives caring for migrant farm-workers throughout the state.
Maine-Dartmouth is also pleased to be the recipient of a grant to fund a collaborative project with our local homeless shelter, Bread of Life Ministries. Together we are improving the access to and quality of care for their clients, many of whom are already our patients. Nina Miller is leading this effort and looks forward to involving residents in the development and implementation of this outreach.
[ top of page ]