Curriculum
Core Rotations
Sample Schedule
Electives
Didactics
Procedures
International Opportunities
At Maine-Dartmouth Family Medicine Residency we believe that excellent family physicians are curious, thoughtful, and critical problem solvers who are committed to lifelong learning. They believe in and practice both the art and science of medicine. They recognize that an individual's health and well being cannot be abstracted from the environment in which they live. Thus, issues of relationship, family, culture, psychosocial health, spirituality, economic status, and life stressors are always relevant and often critical to the well being or illness of a given patient.
Implicit in our educational curriculum are these assumptions:
- Residents are adult learners each with individual learning styles. Though not all residents come to us having developed an understanding of their particular educational needs, part of our work as faculty is to facilitate this knowledge in order to maximize individual growth.
- Residents must feel both supported and challenged in their clinical learning.
- Independent clinical decision making, properly supported, is the best and fastest road to competence.
Most of the inpatient and major curricular topics are organized in 4-week blocks. During all but three away blocks, residents also have office hours in their home clinic site, maintaining continuity with their own panel of patients, including pediatric and pre-natal patients. Residents also follow patients who are in nursing homes or are home-bound. In addition to the block curriculum, several other topics are covered in a longitudinal curriculum – including psychiatry, osteopathy, urology, and integrative medicine.
We offer a wide variety of electives, some of which are well established and others of which have significant room to be tailored to the resident’s individual learning goals. Many of our community specialists have a particular interest in hosting and teaching residents; our local and international faculty and alumnae connections can lead to quite a diverse offering of elective topics and locations.
For details of the call schedule, please see Frequently Asked Questions.
First year
Orientation (1)
Inpatient Medicine/Family Practice (3)
Obstetrics (2)
Pediatrics – Inpatient / Outpatient (2)
Surgery (2)
Geriatrics (1)
Emergency Medicine (1)
Orthopedics / Sports Medicine (1)
2 sessions per week in continuity clinic
Longitudinal Integrative Medicine
Second year
Inpatient Medicine/Family Practice (2.5)
Night Float (4 weeks)
Obstetrics – Nashua, New Hampshire (1)
ICU (1)
Pediatrics – Inpatient / Outpatient (2)
Dermatology (1)
Orthopedics (1)
Gynecology (1)
Emergency Medicine (1)
Elective (1)
Community Medicine (2 weeks)
3 sessions per week in continuity clinic
Longitudinal Integrative Medicine
Group Prenatal Visits
Third year
Inpatient Medicine/Family Practice (2.5)
Night Float (2 weeks)
ENT (1)
Practice Management (1)
No Call Elective (1)
Longitudinal Elective / Senior Practice / Urology (7)*
4 sessions per week in continuity clinic
Longitudinal Integrative Medicine
*In each week of this block: 4 sessions of elective, 2 sessions senior practice,
4 sessions continuity clinic. In addition, there are 3-6 sessions of Urology per block.
Please note – There are 13 total blocks, 4 weeks each, in every academic year.
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| Obstetrics | ICU |
| Rural inpatient/outpatient |
Hospitalist |
| Office-Based Procedures | Gyn Procedures |
| Geriatrics | Palliative Care |
| Emergency Medicine - Acute Care | Sports Medicine |
| Cardiology | Pulmonology |
| Dermatology | Nephrology |
| Neurology | Oncology |
| Pediatrics | Women's Health |
| EKG reading | OMT |
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In addition to the experiential learning of block rotations, residents’ knowledge and skills are augmented with daily didactic lectures. Morning teaching rounds happen at both hospitals on the inpatient rotations, led by a rotating combination of senior residents, faculty and specialist attendings. We also have noon conference every day, covering an organized range of inpatient and outpatient topics. Grand rounds sponsored by the hospital are also weekly, hosting regional specialists from Portland and Boston and highlighting topics of interest led by local physicians.
Each Tuesday afternoon is dedicated to conferences that require a longer period of time, including procedural training, longitudinal psychology topics, ethics, literature in medicine, and case-based seminars particularly focused on chronic pain management, integrative medicine, and nursing home care.
In the last two years, we have developed a highly interactive, participatory procedural skills training format known as Clinical Skills Days. Our family medicine faculty design hands-on procedural models that have become very popular with residents and students. Faculty also “uncover” all inpatient services for these special sessions, allowing complete resident attendance. This past year, we have also begun to cover core outpatient medicine topics such as diabetes, hypertension in a similar intensive manner, incorporating EBM, board review, and individualized quality outcomes.
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We strive to train our residents in the wide range of procedures which are commonly performed by family physicians. Both family medicine centers in Augusta and Fairfield provide comparable facilities enabling residents based in either site to become familiar and comfortable with a multiplicity of office based procedures.
The most frequent procedures performed are the common office based surgeries."Lumps and bumps" including excisions of moles, nevi, cysts, warts, actinic keratoses, and skin tags are quite frequent. With the addition of a dermatologist to our faculty this year, we expect our volume of derm-related procedures to increase even further. Suturing lacerations, cryotherapy of lesions, joint injections, and skin biopsies are also taught. We are also proud of an ongoing innovative program of collaboration with local dentists, providing oral health and dental procedure training, including simple extractions, at both sites.
Both family practice centers are equipped to perform sigmoidoscopies, vasectomies and colposcopies. We serve as a referral site for other community physicians especially for vasectomy and colposcopy, thereby increasing the exposure to these procedures. We offer cervical cryotherapy training in both sites and exposure to LEEP procedures in Fairfield. Training in endometrial biopsy and manual vacuum aspiration in the office for completion of spontaneous abortions or retained tissue is available. Faculty with extensive experience in each procedure supervise residents and we strive to have a resident performing every procedure in each office.
Casting training occurs in both sites. Exposure to both medical and surgical elective abortion training occurs for interested residents both on their gynecology rotations and electively through local family planning clinics. Many residents choose to do one of their electives as a "procedure month" enabling them to concentrate on one or two procedures which particularly interest them or that they feel they will likely be called upon to perform in their future practices.
Please see also Frequently Asked Questions.
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Interest in and enthusiasm for international work runs high at MDFPR. Many faculty and residents come to us with experience in the international arena and many pursue those interests while training with us or on sabbatical.
Maine-Dartmouth has a unique (among family practice training programs) sabbatical program for its faculty. After 7 years of employment, faculty are entitled to 3 months of sabbatical. The majority of the faculty use that time to study or work in the international arena. Examples include Dr. Alto, who traveled to Vietnam, helping the country establish an emergency medical system and then to Australia for a month of lecturing about the family medicine system in the US. Dr. Clark worked in New Zealand for 3 months, and Dr. Jokonya has most recently worked in a rural hospital in Haiti. Please peruse the faculty bios for more international connections.
MDFMR is also part of a project linking four medical schools in Vietnam with four family practice residencies in New England. Our faculty have made faculty development visits to the Can Tho University in the Mekong Delta and physician faculty from Can Tho have visited Maine-Dartmouth to learn more about how the specialty of family practice is taught and practiced in the US. Click here to view a presentation on the first visit to Vietnam.
Several residents have taken advantage of faculty connections, traveling to the Guatemala, Vietnam and Belize for 2-4 weeks at a time on elective. Other residents have used their no-call-pool elective to work in particular countries where they have a personal connection or interest. In addition, several alumni of the residency and community family medicine attendings are involved in other international health organizations and are always happy to involve interested residents. An example is the Himalayan Health Exchange – an organization with several of our local physicians on the board.
We feel family practice training provides an excellent platform for those interested in long or short term international work. Our philosophy of preparing physicians for a lifetime of care in rural areas with emphasis on underserved populations clearly has significant implications for and connections to international work. Academic links to Dartmouth College and the University of New England for masters programs in the Clinical and Evaluative Sciences or Public Health respectively are also available for those interested in international work with a research or public health focus.
Please also see Frequently Asked Questions.