Frequently Asked Questions
What is it like to live in Central Maine?
Are there other residency programs here?
What is call like?
How well do residents develop procedural skills?
How important is obstetrics in your curriculum?
How much teaching and didactics are there?
Are residents involved in teaching medical students?
What is osteopathy? What does it mean to be dually-accredited?
Are there opportunities and support for international rotations during residency?
Are there opportunities for research?
What is it like working in two hospitals?
Is there a difference between the Augusta and Fairfield clinic sites?
How are we assigned to a clinic site?
How well do people get along? Are residents involved in decision making?
What about time off?
Can I have a family while learning family medicine?
Does the residency support international medical graduates?
What do graduates end up doing?
Is there free food on Fridays?
So, why did you come here?
Life in Maine is truly unique – the pace is a bit slower and year round there are amazing outdoor opportunities. Augusta and Waterville are small towns nestled in a valley of peaceful lakes and rivers. Many of us live right on or near water – coming home from work in the summer is like being on vacation each night. Fishing, swimming, kayaking, and hiking as well as cross-country skiing and snow-shoeing can be daily activities.
Waterville is home to Colby College and Augusta is the state capital. Though “small towns,” both are host to a diverse and often quirky collection of cultural opportunities. Railroad Square Cinema in Waterville is a classic art house theatre and sponsors the Maine International Film Festival each summer. There are several eclectic and organic restaurants in the area as well as a great home-town brew-pub. We even have a family-owned sushi restaurant that can compete with any urban establishment! Our location in the center of the state also makes it easy to spend a weekend hiking in stunning Acadia National Park or visiting Portland or Boston for a fix of city life.
Finding work for partners and spouses has not proven to be a challenge for most people. Some residents live closer to Portland or Bangor to facilitate a partner’s commute, and our well-connected community of staff and faculty work hard to assist with transitions – everything from finding a used car to making day-care recommendations.
Though some of us are Maine natives who already know the secret of life here, we often find that those “from away” become hooked after three years and find it hard to leave!
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We are an unopposed family medicine residency program which means there are no other residents working in our teaching hospitals. Our program is based in a community hospital rather than a tertiary care center – this provides a learning experience that more closely represents the type of practice many of us plan to work in after residency. Because we are the only residents here, we never have to “compete” with other specialties and can be the primary physician involved with patients in all departments, from the ICU to labor and delivery. It also allows us to tailor our learning to our individual interests – the rare “slow” night on medicine call can be livened up by calling the ED and getting involved in procedures like central lines and lumbar punctures. We work directly with our family medicine attendings, as well as with our local specialists, who are all enthusiastic teachers. Though we do not have sub-specialists such as neonatology or interventional cardiology in our hospital, we interact directly with these attendings by phone and learn first-hand the skills of stabilization and transport needed to practice in a rural setting. Also, the nurses and other support staff of our hospital quickly get to know us on a first name basis and are another source of invaluable learning.
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First year residents do not take call. They cover the hospital and take admissions with the senior resident on night float. This is two-weeks at a time, two times a year. R1s also have night shifts on some other rotations once or twice monthly.
The call frequency for 2nd and 3rd year residents varies depending on your choice of rotations, but is on average two calls per month, in addition to night float. The residency is committed to compliance with ACGME and AOA work hour rules, and clinical responsibilities are never later than noon on your post-call day. Faculty are also quick to remind residents to go home and get sleep when their shift is complete!
We have a night float system of call for our family medicine service, between 2 to 4 weeks each year in the second and third years. Night float has definitely improved our quality of life when on the day-time service and also increases continuity of care for patients. Labor and delivery is covered with 12 – 14 hour shifts during the first year with 24 hour shifts for senior residents over the weekend.
There are also some rotations where call involves working with specialists and not covering a residency service. Call is usually from home for these rotations, which include surgery and ICU. Call from home does not mean no calls, however. Our attendings are quick to involve us in all their interesting cases and procedures. There is less call during the ER rotation because shifts are usually in the afternoons and evenings, to coincide with the periods of highest patient volume.
How busy is call? Honestly, some nights are busier than others. It is rare that you get no sleep, and usually there is time for a nap at some point. On the family practice service, a typical night includes 2-4 admissions or a delivery as well as 1 or 2 ER or OB evaluations. Residents also cover outpatient phone calls while on call.
Where do I sleep and eat? There are call rooms exclusively for the residents, all equipped with cable TV, a telephone, a refrigerator, a computer with internet access, a few medical texts and beds with clean sheets. Meals from the cafeteria are free for residents when on call.
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All residents are introduced to the core procedures of family medicine through approximately monthly hands-on didactic sessions with our family medicine faculty. This provides us a great introduction to each procedure (“See one, do one…) so that when the opportunity comes again in the office or the hospital, we are ready to jump in!
Procedures on the inpatient medicine service (thoracentesis, intubation, central lines, etc.) are done by residents, and precepted by specialists, ER attendings or our own family medicine faculty. Additional experience in any procedure of choice is easy to come by through setting up extra time with one of these attendings.
All residents spend one rotation away for a more intense inpatient pediatric experience in South Bend, Indiana. On both this rotation and the pediatric rotation in our own hospital we do septic work-ups, endotracheal suctioning of babies born through meconium and other common pediatric procedures.
During our surgery rotation we usually second-assist on major cases and first-assist on minor cases. Residents have a lot of leeway in determining what experiences would be helpful during their surgery rotations. There is ample opportunity for starting I.V.'s, placing central lines, and intubating patients preoperatively under the guidance of the anesthesia staff.
Residents perform office procedures on their own patients and those of our faculty under faculty supervision. These procedures include excision of lumps, bumps, and skin lesions, joint aspiration and injection, casting and splinting, vasectomies, and cryotherapy of warts and other lesions. We have developed a unique collaboration with local dentists and now are also trained in basic dental extraction. In addition, we have experience performing IUD insertion, endometrial biopsy, colposcopy and cryotherapy of cervical dysplasia working directly with our faculty. Colonoscopy and exercise stress testing are not part of our routine procedural training, but interested residents are able to pursue additional training in these areas. The opportunity to learn termination of pregnancy is also readily available but not mandatory through our local Family Planning office.
During inpatient family medicine and emergency rotations, residents gain more experience suturing and casting, as well as caring for trauma patients and running codes. Advanced Cardiac Life Support (ACLS) certification, Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation (NRP) is provided by the residency each year, and the residency pays a stipend for all first-year residents who wish to take an Advanced Trauma Life Support (ATLS) course. Many residents also elect to take Advanced Life Support in Obstetrics (ALSO) as CME.
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We believe that the practice of obstetrics is an integral part of caring for families. It is also among the most joyful facets of our work. At Maine-Dartmouth, all residents complete OB training, with an average of about 70 deliveries by graduation. Recently, some residents with a particular interest in obstetrics have performed as many as 130 vaginal delivers. Our core OB block rotations are in Waterville & Augusta. To gain more concentrated exposure to high risk patients, we complete one month on L&D in Nashua, New Hampshire alongside Dartmouth PGY-2 OB residents. In all locations, we first-assist on C-sections. Because of our rural location, we are able to stay involved and co-manage a variety of higher risk pre-natal patients with our local obstetricians, including twins and gestational diabetics. Most of our faculty provide obstetrical care in their practice and we work with midwives: allowing for education in a variety of labor management styles.
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Everyone learns in different ways, and much of traditional residency work supports learning in an independent, experiential way. Attendings and senior residents teach “on the fly” but there are also daily didactic lectures. Morning teaching rounds happen on inpatient rotations, led by a rotating combination of senior residents, faculty and specialist attendings. We also have noon conferences three days a week, 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, as well as highlighting topics of interest led by local physicians. Tuesday afternoons are dedicated teaching conferences that require a longer period of time, including procedural training, longitudinal psychology topics, ethics, literature in medicine, and case-based groups particularly focused on chronic pain management, integrative medicine, and nursing home care.
The residency is currently expanding didactic and educational offerings in two major directions. We are participating in a collaborative project with other residencies nationwide to offer a structured, longitudinal 3-year curriculum in integrative and holistic medicine. In addition, we are developing a case-based resource center for core outpatient topics. Both of these efforts are in response to feedback and requests from residents and students.
Maine-Dartmouth is also a host site for third year medical students from UNE-COM and Dartmouth Medical School as well as for fourth year students doing electives from all over the country. Residents are involved as teachers and preceptors of students in both the inpatient and outpatient settings. We find that teaching students is one of the best ways to really solidify your own learning.
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MDs have studied allopathic medicine whereas DOs have studied osteopathic medicine. Osteopathic medical school is a four-year training program that is structured much like allopathic training with an additional emphasis on primary care and osteopathic manipulative therapy. Proportionally, osteopaths actually provide more primary care than do allopaths, especially in rural areas.
Our program opened to osteopaths in 1994 and became dually accredited by the ACGME and the AOA in 2004. Allopathically trained residents, have the opportunity to train alongside otseopathic residents who are a great resource in diagnosing and treating musculoskeletal disease, daily. Osteopathic residents take part in an organized three year OMM curriculum and work directly with six osteopathic family medicine attendings as well as many more community preceptors. As a residency we are proud of our commitment to integrating osteopathy with full-spectrum family practice, both in the curriculum as well as in day to day office and hospital practice.
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Members of the residency community have contacts and past experience around the world and are happy to mentor residents and facilitate international experiences. Residents can use their “no call pool” elective for this purpose. Recently, residents and staff have participated in medical work in places such as Haiti, Vietnam, Nicaragua, Costa Rica, Kenya and Nepal to name a few. Please see Curriculum: International Opportunities for more details.
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Many of our faculty and all of our residents are involved in research, primarily related to clinical topics. Each resident is required to have an academic project, and support for this work comes from a faculty member with experience in research and publication. Some current research projects include the use of group visits and alternative therapies for chronic pain management, assessment and comparison of diagnostic testing for dementia, genetic screening in pregnant women, first degree prevention of cardiovascular disease in women, and efficacy of OMT in breast feeding difficulty.
In addition, several members of the faculty are authors of books in the The Little Black Book series of medical handbooks. Residents are often involved in literature review and assist in authoring chapters in these books.
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Maine-Dartmouth has a long history of collaborative relationships with all of the hospitals in our community. Over the years, the hospitals in Waterville and Augusta have come under one administration as MaineGeneral Medical Center. Residents have block rotations in both hospital sites in order to take advantage of the best learning experiences in each area. When on rotation in the opposite site, your continuity clinic in your home site will require a 25 minute commute a few times a week. Mileage is reimbursed for this travel. Despite this occasional inconvenience, those of us who plan to practice in small communities have found it helpful to compare the two different campuses; it's striking to see how hospitals, even in very similar communities, can differ in their strengths and weaknesses.
In December 2013, MaineGeneral will consolidate their two hospitals into a brand new hospital campus in North Augusta. This is an extraordinary opportunity for the residency. Consolidation will further strengthen our pediatric and obstretic rotations. The majority of our inpatient rotations will be sited at the new consolidated hospital and we will continue to provide outpatient care in both the Augusta and Fairfield communities.
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The Family Medicine Institute is located across the street from MaineGeneral Medical Center, Augusta campus. The FMI serves patients from Augusta as well as from surrounding rural areas. Due to its location, more patients of the FMI are able to walk to the clinic, and we have hadnotable exposure to patients with chronic mental health issues after the nearby state psychiatric hospital closed several years ago. The Maine-Dartmouth Family Medicine Center in Fairfield is approximately 5 miles from the MaineGeneral Medical Center, Waterville campus. It has a more rural setting and a smaller patient volume, thus it has fewer providers and staff. The Fairfield practice is notable for its numbers of pediatric patients, in part because our faculty pediatrician is primarily based in that site. Each site has its own "personality" - visiting both during the interview day is helpful in discerning between the two. Both have excellent faculty and staff, and both provide good exposure to a wide variety of clinical situations.
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After both matches (AOA and NRMP) are completed, the residency contacts each of us asking about the strength of our preference for one site or the other (Fairfield or Augusta). The sites do not have separate Match numbers. When the final decisions are made, resident preference is paramount, but an attempt is also made to balance gender of providers and osteopathic/allopathic training between the sites. For the next three years, we see our family medicine office patients at our assigned center. As mentioned above, each place has its own culture, but both offer a wide scope of practice and quality faculty.
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Residents, faculty and staff of Maine-Dartmouth share a commitment to providing comprehensive and compassionate primary care for our patients. At times, this work can be challenging in the face of patients’ poverty, lack of transportation, mental health concerns, language barriers, or our own struggles for personal balance. Our community of care providers is very diverse, with a wide variety of personal beliefs, customs, and medical training. This diversity leads to many different approaches to care and sometimes to spirited debate. We emphasize respect and celebration of our differences and support each other when our work becomes challenging. Because we are working together toward common goals, we find we do get along well as a community.
There is a weekly meeting of all residents in which we discuss issues affecting the program or us. From these meetings, the chief residents communicate residents' concerns to the faculty. Residents and faculty also meet quarterly in a “town-meeting” style noon conference.
Every year, changes are made to curriculum or other residency logistics which demonstrate not only the active role of the residents in helping to shape the program, but also faculty receptivity to residents' suggestions. Two recent examples of resident driven curricular change are the
inclusion of an introduction to osteopathic medicine program for the MD residents, and the consolidation of the majority of inpatient medicine training and call coverage to one hospital.
Away from work, residents form friendships in and outside the residency community. Residents get together on a regular basis for support and decompression, and for remembering how much fun we are having even though we're doctors. Throughout interview season, we host dinners for applicants twice a week, and find this a great time to relax and enjoy each others’ company as well as to share our program with our guests.
Faculty consistently expect that we interact with them on a first-name basis, and they feel like friends as well as mentors. These relationships are fostered by dinners together, and occasional parties which involve family and friends of everyone in the program. The faculty is also exceptionally dedicated to this residency, as evidenced by our low turnover rate when compared with most family practice programs.
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Each resident gets twenty paid days off (combined vacation and sick days) per year, the maximum allowed by the ACGME. There are also five CME days granted per year, and the conference stipend is $2,000 over the three years. Third year residents also get 3 days to interview. There are only a few rotations during which you can not take any vacation, and most rotations allow between 1-5 days of vacation. Holidays are divided evenly among the residents. Usually you work 2 holidays per year, only one of which is a major holiday (Thanksgiving, Christmas, or New Years). On each rotation, each resident always has at least one full weekend off.
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Many of our residents have children and all successfully maintain a variety of relationships with family and friends while at Maine-Dartmouth. Every year we have several new children born to residents and faculty – our community is always growing! The residency works hard to be as flexible as possible to support us in balancing our personal and professional priorities; we are all striving to be engaged members of our families and our communities as well as committed physicians. There is precedent here for shared positions and part-time work – if these ideas interest you, please feel free to contact us to learn more.
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Our selection committee individually reviews and considers applications that meet our criteria. We are open to training any medical graduate from any country who is genuinely interested in family medicine. Unfortunately, at this time we are only able to offer clerkships to active fourth year medical students.
Over the years we have welcomed international medical graduates to Maine-Dartmouth as residents, chief residents, fellows, and faculty and our community has only been the richer for it. Residents, faculty and staff gain not only a different clinical perspective from our international colleagues but are also challenged and strengthened by a continually growing diversity of beliefs, cultures, and perspectives on health and illness. Please feel free to be in touch with any of our residents to learn more about their individual experiences.
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Most graduates practice comprehensive family medicine with several each year doing OB. Though our goal is to provide excellent training to prepare for practice in a rural setting, our residents feel able to practice anywhere – including international and urban locations. We have had many graduates over the years with NHSC commitments. Some alums work in emergency medicine, and several have recently formed a hospitalist service for other private family practice groups in central Maine. Many of our graduates have an interest in teaching and have taken full-time academic clinical positions, and others serve as part-time preceptors in our program.
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There is free food every day for lunch, but it is never sponsored by drug companies. The faculty and residents at Maine-Dartmouth have established a policy of not accepting solicitations/gifts from drug company representatives. We feel very strongly that our education should be free from conflicts of interest, financial or otherwise, to the fullest extent possible. While the issue of drug reps may seem a minor one, it is characteristic of what attracted many of us to this program: a willingness to question assumptions about a physician's responsibilities, and a refusal to do things a certain way simply because of tradition.
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Most of us were drawn to this program by the exceptional mix of faculty and residents who are bound together by a commitment to medicine that is scientifically rigorous and yet always compassionate. A fly on the wall of the hospital wards or in our clinic preceptor rooms will find a lively give-and-take among faculty and residents, characterized by respect for experience as well as desire for fresh perspectives. During these discussions the guiding philosophy of our program is most apparent: we are all students, and we are all teachers. This respect that we hold for each other carries over into the respect we give to the people who are our patients. When the day is long and we are tired, our colleagues help us not to dehumanize our patients but to preserve their dignity.
Many residents choose to come here because of the residency's commitment to the underserved and to improving primary and preventative care in rural communities. We believe that the best way to prepare to practice in a community with limited resources is to train in a similar setting, with mentors who continue to practice full-spectrum care and hands-on learning as the rule.
Finally, there is life in Maine: one of the few areas in New England where community doctors practice the full range of family medicine in an incredibly beautiful setting. Residency can be a physically and emotionally challenging time, and there are few places as stunning as this in which to relax and seek personal balance. Listening to loons sing on a warm summer night or cross-country skiing on a pristine back-woods trail are an added bonus to fulfilling medical training. While there is no expectation that graduates will stay in Maine, it's not hard for us to understand why many do so.
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