The Family Practice Centers of the Maine-Dartmouth Family Residency in Augusta and Fairfield, Maine as well as both in-patient campuses and affiliated nursing homes of the MaineGeneral Medical Center in Waterville and Augusta, Maine.
Duration 4 Weeks
Room & Board
Three student houses are available in the Augusta area, one which is lake-side and furnished in Belgrade Lakes, Maine, with full kitchen and washer/dryer. Heat, lights, local telephone service, wireless internet and cable are provided. Students supply their own linens. Meals are available at both the Augusta and Waterville campuses of the MaineGeneral Medical Center.
- Family Medicine with an outpatient emphasis
- Family Medicine Sub-Internship– inpatient and outpatient work
- Osteopathic Manipulative Medicine
- Hospice and Palliative Care
Maine-Dartmouth is also a core clerkship site for third year students from the University of New England College of Osteopathic Medicine and Dartmouth Medical School.
Comments from Student Evaluations
How were you accepted by patients?
“They made me welcome! It was great… I saw family medicine practiced the way I hope to do it, with compassion and rigorous attention to the recent literature.”
"Patients treated me as part of the team."
Suggestions for improvement?
“Sell this rotation… send info with comments and pics to students across the country. People will come and fall in love with the place.”
“Fun… made great friends I’d like to spend more time with…”
Would you recommend this rotation to other students and if so, why?
“Yes. You get to be a sub-I, not just a student. Good variety of patients, excellent teaching, and good relations with ancillary staff.”
Did you benefit from the experience?
“Yes, ...the experience was valuable for getting the big picture view of a patient’s experience in the hospital.”
How will this experience influence your future career?
“I feel even more strongly that I will pursue family practice. I loved the variety of experience – checking on a patient with r/o MI, going to the delivery of a baby, going to clinic to look at a rash. Fun stuff.”
“I appreciate the broad skill set and knowledge base needed to succeed in family medicine.”
In addition to the specific activities of each rotation, students are invited to attend 45-min. family practice noon conferences three days each week, transmitted to all sites via interactive television systems. Tuesday afternoon didactics are lecture based and are augmented by procedural and clinical skills training.
Students will work with resident and faculty preceptors regarding specific patient encounters. Faculty and residents will evaluate students’ overall performance. Students will meet with faculty for brief formative evaluation sessions. Final evaluation of student performance will be synthesized from these elements. Students are also asked to evaluate their clerkship experience.
Faculty supervisors include board certified family and specialist physicians, physician assistants, nurse practitioners, and a clinical psychologist. Significant teaching time is also provided by a number of board certified family physicians who are based in community practice settings, in many cases local rural health centers.
Setting – The Kennebec Valley, Maine
The Maine-Dartmouth Family Residency spans both semi-rural and rural environs, providing an ideal environment to learn, grow, and perform as a family physician. Augusta, the state’s capital and the site of our larger office practice and MaineGeneral Medical Center-Augusta campus, has a population of 21,000. Once a major textile and paper mill town, Augusta’s main employers today are the state government and several industrial centers. Nineteen miles (25 minutes by car) up the Kennebec River in Waterville (population 17,000) is MaineGeneral Medical Center-Waterville campus. Fairfield (population 7,000), the site of our smaller office practice, is located five minutes north of Waterville. Several colleges (Colby, Thomas, and the University of Maine/Augusta) are located in our catchment area.
Central Maine boasts farmland, forests, gentle hills, and an abundance of streams and lakes. Recreational activities include swimming, kayaking, sailing, canoeing, fishing, and hunting. Cold, snowy winters make for excellent downhill and cross-country skiing as well as ice-skating, sledding, and ice fishing. An hour’s drive east will bring you to the spectacular rocky coast of Maine. Opportunities to mountain bike, hike, and camp in the area include the Appalachian Mountains of Maine (Baxter State Park, Mt. Katahdin, the Bigelow Range, and the Moosehead Lake Region), and the coastal hills (Camden Hills, Acadia National Park). Sightings of deer, moose, fox, coyotes, eagles, loons, and seals are common.
Concerts, theater productions, and an independent fine-arts cinema are available locally. A diversity of fine restaurants are within a half hour’s drive. The local colleges provide additional cultural events. Day trips can be made to larger urban areas: Portland is located one hour south; Boston is 2 ½ hours south; and Quebec is 3 ½ hours north.
The patients of Maine-Dartmouth span all ages and socio-economic categories. We care for local farmers and fishermen, as well as professors and politicians. The majority of people in central Maine are Caucasian, and many strongly identify with a French-Canadian heritage, speaking French as their first language. Our community of immigrants has grown in recent years to include Cambodian and Somali families, among others. In the Augusta area, we are the main provider of health care for the uninsured as well as for the many mentally ill or developmentally disabled people who receive support through the state mental health system. We also partner with the Maine Migrant Health Association to provide care for primarily Haitian and Central American migrant workers who come to Maine in the summer and fall for blueberry, apple, and potato harvests.
Family Medicine with Outpatient Emphasis
Students are assigned to either the Fairfield or Augusta Family Practice Center and will see ambulatory patients 6-7 half days per week, both mornings and afternoons. The student may admit and care for, under the supervision of the Senior Practice Resident and faculty, any inpatients who come out of the student’s practice during the rotation. A typical day starts at 7:00 a.m. sign out; office practice at FPC 8:30 to 12:00; conference/lunch 12:00 noon to 1:00 p.m.; office practice 1:30 p.m. to 4:45 p.m.
The outpatient clinic experience is a mix of independent work as well as shadowing residents and faculty preceptors. Students have 2-3 sessions per week in the office with their own schedule of patients and their own preceptor, with responsibilities modeled after a resident practice. Students consistently enjoy this format which allows them to experience continuity of care, bringing patients back in follow-up in their own schedules. One day per week the student will either join the rural health center practice of one of the residency’s part-time family practice preceptors, or participate in some other relevant community practice experience (prenatal clinic, ER, family planning clinic, home health care visits, migrant health clinic, etc.).
Students will also cultivate clinical research and evaluation skills, and are expected to do an investigation of some primary care topic like an audit of charts at one of the Family Practice Centers, or a primary care research project. Supervision is provided by clinical faculty.
The specific knowledge areas which will be likely covered are perinatal care, immunization, family planning, postpartum care, care of the newborn, well-child care, acute care for many common illnesses, such as otitis media, upper respiratory infections, pharyngitis, lower respiratory infections, gastrointestinal diseases, urinary tract infections, common gynecological problems; and chronic care of diseases such as hypertension, diabetes, alcoholism, heart disease, cancer; and, preventive medicine including routine physicals. There will be a significant number of behavioral problems encountered, both on an acute and chronic basis. There are occasional home and nursing home visits.
Students will see patients in the mornings for routine and acute care at the local nursing homes under the supervision of the geriatric fellows, a resident, and faculty in geriatrics. One afternoon will be devoted to home visits, and one morning to work in a residency family practice center. Several sessions per week will be with fellows, faculty, nurse and social worker in both outpatient and inpatient geriatric consultations. Friday mornings are spent in a multidisciplinary geriatric assessment conference, reviewing the week’s patients with the geriatric team as above, also to include a physical therapist, neurologist, and geriatric psychiatrist.
Students will also cultivate clinical research and evaluation skills, and are expected to do an investigation of some primary care topic like an audit of charts at one of the Family Practice Centers or nursing homes, or a primary care research project. Students often have the opportunity to develop/produce a video as part of their project, as use of video for teaching and assessment is a special interest of Dr. Gershman, director of the Geriatric Fellowship.
Medical knowledge that will be reviewed includes evaluation and management of geriatric syndromes (including dementia, delirium, falls and gait disorders, incontinence), pharmacotherapy in geriatric patients, health maintenance goals, and an introduction to ethical and legal issues unique to older patients. Emphasis is also placed on the experience of working in multidisciplinary teams and the use of family therapy techniques in facilitating assessment of the older patient and their care-givers.
Family Medicine Sub-internship
Students will become a member of the Family Practice Center faculty and resident inpatient team. They will care for 2-5 inpatients, interacting directly with the attending to formulate treatment plans and meet with families. Students will take practice night call once a week with a senior resident and a faculty member and two weekend calls (Friday evening to Saturday noon).
One or two afternoons a week, students will see shadow senior residents in the outpatient clinic. Students will also work at least one afternoon a week with the resident on the inpatient service, managing hospital cross-cover issues and doing new admissions. This combination of inpatient and outpatient care most closely models the practice of a family medicine intern. Sub-I students are also involved in Tuesday afternoon teaching sessions.
The majority of medical knowledge reviewed on this rotation is linked to direct inpatient care and individual patients. Medical students will also be part of the morning inpatient didactic series, led by residents, family medicine faculty and local consultants. These didactics are a mix of case review, physical diagnosis rounds, and medical topic reviews. Students are expected to give one morning talk as part of their rotation. There is opportunity to participate in procedures common to inpatient medicine, including central line placement, LP, etc. Since the inpatient service in Augusta includes obstetrics and pediatrics, sub-I students in this site may also be involved in deliveries as well. The skill of documenting Admission H&Ps and Discharge Summaries efficiently and accurately is also emphasized, with mentorship from senior residents and faculty.
Osteopathic Manipulative Medicine
Student will work with osteopathic faculty in both the inpatient and outpatient setting with a focus on OMM techniques and the integration of manipulation into the typical primary care encounter. Our faculty teachers are experienced in the range of osteopathic techniques and treat patients in varied settings, from the newborn nursery to the Alzheimer’s care center. Details of this rotation are arranged directly with the Director of Osteopathic Education in order to meet your specific educational goals.
Recent student OMM electives have involved direct work with our osteopathic faculty in both a consultative and primary care role. Students also have taken the opportunity to experience the range of providers offering OMM in the community, working with osteopaths in an exclusively consultative practice as well as with primary care physicians in surrounding communities who have advanced osteopathic skills and an interest in teaching.
Hospice and Palliative Care
Students will explore symptom control and relief of suffering. End of life issues will be experienced and explored. Students will get a better appreciation of how to deliver “bad news”. Time will be spent with local hospice and Palliative Care Physicians as well as making home visits.
We welcome your enthusiasm for family medicine and invite you to learn more about Maine-Dartmouth.
We look forward to hearing from you!