Our clinical experiences are designed to provide residents with robust training in the full spectrum of family medicine as well as to offer opportunities for exploring other areas of medicine and following individual passions.
With the exception of an inpatient OB rotation at Southern New Hampshire Medical Center in Nashua, NH, and an inpatient pediatric rotation at Maine Medical Center in Portland, required clinical rotations are based within our local hospital system.
The bulk of our clinical experiences are structured as four-week blocks. Outpatient continuity practice is longitudinal, and residents assume more patient-seeing time in their family medicine clinics as they progress through training. Some outpatient experiences, such as geriatrics, pediatrics, and OB/GYN, are organized as four-week blocks with additional exposure longitudinally. Inpatient adult medicine is arranged in a block format with progressive supervising, teaching, and patient care responsibilities within the inpatient service in the second and third years of training. See sample schedule for details.
There is a wide variety of elective opportunities, some of which are well established and others of which have room to be tailored to a 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. Elective choices include:
- Addiction Medicine
- EKG Reading
- Emergency Medicine – Acute Care
- Farmworker Health & Advocacy
- Functional Medicine
- Geriatric Medicine
- Gyn Procedures
- Hospital Medicine
- Integrative Medicine
- International Medicine
- Office-Based Procedures
- Palliative Care
- Rural Inpatient/Outpatient Medicine
- Sports Medicine
- Women’s Reproductive Health
As a training program for both allopathic and osteopathic family physicians, MDFMR believes it is important for allopaths to have exposure to osteopathic principles and practice, and for osteopaths to develop skill in osteopathic manipulative techniques.
All of our residents participate in monthly osteopathic education, usually in combined sessions. Our osteopathic faculty, sometimes in conjunction with our ONMM residents, are present as table trainers to help allopathic residents gain competence in palpation and basic manual medicine techniques and help osteopathic residents advance their OMT skills. Residents apply their osteopathic skills in family medicine practice under the supervision of OMT preceptors.
We provide robust training in obstetrics, with most residents averaging 70 vaginal deliveries before graduation. All residents spend 2 to 3 months on the labor and delivery floor at MaineGeneral Medical Center and one month in Nashua, New Hampshire. MaineGeneral Medical Center averages about 1,000 deliveries each year and has a Level II nursery with in-house pediatric hospitalist support 24 hours/day. Residents are required to complete at least 7 continuity deliveries by graduation with emphasis on providing the majority of prenatal, intra-partum, and post-partum care for patients in the context of a continuous family medicine relationship.
Residents gain skills performing procedures common to family medicine by working with an attending preceptor in dedicated procedure clinics and during regular office visits.
Other Clinical Opportunities
Acupuncture: Residents with an interest in medical acupuncture have the option to participate in a longitudinal acupuncture curriculum leading to certification by the American Board of Medical Acupuncture. See ACUPUNCTURE for details.
Basic dentistry: Access to dental care is a significant challenge in Maine, and especially so for adults living in poverty. This presents a unique opportunity to prepare our primary care physicians for rural practice by teaching them how to perform extractions and other basic dentistry. See DENTAL CARE for more details.
Addiction medicine: As in other parts of the country, Maine is increasingly experiencing an epidemic of adults struggling with opioid use disorder (OUD) and babies born with neonatal abstinence syndrome. Medication assisted treatment for pregnant people with OUD is offered at both of our family medicine training practices, and residents have the opportunity to join our treatment groups as a guest observer as well as take an addiction medicine elective with an experienced faculty attending to learn more about this facet of care. Residents also participate in a required four-week addiction medicine/behavioral health rotation during their second year of training.
In addition to prescribing buprenorphine, our comprehensive program for OUD includes prenatal care; care during labor, delivery, and postpartum; pediatric care for affected infants; group support; social work and nurse care management; and behavioral health services. Partners are also included in program services and are offered medication assisted treatment to support development of a healthy family unit.
Longitudinal abortion care: In addition to an optional clinical experience during their gyn rotation, residents interested in providing abortion services (especially in low-access areas) after graduation can apply to participate in a longitudinal experience to receive tailored, in-depth training with a larger volume of procedures, access to an online curriculum, and the opportunity to attend or present at a national reproductive health conference.