Curriculum

The major focus of the Eastern Maine Medical Center Family Medicine Residency Program is to train residents to practice in rural settings. In order to accomplish this, the curriculum is designed to address specific aspects of medical care in rural populations.

In addition to the required rotations, residents are responsible for outpatient and inpatient care of their family practice center patients.

Although most rotations are reasonably demanding, at EMMC we recognize the need to balance experience with education. Therefore, residents' schedules allow sufficient time for discussion of interesting cases. Our faculty has a wide range of expertise in a variety of areas to provide teaching and consultation on all patients.

Residents are encouraged to establish links with the community. Home care and nursing home visits, with support from community organizations and faculty, are encouraged. Regularly scheduled hospital conferences presenting a variety of topics, are sponsored by the following departments: obstetrics/gynecology, pediatrics, family practice, pathology, orthopedics, emergency service, urology, surgery, and dermatology. Weekly half-day conferences are held to address a broad range of medical and behavioral medicine issues.

Wednesday afternoons are reserved for continuing education for residents and faculty. Lectures begin after a free lunch and cover family medicine topics, as well as allows time for journal club presentations by residents, patient case presentations, Balint group, support group and resident meetings.

Adult Medicine Teaching Service
This is an inpatient Internal Medicine rotation covered by one PGY-3 Resident, one PGY-2 Resident, and two PGY-1 Residents. Twelve weeks as PGY-I, six weeks as PGY-2, six weeks as PGY-3.

The Adult Medicine curriculum is presented throughout the three years of residency training. On this rotation, a team of two first year residents, a second year resident, and a third year resident cover a busy inpatient service. The third year resident serves as a senior resident, overseeing the care given by the first and second year residents and assumes a major teaching role.

Patients admitted to this service exhibit most of the common problems treated by primary care physicians. Teaching emphasis is on cardiovascular disease, including myocardial infarction and congestive heart failure; infectious disease; neurological disease; rheumatoid disease; gastrointestinal disease; hematology; oncology; endocrine disease; and substance abuse rehabilitation. Patients without primary care physicians in the area, selected patients of service attending, and other interesting cases are admitted to this service.

Average week for a PGY 1 Resident on AMTS.
Monday 7:00 am - Morning Sign-out
8:00 am-12:00 pm - Rounding on Medicine Patients
12:00 pm - 6:00 pm - Finish Rounds, Time for Walk Rounds, Admit New Patients to Service
6:00 pm - Evening Sign-out
Tuesday 7:00 am - Morning Sign-out
8:00 am -11:30 am - Rounding on Medicine Patients
11:30 am - ALCS Review Rounds
1:15 pm - 5:00 pm - Continuity Clinic at Center for Family Medicine
6:00 pm - Evening Sign-out
Wednesday 7:00 am - Morning Sign-out
8:00 am -10:30 am - Rounding on Medicine Patients
10:30 am - Cardiology Rounds
11:15 am - Radiology Rounds
12:00 pm - 6:00 pm - Finish Rounds, Time for Walk Rounds, Admit New Patients to Service
6:00 pm - Evening Sign-out
Thursday 7:00 am - Morning Sign-out
8:00 am -10:30 am - Rounding on Medicine Patients
10:30 am - Infectious Disease Rounds
12:00 pm - 6:00 pm - Finish Rounds, Time for Walk Rounds, Admit New Patients to Service
6:00 pm - Evening Sign-out
Friday 7:00 am - Morning Sign-out
8:00 am -10:30 am - Rounding on Medicine Patients
10:30 am - Weekly Evaluation of Residents
12:00 pm - 6:00 pm - Finish Rounds, Time for Walk Rounds, Admit New Patients to Service
6:00 pm - Evening Sign-out
Saturday/Sunday Team consists of one PGY3/PGY2 resident with one PGY1 resident per day
7:00 am - Morning Sign-out
8:00 am - 6:00 pm - Round on Patients, Admit New Patients to Service
6:00 pm - Evening Sign-out

Airway Management
One week required rotation in the anesthesia department learning airway intubation techniques.

Behavioral Medicine
A full-time PhD Clinical Psychologist directs our Behavioral Medicine program. The Behavioral Medicine curriculum is longitudinal and offers courses in individual and family life psychosocial, human sexuality, death and dying, psychopathology, addictive disorders, family dysfunction, and much more. Residents learn to construct genograms to identify significant family patterns that influence illness and its treatment, conduct diagnostic interviews and brief clinical interventions. Major learning opportunities for residents are afforded through videotape supervision of patient encounters and small group seminars. The residency is committed to the emotional well being of its residents. Postgraduate medical training places significant stress on the resident, their spouse or significant other, family and friends. To help deal with this stress, the program facilitates resident support groups, spouse/significant other support groups as well as Balint groups.

Cardiology
Three week required rotation with Northeast Cardiology Associates.

Community Medicine
Four week required rotation which puts the resident in various community situations including, free women's clinic, STD clinic, substance abuse recovery centers and local elementary schools.

Dermatology
Dermatology is taught on a longitudinal basis throughout the three years of residency as well as in two, one week blocks with outpatient dermatologists. One week is spent in a pediatric dermatology clinic and the other in an adult dermatology clinic.

Electives
Electives are offered in allergy, endocrinology, gastroenterology, infectious disease, nephrology, nutrition, neurology, occupational medicine, pain management/rehab medicine, podiatry, family violence, behavioral medicine, international health, osteopathic medicine, family counseling, pulmonology, radiology, research, rheumatology, sports medicine and women's health. Individualized electives may be set up by residents, subject to approval by the residency director.

Emergency Medicine
Four week required rotation spent in the Emergency Department at EMMC.

ENT
Two week required rotation with local Otolarygnologist.

Ethics
Rotation taught within the three year curriculum to include participation in medical ethics boards and lectures given by family medicine attendings.

Family Medicine Continuity Clinic
From your first day as a resident you are assigned a panel of patients. Each week you spend a certain amount of time in continuity clinic. As a PGY-1 you spend one half day a week in clinic, as a PGY-2 you spend two half days in clinic, and as a PGY-3 you spend three half days in clinic.

Geriatrics
Geriatrics is taught in a longitudinal fashion throughout the three years of residency and in a four week required rotation. Training occurs in the Center for Family Medicine , nursing homes, inpatient units, and the rehabilitation unit. Home visits are encouraged. Geriatric functional assessment and participation as a member of an interdisciplinary geriatric health care team are emphasized.

Gynecology
A four week rotation in Gynecology is required. OB/GYN's and Family Physicians with expertise in gynecology present a curriculum that includes colposcopy, contraception, infertility, GYN endocrinopathies, hormone replacement therapy, prevention of osteoporosis, STD's and breast disease.

Night Float
"On call" responsibilities are a necessary part of residency training. Being "on call" provides residents with the opportunity to gain valuable experience managing a variety of clinical problems as they arise, as well as allowing residents to gain a sense of confidence and autonomy. Conversely, most of the educational benefit of re sidency is missed if residents are excessively fatigued. To relieve this, the EMMC Family Medicine Residency Program has instituted a night float system to cover the Internal Medicine and Family Practice Teaching Services. Residents are scheduled to perform "night float" in two week blocks. Residents performing "night float" have no daytime responsibilities.

Obstetrics
The Maternity Care curriculum is taught both in the inpatient and outpatient setting. The structured inpatient experience at EMMC occurs during all three years of residency. EMMC averages 1500 deliveries annually. Residents participate in all Family Practice Center and some private deliveries. A broad curriculum in obstetrics is presented which includes: recognition and treatment of complications of pregnancy, basic obstetrical ultrasound skills, labor and delivery management, and recognition and treatment of complications during labor and delivery. The EMMC Center for Family Medicine serves as the training site for the outpatient portion of the Maternity Care curriculum. The Center cares for over 400 prenatal patients per year. Thus, residents have ample opportunity to learn to manage patients during the prenatal period. They also learn to manage the majority of complications that occur during pregnancy. These include: first trimester bleeding, third trimester bleeding, premature labor, hypertension in pregnancy, gestational diabetes and management of pregnant patients with significant medical problems. Residents are able to follow high-risk pregnancy patients with appropriate obstetrical and/or perinatology consultation. A unique aspect of the Maternity Care inpatient and outpatient curriculum is that the vast majority of it is taught by Family Physicians with significant obstetrical experience. A part-time obstetrical faculty member and a perinatologist add the perspective of a specialist to the curriculum.

Average week for a Resident on Inpatient Obstetrics
Monday 24 hour OB Call Starts
8:00 am - 9:00 am - Morning Sign-out and Attending Rounds
9:00 am until 8:00 am - following morning round on post-partum patients, laboring patients, deliver babies, first assist obstetricians with C-sections, round on newborns, perform circumcisions, evaluate antepartum patients, prepare presentation for am rounds
Tuesday 7:00 am - 8:00 am - Pre-round on Postpartum, Laboring, and Newborn Patients
8:00 am - 9:00 am - Attend Morning Sign-out and Attending Rounds
9:00 am-10:00 am - Neonatologist Rounds
10:00 am - 24 hour OB Call ends; Post Call - No inpatient/outpatient requirements
Wednesday 8:00 am - 5:00 pm - Continuity Clinic or Gynecology clinic
Thursday 24 hour OB Call Starts
8:00 am - 9:00 am - Morning Sign-out and Attending Rounds
9:00 am until 8:00 am - following morning round on post-partum patients, laboring patients, deliver babies, first assist Obstetricians with C-sections, round on newborns, perform circumcisions, evaluate antepartum patients, prepare presentation for am rounds
Friday 7:00 am - 8:00 am - Pre-round on Postpartum, Laboring, and Newborn Patients
8:00 am - 9:00 am - Attend Morning Sign-out and Attending Rounds
9:00 am -10:00 am - Neonatologist Rounds
10:00 am - 24 hour OB Call ends; Post call, no inpatient/outpatient requirements
Saturday OFF
Sunday 24 hour OB Call starts

This Q3 day call schedule continues for three weeks.

Ophthamology
One week required rotation with local Ophthalmologist.

Oseteopathic Internship
Since 1990 the EMMC Family Medicine Residency Program's PGY-1 year has been accredited by the American Osteopathic Association (AOA) as a "T type" osteopathic internship.

In order to maintain our osteopathic interns' and residents' professional identity and continue their osteopathic education, we have integrated osteopathic principles and practice into the residency curriculum. This curriculum includes:

Once a month, respected lecturers/clinicians in osteopathic medicine give didactic sessions. One half day per month is devoted to an Osteopathic Specialty Clinic for patients with difficult musculo-skeletal problems referred from the EMMC Family Practice Center. Osteopathic residents are encouraged to actively apply osteopathic techniques to diagnose and treat patients they see in the EMMC Family Practice. The Center has patient rooms with osteopathic treatment tables where OMT can be performed.
A full time faculty member and part time preceptors with skills in osteopathic medicine are available to residents for telephone and on site consultation if desired.

All osteopathic manipulation documentation is reviewed. Residents receive feedback on appropriate use of osteopathic manipulation.

A two to four week elective rotation is available for interested MD or DO residents.

Pediatrics
The Neonates, Infants, Children, and Adolescents curriculum is taught in both the inpatient and outpatient setting.

The inpatient experience requires four months of training. Residents function as a team, caring for patients that are admitted to the pediatric teaching service. The rotation includes involvement in the neonatal intensive care unit. Four full-time neonatologists provide teaching and assessment, resuscitation, stabilization and preparation for transport of newborns.

Pediatricians and Family Physicians provide the majority of teaching on this rotation. Rounds and teaching conferences are held daily.

The Pediatric Inpatient Service has more than 1,600 admissions per year. EMMC serves as a pediatric tertiary care center for northern and eastern Maine. The unit also serves as the inpatient treatment center for all the community Pediatricians and Family Physicians who have pediatric patients requiring admission. This combination allows residents to be exposed to both common pediatric problems as well as those seen in tertiary care centers.

In February 1994, a new Inpatient Child's Center opened on the top floor of the hospital. This family-centered care unit contains 14 general pediatric beds, a four-bed adolescent unit, and a six-bed Pediatric Intensive Care Unit. Each room has a bed for a parent to stay with their child if they desire. There is adequate family support space with areas for families to cook, eat and relax, a teenage recreation room, a young child playroom, and a large community living area. A large conference room, a resident on-call room and an interviewing room are also available on the unit.

The outpatient Pediatric rotation allows residents to gain a perspective of how general pediatricians care for their patients in the outpatient setting. The outpatient Pediatric curriculum is also taught longitudinally in the Family Practice Center. Resident patient panels have a large number of pediatric patients, allowing them to care for children with a Family Practice perspective.

Inpatient Pediatrics

Average week for a PGY-1 Resident on Inpatient Pediatrics.
Monday 7:00 am - Morning Sign-out
7:30 am -9:00 am - Rounding on Pediatric Patients
9:00 am -10:00 am - Table Rounds with Attendings
10:00 am -12:00 pm - Finish Rounds, Time for Walk Rounds, Admit New Patients to Service
1:15 pm -5:00 pm - Continuity Clinic at Center for Family Medicine
Tuesday 7:00 am - Morning Sign-out
7:30 am - 8:00 am - Rounding on Pediatric Patients
8:00 am - 9:00 am - Radiology Rounds
9:00 am -10:00 am - Table Rounds with Attendings
10:00 am -7:00 pm - Finish Rounds, Time for Walk Rounds, Admit New Patients to Service
7:00 pm - Evening Sign-out
Wednesday 7:00 am - Morning Sign-out
7:30 am - 9:00 am - Rounding on Pediatric Patients
9:00 am -10:00 am - Table Rounds with Attendings
10:00 am - 7:00 pm - Finish Rounds, Time for Walk Rounds, Admit New Patients to Service
7:00 pm - Evening Sign-out
Thursday 7:00 am - Morning Sign-out
7:30 am - 9:00 am - Rounding on Pediatric Patients
9:00 am -10:00 am - Table Rounds with Attendings
10:00 am - 7:00 pm - Finish Rounds, Time for Walk Rounds, Admit New Patients to Service
7:00 pm - Evening Sign-out
Friday 7:00 am - Morning Sign-out
7:30 am - 8:00 am - Rounding on Pediatric Patients
8:00 am - 9:00 am - Walk Rounds with Attending
9:00 am -10:00 am - Table Rounds with Attendings
10:00 am - 7:00 pm - Finish Rounds, Time for Walk Rounds, Admit New patients to service
7:00 pm - Evening Sign-out
Saturday/Sunday One resident on service per day, alternating between PGY-1/PGY-2/PGY-3 on service. In one three week rotation a “Golden Weekend” off is alternated between residents on service.
7:00 am - Morning Sign-out
8:00 am -7:00 pm - Round on Patients, Admit New Patients to Service
7:00 pm - Evening Sign-out

Practice Management
A three year practice management curriculum is required and includes seminar and didactic presentations throughout the year for all residents.

Procedure Clinic
Procedure clinics are scheduled to allow residents to become proficient in several office based procedures including: lesion removal, circumcisions, colposcopy, LEEP, flexible sigmoidoscopy, cryotherapy, endometrial biopsy, IUD insertion and removal, vasectomy, nail removal and more.

Rural Rotation
A one month experience at a designated rural rotation site is required during the second year. A curriculum emphasizing rural medicine has been established for this rotation. Maternity care, geriatrics, orthopedics, general outpatient management of acute and chronic medical problems and practice management are emphasized during this experience. During this rotation, the resident is expected to become a member of the rural community as if he/she were a private physician practicing there.

Sports Medicine
Eight week required rotation spent between local Orthopaedic offices and the Sports Medicine department at the University of Maine Orono.

Substance Abuse
Rotation taught within the three year curriculum which includes; Suboxone/Subutex therapy

Surgery
General surgery is a two month required rotation. This rotation emphasizes surgical diagnosis, preoperative evaluation, and post-operative care in the broad area of expertise required of the general surgeon. Sterile technique and operating room procedures are taught, along with skills in minor surgery, and surgical assisting. Residents work one-to-one with a surgical attending.

Urology
Two week required rotation with local Urologist.