Internal Medicine-Pediatrics Residency
We would like to welcome you to the Combined Internal Medicine-Pediatric Residency Program at Maine Medical Center (MMC). The combined residency received approval from the American Board of Internal Medicine and the American Board of Pediatrics in November of 1999, received initial ACGME accreditation in 2007, and re-accreditation in September 2012 for a ten-year cycle. We offer a four-year program combining two outstanding departments. The program provides optimal, comprehensive training to prepare Med-Peds doctors for a broad array of career options including primary care, sub-specialty fellowships, research, hospital medicine, and academic medicine.
MMC fosters professional training in an atmosphere in which we treat patients, families, and fellow health care workers with respect. We serve a large and diverse patient population, including a large immigrant community due to Portland's refugee resettlement resources. We take pride in the high caliber of teaching that effectively balances resident supervision and independent decision-making. The size and structure of our program provides ideal resident involvement as well as flexibility in achieving individual resident training goals.
If you are up to the challenge, we at MMC will deliver the training opportunity of a lifetime. Consider joining us in a great coastal city rich in beauty and abundant in cultural and recreational opportunities.
- 4 Med-Peds residents per class
- 4th year Med-Peds Chief Resident
- % of graduates pursuing fellowship: ~30%
- % of graduates pursuing primary care: ~45%
- % of graduates pursuing hospitalist work: ~25%
Maine Medical Center
- 637-bed hospital, not-for-profit institution
- Diverse patient population - more than 50 languages are spoken in Portland
- Home to The Barbara Bush Children's Hospital; with 116 beds, including 31 Level III NICU Beds and 20 Level II Continuing Care Nursery beds and 8 PICU beds, it is Maine's premier referral hospital, offering services not available elsewhere in the state
Medical School Affiliation
- Tufts University School of Medicine-Maine Medical Center Program (TUSM-MMC)
- Rotate every 4 blocks between Internal Medicine and Pediatrics
- Combined Med-Peds continuity clinic, hospital based, precepted by Med-Peds trained attendings
- Weekly Med-Peds conference/meeting in addition to weekly ½ day teaching conferences in categorical Internal Medicine and Pediatrics
- All residents do one rural rotation and one community Med-Peds rotation during residency
- Personal Learning Blocks (PLB's) - 10 weeks of self-directed elective time spread out over 4 years of residency
A Day in the Life
We asked some of our interns to describe in detail what a 'Day in the Life' was like as a resident.
Kiera McElrone, D.O.
Pediatric Senior Resident
6:00: Arrive at MMC! I typically grab a coffee from the front kiosk before heading up stairs. Before sign out with the overnight senior, I glance at the list and notes on the computer and try to pick a few teaching topics for the day based on our patient list as well as try to anticipate some of the main plans for the day.
6:45AM: Grab sign out from the overnight senior. There are consistently 3 seniors on each rotation month with two day teams and a night senior! The camaraderie among my colleagues formed during these months is some of the best during my times at MMC. A few of those minutes in the morning are spent chatting and joking with fellow senior residents. I then spend some time prepping for rounds with an article, a teaching topic, etc.
7:15am: Show up on the in-patient unit and quickly check-in with the interns and medical students. I work directly with fourth year medical students, who are participating in acting internships. At MMC, we allow our 4th year students a lot of autonomy. They write and I sign their orders, and I think it's great prep for them for their intern year. I try to allow the interns to captain the ship with their 3rd year medical students. I will then go and see any patients that I'm worried about or that are new.
8:00AM: Head down to morning report. Most mornings we have an interesting case from the inpatient unit or the clinic, but we will occasionally have resident presentations from elective months or a specialist lecture (child abuse, dermatology, etc.)
8:45AM: I meet with my team (one senior resident, one to two interns, two to four medical students and a pediatric pharmacist), and we begin rounding with our attendings. There are no fellows, which means we’re running the show. On the Pediatric unit, we do a lot of family centered rounds. Nurses are also present for all our rounds. Our Pediatric Attendings are wonderful at pointing out physical exam findings and incorporating teaching into our daily rounds. Our pharmacists are a wealth of knowledge. I often bring a computer on rounds to help with orders and bring up images.
Mid morning - Mid afternoon: Get to work! Help interns and med students facilitate plans for the day.
2:00 PM: Interdisciplinary Rounds: The senior residents attend these with our ancillary staff to help with discharge planning.
Admissions: The two seniors on the floor alternate days carrying the admission pager and the afternoons are often filled with new admissions and fielding calls from outside hospitals and primary care physicians regarding patient transfers to our facility. Working with the interns and medical students, we do our admissions and try to get everyone “tucked in” for the night team. Sometimes, if the afternoon is slow, one of the senior residents may give a quick “chalk talk” or work with students to practice starting IVs or other procedures.
5:00PM: We sign out to the night team, which is made up of one senior and one intern (and often a medical student). The seniors work Sunday through Thursday nights when on the night team. Traffic is not too bad in Portland, so it’s very reasonable for me to be home by 5:45 or 6:00PM.
Learning opportunities: We have a lot of great learning opportunities during the Pediatric month. I often work with other senior residents to do chalk talks throughout the month and we usually organize a talk or two by our Pediatric Pharmacists. We have radiology rounds three times a week to go over Pediatric images, and every Friday we have a Simulation Session with our attendings to go over an emergency situation. This includes residents, RNs, pharmacists, and respiratory therapist and they are a lot of fun.
Allison Fluke, D.O.
5:00AM: My alarm goes off. I am usually on the way to the hospital by 5:50. My walking commute to work is only about 5-10 minutes long. Many of the residents live close enough to the hospital to walk or bike.
6:00-6:10AM: I arrive at Barbara Bush Children’s Hospital after grabbing coffee (or tea) at the coffee shop on the first floor. I print my lists, pre-round by checking any overnight notes, vitals, labs, etc. on the computer.
6:30AM: Sign out. I meet with the overnight intern and overnight acting intern 4th year medical student for sign out. I touch base with the 3rd year medical students and find out which patients they are interested in seeing for the day. For those patients, I will encourage them to come see those patients with me. I try to speak with the overnight nurses before they sign out at 7:00AM. The nurses are fabulous, easily accessible, and great at sharing information from overnight. If kids are sleeping, we let them sleep and examine them on rounds. Otherwise, I examine my patients and talk to parents before rounds. I update the treatment board of who the medical team is for the day so the patient’s family knows who to expect on morning rounds.
8:00AM: Morning report! Most days the topic is an interesting case from the floor, but resident or attending presentations from various specialists are often in the mix as well. On Thursdays we attend a Grand Rounds at 9:00AM and two didactic sessions from 10 to 12 instead of morning report. On Thursdays rounds will be quicker prior to Grand Rounds to ensure everyone has a plan prior to Grand Rounds. Journal club on pertinent Peds articles occurs monthly after didactics.
8:30-11:00: Rounds. I meet with my team (one senior resident, two interns, and two to three medical students). Typically there is also a pediatric pharmacist on rounds with us. The pediatric pharmacists are easily accessible by page and usually readily available on the floors for questions. There are two teams on the floor every month. One team has hospitalist and pulmonology patients while the other team has hospitalist and hematology/oncology patients. Additionally, both teams share low-census subspecialist patients (cardiology, neurosurgery, gastroenterology, endocrinology, etc.). After rounding with the hospitalist and oncologist (or pulmonologist), we contact any additional subspecialists whose patients we may be caring for. Rounds is a great time for learning. We primarily do bedside rounds, but occasionally do table rounds (Thursdays).
11:30AM: On Monday, Wednesday and Friday I head off to pediatric radiology rounds where any new images are pulled up on the projector for discussion of the patient. This helps us to become more familiar with looking at pediatric images and allows for direct discussion/questions with the radiologists.
1:00PM: I finish up remaining notes, call consults, work on discharging patients and on admissions from the emergency department, clinic, and outside hospitals. Sometimes we have a lecture from an attending and/or senior resident in the afternoon. I also take this time to touch base with our wonderful social workers, nutritionists, physical and occupational therapists and other ancillary staff on certain patients. Sometimes in the afternoon we will attend family meetings on our complex patients.
5:00PM: Time to sign out to the night team. The overnight intern works one week of night float (Sunday through Friday night) at a time with an overseeing senior resident.
Jarrod Tembreull, M.D.
5:20AM: The alarm goes off and I promptly hit the snooze button knowing my phone will wake me again at 5:30 which is when I actually get out of bed. My commute to work is only about 3 minutes by bike from door to door. I usually brave it and make the trek (pun intended) without a raincoat since it is so short. That was only a bad idea one time. Many of the other interns live within walking distance or a short 10 minute drive to the hospital. The time before heading into the hospital is also a great time to log into Epic (the hospital EMR) briefly at home to see how many new patients the team picked up overnight and gives a good idea for how the morning will go.
6:15 -6:20AM: Arrive at Maine Medical Center. The time of arrival varies slightly for me based on number of new admissions, as these take a bit more time to review. First thing I do is print out my patient list and begin pre-rounding on my patients through Epic. I usually bring in my headphones and have a good mix of jams to help me start the day and focus. I generally try to get all the information I need from chart checking and start my daily notes before sign out so I will only need to see my patients afterward. Once you get a good system to follow for checking information this can generally go pretty quick, especially when paired with a hot cup of coffee and a little classic rock. It’s great if you can get as much done as possible before sign out so that you can ask the night team meaningful questions.
6:45AM: Meet with the overnight team for sign-out, discuss new patients with senior resident, and then finish pre-rounding.
7:30-8:30AM: Morning report. A senior resident presents a patient with an interesting diagnosis or a complex problem and hospital course. After the presentation the resident, chief resident and/or an attending from the relevant subspecialty will give teaching points on a topic relevant to the case. Interns may prioritize patient care activities during morning report if needed. It’s not always expected for interns to make it to morning report and sometimes it is next to impossible depending on the daily workload. I find that pretty much everyone understands when you can’t make it but it can also be a fun time and good opportunity to see other folks for a few minutes.
9:30AM: Time for rounds with the team! Depending on your service this can include the attending, the senior resident, a co-intern or MS4, one or two MS3s, and a pharmacist. In general I’ve usually only had one intern (me!) and one senior resident. Rounds take different forms depending on attending and senior resident preference, but typically we do bedside rounds for any patients admitted overnight so they can meet the entire team. We also do “table rounds” in which we sit together in a conference room to discuss the remaining patients on the service. The senior resident or occasionally an intern will use a computer on wheels (COW) during rounds to put in new orders as plans for the day are finalized and look up laboratory data and significant imaging for the team to review. Friendly tip, never let a patient hear you saying you have the COW, they inevitably think you are talking about them, its udder nonsense.
11:30AM: Rounds end, and I meet with the senior resident, co-intern, and med students to run through the list and prioritize clinical tasks to be completed before any daily conferences or continuity clinic. Typically, discharges and calling necessary consults for patients are at the top of the task list.
12:00PM: On Thursdays we have intern report, a 1 hour didactic session run by the chief residents designed to address floor topics commonly encountered by interns. I haven’t been able to make it to intern report because I have continuity clinic in Windham so have to use that time to drive. I hear it is quite a riot though and something people don’t like to miss. There is nothing that can excite an intern like a 45 minute talk about how to be more efficient with Epic, Seriously!
1:00PM: On Thursdays I have my continuity clinic in Windham which is about a 35-45 minute drive. The drive time can be a good time for either doing some CME audio or just to unwind a bit. On Fridays we have didactic teaching sessions from 1-3:30PM covering important topics in in-patient medicine with the chief residents and usually an attending or pharmacist. On other afternoons I finish my notes, update sign out tabs, call any remaining pending consults and follow up on any test results that come in throughout the day. As time permits, I will check in with my patients and discuss plan changes with them and their families. I also work on new admissions that come in to the teams during this time. The teams will often reconvene in the late afternoon (3-4PM) to go over some relevant teaching points related to one of the patients on the service with the attending or senior resident. "Chalk talks" are great and in my experience all of the attendings have a few excellent ones. The other benefit is that there is no "pimping" culture here so attendings and seniors will ask you questions but in an educational manner. Fur coats are optional at chalk talks.
4:30PM: All teams that are not on long call stop taking admissions. I.e. this is a time for daily celebration! Every 4th day, the team takes “long call.” The long call team is responsible for all admissions from 4:30PM until they are relieved by the night team after the other teams have finished signing out, usually by about 6:30PM. The great part about long call is that you get to wear scrubs, the downside is that sometimes extra admissions don’t actually go to your team. Other than the extra 1-2 hours of admitting time long call is just like any other day.
5:30PM: Time to sign out to the night team! We generally print copies of the updated sign out sheet for the day to give to the night team and update them on any pending tests or lab values and contingency planning for the patients on the service. I find they love it if you have time to doodle a fun little drawing on the corner. Especially dinosaurs, everyone loves dinosaurs.
6-6:30PM: Finish sign out. On long call days and days with a particularly heavy work load I will spend some extra time at the hospital finishing up notes for the day and tucking in new admissions. Make sure not to make the sheets too tight and I find a night light is generally a good idea but avoid ghost stories, it takes too long to build the suspense. In general I get home by 7 or 7:30PM at the latest so I can eat dinner, do something physical, and get plenty of sleep for the next exciting day on the wards!
Alexis Beinlich, D.O.
Medicine Senior Resident
6:00-6:15AM: I’m out the door, on the way to MMC. If you live close enough to walk or bike, do it! If you drive, head to the parking garage, and you’ll have no trouble finding a spot. I head to the Med-Peds room to get ready. I print a patient list, do some quick chart checks and head up to the R2 work room and figure out patient assignments with my team.
6:45AM: Sign-Out (R2 work room). This place is abuzz from about 6:30-7am with attending physicians, residents and interns signing out. Each of the four medicine teams breaks off one at a time to get the skinny on what happened overnight, who behaved, who didn’t, big events and a brief H&P on any new patients.
I pull the team back together to make a general plan for the day, and quickly “run of the list” to make sure we prioritize active/sick patients, new admissions, time-sensitive tasks and discharges. I try to see a few patients and get what I can in motion before heading to morning report; depending on the day, that can be anywhere from 1-4 people.
7:30-8:30AM: Morning Report! Takes place in the Dana Center. Coffee’s provided, and this is when I make time for breakfast.
Our medicine chiefs run morning report and usually we start and/or end with board questions related to a selected topic, followed by a case presentation to further illustrate key teaching points. We are fortunate that our specialists are consistently present to help facilitate these didactics and offer a wealth of experience and wisdom around key educational concepts, evaluation, diagnosis, management, etc.
8:30AM: Head back to your team’s floor (we are cohorted) to attend interdisciplinary care rounds (IDCR) – a meeting of all nurses, ancillary staff and physicians (either you or your attending will go) to review and discuss specific patient issues, clarify care plans and anticipated discharges, etc. for each patient on the floor.
I bring a computer to work on notes, look up teaching topics, and check orders when patients covered by other teams are discussed.
If I’m not in IDCR, I check in with my team, address any questions/active issues, and see any other patients I can before we start rounds sometime between 9 and 9:30.
9:00AM: ROUNDS! I always start with non-medical trivia before we dive into work rounds. Rounding style is determined by the senior resident and attending. Bedside rounding is a priority and we see any new/active patients, people with good exam findings, and sometimes, the whole team! I round with a wheeled computer so we can check data, review imaging, and put in orders as we go. For the remainder of patients we don't see together, we talk through on table rounds.
11:00AM: Ok, 11:00 may be a bit idealistic- so I’ll say we finish rounds between 11am -12pm. Then I do a quick recap with the team and reprioritize tasks, grab something to eat, and get to work!
12:00PM: Tuesdays I head to my continuity clinic at our Windham site. Attending and/or teaching seniors help cover the remainder of the day.
Wednesdays we have Med-Peds conferences at 12:45PM. Once a month we have a meeting, and the rest are usually teaching, program updates, reminders, etc. Teaching is done by your fellow med-peds colleagues on a topic of their choice; this ranges from questions for board review, case presentations, reviewing physical exam skills, and discussing journal articles.
Thursdays I hold pagers for interns and medical students so that they can attend an intern-specific conference from 12-1.
Fridays from 1:00-4:00pm are our protected medicine teaching block; the attending physician holds our pagers during this time so we can focus on didactics.
1:00PM: Work time! Finish notes, help call consults, follow up on tests, labs, recommendations and make sure families and patients are updated. Throughout the day I like to “run the list” so we can keep patient care moving.
As the day allows, I try to break up the afternoon with some type of teaching- whether it’s a more traditional “chalk talk”, wrangling in a specialist to elaborate on an opinion they rendered, or taking a field trip to pathology or radiology to review findings.
4:30PM: All teams that are not on long call stop taking admissions. We re-group again and review labs, update sign out tabs for the night team and think about who might be discharged the next day.
5:30PM: Sign out to the night team. Every fourth day your team is on "long call." The long call team continues to work on admissions one by one until relieved by the overnight team (they are also the Code Team for that day). This provides coverage during the sign out hour to minimize interruptions for the other teams. The long call team usually signs out between 6 and 6:30pm.
Then it’s home, (workout), dinner, and call it a night.