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Internal Medicine is the largest teaching department of MMC. The Department of Medicine is staffed by over 154 board-certified internists, two-thirds of whom have subspecialty certifications and are members of one of the 15 divisions within the department. All of the subspecialty divisions have major referral practices from community physicians who serve more than 1.4 million people in the state of Maine. This ensures a large and diverse patient population for training, ranging from primary care to a full spectrum of tertiary care problems.
Each ward team consists of an attending physician, two senior residents, two or more first-year residents, a medical student acting intern, and a clinical clerk medical student. The first-year residents assume primary patient care responsibility with guidance from senior residents and the attending physician. The number of patients varies among the services, and averages eight per first-year resident.
The senior residents work with interns and medical students during rounds on all patients. The senior resident also makes the final decision to admit patients after their initial triage and evaluation. Other responsibilities include teaching salient clinical points as well as providing evidence-based literature and educational support when appropriate. The medicine residency program highly values the teaching ability of its residents. In the 2nd year, all residents attend a seminar series (based on the Stanford teaching series model) to improve their skills in teaching and evaluation.
Our teaching faculty continues to be one of our program strengths. Only attendings with a long track record of thoughtful and educational admissions remain as service attendings. Several have been selected by The Best Doctors in America as outstanding clinicians and teachers. As teaching attendings, they conduct teaching rounds four times each week. During these sessions, attendings teach an evidence-based approach to diagnosis and clinical decision-making, they discuss the pathophysiology and manifestations of disease, and they role-model clinical behavior and physical exam skills at the patient bedside. In addition to teaching duties, faculty also have attending physician responsibilities for their own patients admitted to the service.
The intensive care unit at MMC is a 45-bed unit divided into a General Surgical ICU, Cardiothoracic ICU, Pediatric ICU, and the 22-bed Medical ICU. The Medical ICU has dedicated teams of resident’s supervised full time by pulmonary/critical care physicians and fellows. All general medicine patients admitted to the unit are cared for by one of the dedicated critical care teams, whereas subspecialty services (Cardiology, Nephrology and Hematology/Oncology) continue to care for their patients who are critically ill. Critical care teams consist of an attending physician, one 2nd- or 3rd- year resident, one 1st- year resident, and medical student acting intern. The focus of daily rounds is on diagnosis and management of the critically ill patient, pathophysiology of disease, and the appropriate use and management of invasive technologies in the critical care setting (arterial lines, pulmonary artery catheters, intubations, resuscitations, ventilator management, and other procedures). Residents on the critical care service develop skill in the management of patients critically ill from respiratory or circulatory failure.
Residents rotating through the cardiology service will learn to provide state-of-the-art care for their patients in the CICU who are receiving critical care. The CICU is a 12 bed ICU where patients with primary cardiac concerns may be monitored, maintained on cardiovascular support, and monitored on respiratory support with mechanical ventilation, in the event of pulmonary failure. A cardiology consults service staffed by a cardiology fellow and on-call staff cardiologist is available 24 hours a day to provide supervision.
While on the cardiology service, residents receive didactic teaching sessions from cardiology attendings and fellows. Teaching attendings conduct teaching rounds four times each week. During the sessions, attendings teach an evidence-based approach to diagnosis and clinical decision-making, as well as cardiac physiology and pathophysiology. Through these experiences residents have the opportunity to care for patients with a spectrum of cardiac and multi-system disease.
The program is organized around a firm model in which faculty and residents work together in a group practice caring for a panel of patients. Each resident enrolls in an internal medicine firm led by a group of primary care internists. As part of the group, the resident maintains a practice of 100 to 150 patients in an onsite primary care practice with full clinical and administrative support staff. Full technical support is provided for dictation, word processing, and resident use of personal computers. The clinic has recently transitioned to a completely electronic medical record for all new patients. The computer system is on a network allowing access to clinic patient medical records throughout the hospital and the Emergency Department. The goal of the ambulatory clinic is to provide a cohesive experience for the resident in their own private office combined with encounters on a dedicated inpatient medical service.
The Department of Critical Care Medicine manages a 42-bed Multidisciplinary Special Care Unit in the hospital's newest wing. Department members are specialists in Critical Care Medicine who provide professional and educational direction for fellows, residents, and medical students.
The department provides sophisticated intensive care for all types of critically ill patients except those requiring coronary care or neonatal intensive care (who are managed in separate units). Critical Care patients include post-op open heart patients, trauma, burn, neurosurgical, and general surgical patients, and the entire spectrum of critically ill medical and pediatric patients. Residents from all major clinical services are provided an excellent broad-based education in critical care.
The laboratories of the Department of Pathology and Laboratory Medicine produce more than two million test results and process approximately 16,000 surgical specimens, 45,000 cytologic examinations, and 150 autopsies each year.
The department is staffed by full-time pathologists and an extensive technical and ancillary staff, which provides service to the hospital 24 hours a day, seven days a week. The pathologists actively participate in teaching conferences throughout the hospital, and the department offers clinical rotations and electives for residents and students.
The department's blood bank offers a wide variety of blood components to support the transfusion needs of the clinical services, and also offers therapeutic hemapheresis services.
MMC is one of only three trauma centers in the state of Maine, and the only with Level I designation by the American College of Surgeons. Staffed 24 hours by board-certified emergency physicians, the MMC ED has approximately 70,000 patient visits per year. The majority of patients on the inpatient medical services are admitted through the Emergency Department. Medicine residents work alongside house staff from other Maine Medical Center residencies as well as Emergency Medicine teaching faculty. Residents assume various levels of responsibilities in the evaluation and management of medically ill patients. The Emergency Department provides related training in orthopedics, ophthalmology, OB/GYN, and minor surgery.
ResearchWith strong support from the board of trustees, research at MMC has grown rapidly over the last decade. In the process it has significantly broadened the diagnostic and treatment options available to patients and enhanced the quality of house staff education. Participation in ongoing research is offered by clinical services throughout the hospital, and the development of individual research projects by house officers is further encouraged by a specific funding program and expedited review of proposals by the Medical Research Committee.
The scope of research interests and approaches at MMC is broad. For example, a variety of clinical trials examine the efficacy of new drugs, devices, and therapeutic methods; oncologists collaborate in national chemotherapy protocols; the Cardiology Division is heavily involved in cooperative studies of thrombolytic agents in myocardial infarction; and the Ambulatory Care Division is undertaking a large lipid management epidemiologic study.
In the very modern facilities of the Maine Medical Center Research Institute, sophisticated tools such as flow cytometry are used to investigate the functions of the genetic makeup of living cells at the molecular level. This facility has become the research backbone for the hospital's oncologists, hematologists, pathologists, nephrologists, and endocrinologists. At the same time, it has evolved as a major resource for the hospital's postgraduate educational program.
Hormonal responses to clinical stress and the metabolism of proteins in exercising diabetics are among subjects being studied by hospital endocrinologists, while investigators interested in infectious diseases and environmental health have joined to examine the ecology and epidemiology of emerging Lyme Disease. Both collaborative and MMC-initiated projects are being conducted as well in the areas of neonatology, gastroenterology, lung disease, emergency medicine, and others.
Thus, research and the reasoned inquiry it inspires have permeated clinical medicine as it is practiced and taught at MMC. Its impact on the quality and sophistication of care is clear. Equally evident are the diverse and challenging opportunities that present themselves to the house officer who wishes to include a meaningful research experience in his or her postgraduate education.