Personal Learning Block (PLB)
Constitutes 9 weeks of self-directed elective time spread out over 4 years of residency. A unique opportunity that blossomed from the asynchronous rotation length of Medicine (4-week) and Pediatric (1 month) rotations. PLBs occur during transitions between these specialties (i.e. Medicine to Pediatrics or Pediatrics to Medicine). Residents have an opportunity to create a specialized curriculum that suits their particular interests.
Previous scholarly activities include:
- Writing a case for publication
- Completing a poster for the research forum
- Clinic quality improvement projects
- Writing e-learn modules
- Practice of procedural/technical skills
- Integrative Medicine
- Extension of International Health electives
- Rural Rotation
Two blocks during residency provide a special opportunity for residents to work in more rural settings outside of Portland. Residents are matched with a Med-Peds rural practitioner to give residents an opportunity for immersion into what it is like to practice in a rural area away from the specialty environment of Maine Medical Center. Sites include Windham (West of Portland), Norway, Dover Foxcroft and Ft. Kent (Northern). Residents also enjoy the opportunity to take advantage of some other parts of Maine’s beautiful outdoor activities in the more remote settings. These rotations are highly praised by residents.
International Health Elective
Residents have ample exposure to a diverse population in Portland due to a large refugee/immigrant population but for those who are interested in expanding global health education outside of the country there is opportunity for elective rotations. Residents have completed rotations in Haiti, Belize, Dominican Republic, Guatemala, El Salvador, Zambia, Uganda, Malawi, Lesotho, and Cambodia. Konbit Sante is a Portland based organization that collaborates with hospitals in Haiti where several residents have participated in rotations with Dr. Lemire, one of the Med-Peds faculty. For those residents looking for other opportunities, faculty are available to help find established sites to participate in global health experiences.
Pediatric Inpatient Unit
More than 2,000 patients per year are cared for on the inpatient unit of the Barbara Bush Children's Hospital (BBCH). Pediatric diagnoses range from common respiratory and gastrointestinal disorders to congenital heart disease, metabolic disorders, and end-stage renal disease. The attending faculty at the BBCH includes a Pediatric Hospitalist group and a full range of sub-specialists involved in medical and surgical specialties. In addition, community pediatricians admit their private patients to the inpatient unit and follow these patients with residents and medical students.
Pediatric Intensive Care
Med-Peds residents rotate for one block in our 10-bed PICU during their second year before doing their first Pediatric Supervisory block. Here, residents are the primary caretakers for critically ill children under the direction of our PICU staff and Pediatric sub-specialists. The patient population in the PICU is varied, so residents care for children with a myriad of diagnoses including, but not limited to, status epilepticus, respiratory failure, diabetic ketoacidosis, and sepsis. Unique to this program is the opportunity to care for children with both non-surgical and surgical cardiac disease in both the pre- and post-operative periods. Residents are also members of the Pediatric Critical Care Transport Program. This is a ground-based system that transports critically ill children from Maine and New Hampshire hospitals to the Barbara Bush Children's Hospital.
Neonatal Intensive Care Unit
The neonatal intensive care unit experience occurs in our Women and Infants East Tower, a state-of-the-art 50-bed NICU and Step Down unit as well as a new Labor and Delivery suite that opened in September 2008. The Barbara Bush Children's Hospital sees 2,500 deliveries per year. The NICU has an average of 700 admissions per year, of which 150 are transports from outlying hospitals. Residents are supervised by board certified neonatologists with a wealth of experience caring for premature infants as well as educating residents. Residents gain valuable delivery room experience, manage premature infants with complex needs, and learn assessment skills to quickly triage those infants requiring intensive care from the delivery room. A team of experienced neonatal nurse practitioners complement the neonatology service and are involved in many aspects of the hands-on training in the NICU.
Medicine Inpatient Rotations
The Department of Medicine has an average daily census of more than 280 patients. Patient care at Maine Medical Center ranges from primary care to a full spectrum of tertiary care issues, ensuring a superb patient population for residency training. Tertiary care is provided through programs such as invasive cardiology, ERCP, advanced critical care, neurosurgery, infectious disease consultation, renal and bone marrow transplantation, and cardiovascular surgery. The department is staffed by over 150 board-certified internists, two-thirds of whom have subspecialty certifications. The attending faculty includes an Adult Hospitalist group, subspecialists as well as community internists. Residents complete inpatient rotations in general medicine, cardiology (including cardiac ICU), renal transplant and hematology/oncology. In addition many residents choose elective on the inpatient subspecialty consult services.
Medical Intensive Care Unit
Residents spend 2-3 blocks in the 45-bed intensive care unit. The ICU is staffed by board-certified combined pulmonologists/intensivists (including a Med-Peds trained attending) with approximately 2,000 admissions per year. A thriving pulmonary and critical care fellowship program fosters a vibrant learning and research environment. Med-Peds residents find that they are exposed to a challenging mix of patients, providing both ample procedural and medical experience with critically ill adult patients. In addition to the time in the Medical ICU, residents are exposed to the Cardiac Intensive Care Unit during their subspecialty cardiology rotations.
Ambulatory experiences take place in many locations including the MMC Internal Medicine Ambulatory Clinic, MMC Pediatric Ambulatory Care Center, MMC Internal Medicine-Pediatric Continuity Clinic, Lakes Region Primary Care Internal Medicine-Pediatric Practice, VA outpatient center, International Health Clinic and Rural Internal Medicine-Pediatric practice sites. In the course of their ambulatory training, residents master the diagnosis and treatment of a wide variety of problems from those that are common to those that are very rare. Many of the patients at the MMC clinics are refugees or immigrants. Portland is a refugee resettlement city, and MMC has developed an International Health Service within its clinics to help transition refugees into the Maine health care system. This provides a unique opportunity to learn how to address a multicultural and diverse population of patients. In addition there is a Global Health Curriculum to help expand on residents knowledge for all levels of interest and experience.
The Pediatric months are spent in the Pediatric Ambulatory Care Center where there are 7,500 patient visits each year. During the Pediatric Ambulatory Care blocks, residents rotate onto the Newborn Nursery Teaching Service under the supervision of the dedicated Newborn nursery faculty. These experiences allow residents to learn first-hand about general pediatric practice. In addition, residents engage in Quality Improvement projects based on their continuity clinic population. Residents will also work in the Teen, Dermatology and International Clinics while on ambulatory rotations.
The Medicine ambulatory blocks are spent in the Medicine Ambulatory Clinic. Residents have the opportunity to partake in a range of subspecialty including Dermatology, ENT, Geriatrics, International Health, Ophthalmology, Orthopedic, STD, Urology, Women's Health, and Urgent Care as well as perform a Quality Improvement project based on their continuity clinic population.
Three blocks are spent in the ED. Residents care for children and adults who present to the ED including those with major or minor trauma, orthopedic injuries, poisonings, ingestions, and lacerations. Interns are expected to see both Pediatric and Adult patients during their first block in the ED. The MMC ED serves approximately 80,000 patients per year. This level one trauma site provides residents the opportunity to manage adult and pediatric patients that present with critical medical and surgical problems.
The second and third blocks are Pediatric ED supervisory blocks in the Pediatric Emergency Department. The newly dedicated pediatric emergency department was opened in summer 2009 with 10 beds dedicated to pediatric patients. It is geographically distinct from the rest of the department and is open 13 hours a day. This experience is supervised by board-certified emergency medicine physicians. Residents have the opportunity to supervise the learning of pediatric and emergency medicine interns in the care of pediatric patients in the ED. Residents also spend time at the Northern New England Poison Control Center during this time and gain valuable knowledge about toxicology during this month.
Adolescent medicine training includes a block in the second year where residents work side by side with faculty in school-based health clinics, eating disorders clinic, adolescent psychiatry clinic, sports medicine clinic, STD clinic, and other venues where care is directed toward teens. This experience also includes the weekly Teen Clinic which takes place at the MMC Pediatric Clinic during afternoon-evening hours
Developmental and Behavioral Pediatrics
This is an intern year rotation where residents work with board-certified developmental pediatricians (one of whom is Med-Peds trained) and a neuropsychologist caring for children with behavior issues, autistic spectrum disorders, ADHD, and learning disabilities. The bulk of this rotation occurs in the outpatient developmental-behavioral pediatric clinic. Time is also spent in pediatric neurology clinic, spina bifida clinic, child abuse clinic, and developmental team clinic. The rotation involves interactions with a diversity of experts in child development, learning disabilities, neurology, and child psychiatry.
During this rotation, residents are able to get a flavor of both the inpatient and outpatient care of geriatric patients. Residents will work in the ACE unit (Acute Care for the Elderly) and with HELP (Hospital Elder Life Program) during the days they are in the hospital. In addition, they do geriatric and palliative care consults on inpatients. For their outpatient experience, residents work with Hospice of Southern Maine and also go to the Geriatric Center. Scheduled educational sessions include a weekly morning conference and a talk by a geriatric fellow. Geriatric Grand Rounds and Journal Club occur once a month.
Five blocks of Internal Medicine and six blocks of Pediatric electives are set-aside over the four years of training. All of the major subspecialty areas are represented in our program. With the advice of the Program Director and resident faculty advisors, and taking into account future interests and in-training exam data, the elective time is designed to meet the individual resident's needs.
Electives may be chosen from the following areas in Pediatrics: Allergy/Immunology, Anesthesiology, Cardiology, Child Abuse, Child Psychiatry, Endocrinology, Gastroenterology, Genetics, Global Health, Hematology/Oncology, Hospitalist Medicine, Infectious Diseases, Nephrology, Neurology, Ophthalmology, Orthopedics, Parenting, Pulmonology, Research Experience, and Sports Medicine.
Medicine Electives include: Addiction Medicine, Adolescent Medicine, Cardiology Consults, Endocrinology, Gastroenterology, Global Health, Homeless Health, Hospitalist Medicine, Infectious Disease, Medicine-Law-Ethics, Neurology, Pharmacology, Psychiatry Consults, Pulmonary, Quality Improvement/Safety, Rehabilitation Medicine, Research Elective, and Rheumatology.