Program Overview
The Leadership in Preventive Medicine program has been accredited by the ACGME since 2015. Fellows are expected to have demonstrated interest and capabilities in public health and preventive medicine. We select physicians who have already completed other residency training, have expertise in clinical learning and are skilled clinicians. The program requirements are robust, but there is significant flexibility in how each learner structures their time to meet the requirements for the program and for American Board of Preventive Medicine certification eligibility.
As can be seen on the attached block schedule diagram, there are substantial longitudinal threads across the two years of the program, as well as clinical, public health, teaching and leadership activities that are flexible in their implementation timing.
In the below segments, we describe the contents and opportunities in the requirements of the program.
Practice Sites
Our sites include the sponsoring institution, MMC as the main home site for clinical activities; UNE School of Public Health for MPH, Portland Public Health for general preventive medicine and government public health, VAMC for general preventive medicine and clinical preventive medicine, and Maine Health organizations for clinical and general preventive medicine rotations.
Length of Training and Weekly Schedule
All program trainees complete 2 years of the training program, including the courses for a degree of MPH or equivalent. We work with UNE School of Public Health for this degree and that coursework and for additional guidance and supervision of the practicum project. Our program didactics are held on dedicated Monday morning hybrid sessions from 10:30 – 12:30. We hold quarterly team meetings and journal club sessions at a faculty home to review key public health and leadership literature. The MPH degree work requires two courses per 8-week block / six sessions per year; assignments are due on Wednesday and Sunday; we calculate this takes about 20 hours/week (per UNE’s calculations). Most other UNE students are working a full-time health related job in addition to taking courses, and we expect our learners to manage their schedule to complete their work on days/nights/weekends, depending on the assignment and their working style. The clinical sessions (as longitudinal coverage of chronic infectious disease clinics, continuity clinics, public health clinics, etc.), in-person public health requirements and didactics requirements generally add up to approximately 15 hours/week. Additionally, they are assigned teaching sessions (with medical students/residents/fellows/community members and in professional development webinars as facilitators), participate in organizational, city and county public health work groups, co-chair an interdisciplinary faculty development conference, work on system qi or research projects, and form and lead interdisciplinary teams to develop and implement a Master’s/ capstone project over the second year (research/QI/ program evaluation).
Curriculum Expectations
Public Health and General Preventive Medicine ACGME requirements
As per the educational expectations, the trainee education must take place in settings where decisions about the health of defined populations are routinely made and where analyses and policies affecting the health of these individuals are under active study and development.
- Clinical experiences must include participation in learning activities related to the current recommendations of the US Preventive Services Task Force.
- Trainees must have a minimum of two months of direct patient care experience during each year of the program.
- Trainees should be assigned to sites appropriate for specific learning activities, including hospitals, managed care organizations, health departments, non-governmental organizations, and community-based organizations.
- Trainees must have a minimum of two months (or equivalent) experience at a governmental public health agency.
- Trainees will complete the coursework necessary to get an MPH or equivalent degree.
Competencies and Milestones
ACGME delineates the competencies for PH/GPM trainees in the milestone document here. We provide both longitudinal and block rotations in which we expect trainees to obtain exposure and expertise in these specific competencies and milestones.
Regularly scheduled didactic sessions include: MPH courses, topics in public health and general preventive medicine, advanced applied epidemiology (to include acute and chronic disease), advanced biostatistics, advanced health services management, clinical preventive services, and risk/hazard control and communication.
Evaluation Procedures
Trainee evaluations will be ongoing, completed by staff and faculty of the individual rotation, and collated into summative and formative review every 6 months for tracking of progress towards milestones and practicum experience.
Rotation evaluation by the trainee, and evaluation of program, faculty, and sites will occur on a yearly basis by trainees, and by the Program Evaluation Committee (made of faculty, staff, one trainee and community members).
An Advisory Committee will also guide the program and ensure meeting of standards and implement innovation.
Trainee duty hours, policies on moonlighting, process for grievances and dealing with transitions of care are all delineated according to MMC’s general policies.
Faculty Coaching
Each fellow is assigned a coach who is their longitudinal faculty for program navigation. Coaches are selected based on their own preventive medicine experiences as well as their clinical, leadership and educational background.
- Provides mentorship to assigned trainee in the context of a clinical faculty with significant leadership experience.
- Provides institutional and community connections to facilitate resident’s successful completion of practicum project and all other aspects of educational program.
- May serve as practicum project advisor, including advising resident about scope and feasibility of project and assisting resident in adhering to timelines.
- Assists resident in incorporation of rapid cycle improvement to improve educational and practicum outcomes.
- Conducts on-going examination and modification of curriculum, with the Residency Advisory Committee, to meet education needs.
Rotations
LPM Schedule Block Diagram
Our learners have clinical care opportunities that encompass the full spectrum of preventive care. Additionally, we assure they have ongoing clinical experiences in their primary clinical training field.
- Portland Family Medicine: addiction treatment, lifestyle and wellness group medical visits
- MMC Gilman Clinic – virology
- MMC TB Clinic
- Portland Public Health STD Clinic – including harm reduction/ needle exchange clinic, travel clinic, counseling and pre-exposure prophylaxis, travel, HIV+, refugee health screening
- Preble Street Learning Collaborative: care for underserved populations
- Integrative and Complementary Medicine: University of Arizona Integrative Medicine Residency curriculum; Complementary and Integrative Medicine Block with field trips and experiential learning.
- Other opportunities include: poison control, international health/refugee services, genetic counseling, familial cancer care program, Employee health (WOW fair), pre-employment physical, worksite injury surveillance and exposure management; inpatient tobacco and substance use reduction programs; maternal and neonatal NAS programs
- Medical Student Teaching:
- Structure: lectures, small group facilitation, sim center supervision, project mentorship;
- Content: motivational interviewing, physical diagnosis exams, diabetes management, documentation, effective case presentation, and giving and receiving feedback
- Resident Teaching:
- Structure: Lectures, case-based learning, Journal club, Patient Safety and Quality sessions, mentoring in clinical settings
- Content: USPSTF guidelines, shared decision-making, health systems, government regulations, healthcare financing, community-informed care, diseases of public health significance;
- Grand Rounds: VAMC, Internal Medicine
- Facilitation: Project ECHO, conference planning
- Leadership Training: Hanley Health Leadership Development
- Advocacy: local, state and federal legislative action
- Enduring Materials:
- Just in Five: Brief informational training videos for physicians on behavioral health techniques
- COVID –19 videos made at the time of the vaccination campaign
- Annual Interdisciplinary Preventive Medicine Faculty Development Conference
- Our LPM has produced an Annual Regional Interdisciplinary Preventive Medicine Faculty Development Conference that highlights emergent research and addresses topics that are central to the work of Preventive Medicine. Our topics have been Health Equity, Food for Health and Healing, Language and Literacy, Population Health, and Social Determinants of Health and these conferences have been very well attended and received (both in person and virtual). The fellows serve as co-chairs of the conference planning committee, developing communication and networking skills, investigating community partners and outside leaders to bring high level presenters to our institution for this faculty development offering.
- VA Maine
- MHIR
- NNE CTR
- Dartmouth Coop
- QI curriculum
One of the program’s required rotations will be a longitudinal rotation in a Federally Qualified Health Center (FQHC) in rural and/or medically underserved communities. LPM trainees will complete longitudinal rotations in one of the five FQHC partners we will be working with. These health centers collectively cover a service area spanning two-thirds of Maine’s 16 counties, and serve a dynamic array of Maine populations, who are variously at risk due to social determinants of health barriers — such as food insecurity, lack of transportation or access to essential services, low-income status, and/or unstable housing or homelessness—that disproportionately impact their health. Our preventive medicine residents will have the opportunity to activate their knowledge and skills in population health, epidemiology, health assessment, and other areas to enhance their understanding of the health disparities experienced by FQHC patients, and design interventions or quality improvement cycles to address them.
What are FQHCs?
- Federally Qualified Health Centers (FQHCs) are outpatient clinics that qualify for special reimbursements under Medicare and Medicaid.
- Includes all organizations that are receiving grants under the Section 330 of the Public Health Service Act
Requirements for a facility to be considered as an FQHC:
- FQHCs must serve an underserved area and/or population
- Offer a sliding scale
- Provide comprehensive services
- Maternity and prenatal care
- Preventive health
- Dental services
- Emergency care
- Pharmaceutical services
- Mental health services
- Substance use services
- Specialty care
- Must provide a full discount (100%) to any patients with an annual income below 100% of the poverty guideline.
- Services must be available for all patient with an annual income below 200% of the poverty guidelines.
FQHCs in Maine
- Can be found here: Federally Qualified Health Center (FQHC) - Maine | Page 1 (npidb.org)
- There are currently 173 locations in Maine
FQHCs we are working with in Maine:
| FQHC | Target Population(s) | Mission | Useful Info |
| HealthReach | Central and Western Maine | To provide high-quality, affordable, patient-centered healthcare in the medically underserved communities of Central and Western Maine. |
|
| Greater Portland Health (GPH) |
Southern Maine | Provide high-quality, patient-centered healthcare that is accessible, affordable, and culturally sensitive. |
|
| Nasson Health | York County | To alleviate the effects of poverty, attack its underlying causes, and to promote the dignity and self-sufficiency of the people of York County, Maine. |
|
| Maine Mobile Health Program |
Migrant and seasonal farmworkers |
To improve the health status of Maine’s seasonal workers and their families by providing culturally appropriate care and services. |
|
Resources
- Medicare Enrollment Guide for Institutional Providers | CMS
- Federally Qualified Health Center (hhs.gov)
- FTCA Frequently Asked Questions | Bureau of Primary Health Care (hrsa.gov)
- Federally Qualified Health Centers (FQHCs) and the Health Center Program Overview - Rural Health Information Hub
- Federally Qualified Health Center (FQHC) - Maine | Page 1 (npidb.org)
- Chapter 10: Quality Improvement/Assurance | Bureau of Primary Health Care (hrsa.gov)
- 2021 National Report (hrsa.gov)