Frequently Asked Questions
Below is a list of frequently asked questions about the Meds-Peds residency program.
Q: How often will I be on call?
A: Peds: We have a night team system where interns do one week of night team during each inpatient unit month. They work from 5pm to 7am Sunday through Friday night and have no day-time responsibilities. Senior residents typically do two weeks during 2 of their required 3 senior inpatient months. Residents are in the call pool while on the inpatient unit rotation and when on electives for weekend coverage for days and nights. NICU utilizes a night team system as well but runs Thursday - Monday nights, with NICU NP's covering on Tuesday and Wednesday nights.
A: Med: The Medicine department also uses a night team system. Interns (may be pgy1 or pgy2 level intern) and senior resident (as pgy3 or pgy4) do 2 weeks of night team for General Inpatient Medicine and 2 weeks of night team for CAT (cardiology, oncology, transplant), working 5:30PM to 7:00AM Sunday through Thursday. Residents on inpatient service cover the weekend days. Residents are in the call pool while on electives for weekend night coverage.
The Adult Critical Care rotation uses a night team within the critical care block with interns covering 2 stretches of 3-5 nights during the rotation and seniors doing one 7 night stretch.
Q: Do Med-Peds Residents participate in a back-up system?
A: Peds: Senior residents participate in a back-up call system on non-inpatient rotations. They also can take transport call (paid moonlighting for transports). Transport call means that you are part of a team (includes a PICU nurse, respiratory therapist, ambulance driver, senior resident) that goes to outside hospitals to transfer pediatric patients that are felt to require “pediatric transport”. PICU attendings are available by phone and meet you back at the PICU in MMC but are not there during the transfer. The schedule for back-up/transport varies day-to-day to ensure residents do not miss continuity clinic.
A: Med: Both intern (IM and prelim interns only, not Med-Peds interns) and senior residents participate in a "jeopardy" backup system. They cover if a resident is sick/emergently need to leave their rotation. These are done in week long blocks of time.
Q: What is faculty supervision like?
A: Peds: There is a Neonatologist and Pediatric Hospitalist in-house 24/7. There is always supervision at deliveries when on NICU. The neonatologist will be there but utilize a “gloves off” approach to try to allow the resident the opportunity to initiate resuscitation if needed but are there at your side to jump in as needed. PICU attending stay in-house if there is post-operative cardiac patient for at least the first night, any unstable patient and come in for all new admissions. It is a good balance of having opportunities to see patients and think about plans independently while having support close by.
A: Med: There are Internal Medicine Hospitalists and Intensivists in-house 24/7. Residents take all initial calls though and triage with nurses before involving the attending except in critically ill patients. 2 senior and 2 intern IM/Med-Peds residents hold the code pagers and typically it is a senior resident who “Runs” the code. A critical care attending also carries a code pager and comes to all codes and is there to take over as needed (the code team also includes respiratory therapists, critical care nurses, anesthesia). You have good opportunities to lead but there is never help far away.
Q: How does the program support diversity?
A: Portland is growing to be an increasingly diverse city and is a refugee resettlement area, and also a refuge for many asylum seekers. Resident clinics see diverse populations including many recent immigrants. In addition, residents advocated for an immigrant health elective to improve their knowledge of community resources which was awarded a grant by the Maine Med Educational Innovation Grant committee; which will start Fall 2020.
As a program, we strive to learn more about what makes people of all backgrounds unique based on their gender, culture, relationships and race. We also recognize that groups of people have been marginalized and their health impacted by these factors and we are committed to educating ourselves and others to improve care of our patients and the wellbeing of our community. We have a director of diversity and inclusion for MMC and feel our institution and leadership are also working to learn and grow to identify racism and bias and to make positive changes. The hospital is actively engaged in recruiting a more diverse workforce, including in our residencies, so that we can better serve and represent our Portland community. We include perspectives from our patients and colleagues of under-represented minorities in our recruitment process. We welcome and encourage applicants from all backgrounds to apply to our program.
Q: Will I be doing much teaching and supervising?
A: All residents (including interns) are actively involved in supporting the Clerkship and 4th year medical student experience. This involves direct supervision of inpatient and ambulatory rotations and also teaching sessions with the medical students. Second, third, and fourth year residents directly supervise interns and students.
Upper level Med-Peds residents have the opportunity to complete modules on our online learning platform (Canvas) on Residents as Teachers. With a curriculum specifically aimed to the resident teacher, the modules reviews general teaching principles including setting the learning climate, communication of goals, control of session, evaluation, feedback, and promotion of understanding and retention.
Tufts School of Medicine - Maine Medical Center Program "Maine Track" students will spend all of their second and third and most of their fourth years of medical school at MMC and in rural areas of Maine. In addition, students from the Boston-based Tufts, the University of New England, and medical students from all over the country partake in clinical experiences at MMC. This allows ample opportunity for residents to interface with and teach medical students.
Q: What are Personal Learning Blocks?
A: The Personal Learning Block (PLB) is a unique opportunity that blossomed from the asynchronous rotation length of Medicine (4-week) and Pediatric (1 month) rotations. Pediatrics has now transitioned to 4-week blocks but we kept PLB as a needed opportunity for longitudinal elective time. PLBs occur during transitions between these specialties (i.e. Medicine to Pediatrics or Pediatrics to Medicine). During this time period, residents have an opportunity to create a curriculum that suits their particular interests and educational requirements. For example, some residents have used this time period to work on scholarly activities such as writing a case for publication, completing a poster for a conference, working on clinic quality improvement projects, and writing useful e-learn modules. Others have used this time to acquire procedural/technical skills of interest such as ultrasound, OMT, cardiac stress testing. In addition, we are incorporating quality improvement/patient safety and preparation for M&M conferences during these blocks.
Q: Will I get any feedback on my performance?
A: Feedback is frequent and regular, including formal rotation evaluations written on each resident. A few times each year, an evaluation committee meets to provide an overview of the residents' progress. The Internal Medicine-Pediatric Program Director/Associate Program Director discusses the evaluations with each resident during one-on-one evaluation meetings. Faculty is expected to provide verbal feedback during rotations to address expectations and ways to improve. Residents also complete evaluations of the faculty and of the different rotations, which are taken very seriously in ongoing program development, as well as self-evaluations, which are used to guide resident goals and objectives for each year of training. Additional evaluative measures for residents include OSCEs, patient and paraprofessional evaluations, in training exams, and direct observation.
Q: Do residents have input into the program?
A: We actively solicit our residents' opinions about their training. These opinions can be anonymous or direct. We have a great training program and desire to improve it even more. The best insights often come from our residents. An example was moving the Med-Peds didactic from a noon conference, which residents found difficult to get to in the middle of the workday, to evening at a resident’s home (pre-covid, now outside). This timing, more relaxed atmosphere and having food provided has made it an activity residents look forward to.
There are formal lines of communication, but primarily we rely on open dialogue between faculty, residents, and support staff. Residents are an integral part of our education committees and monthly resident meetings where major programmatic changes and development take place. Residents complete confidential program evaluations each year to help give feedback and direct goals for the coming year. Each year we have a Med-Peds Spring Retreat - an opportunity for residents to reflect further on the program and work together to develop recommendations for change. Additionally, the Med-Peds administrative office has an open door policy.
Q: What are the ancillary services like at MMC?
A: Ward teams are assisted in their daily responsibilities by a diverse network of ancillary personnel providing a multitude of services. 24-hour phlebotomy, IV placement, and electrocardiogram services are provided. Residents are encouraged to perform as many procedures as possible and if they choose can have the first attempts at phlebotomy and IV’s with the assistance of nursing staff and child life specialists. Attendings or senior residents supervise other procedures such as LPs, etc. A consult service is available for PICC line placement and difficult peripheral IV. In addition to these ancillary services, expert advice is available from a variety of clinical fields. Clinical pharmacists round with inpatient teams. Dietary consults are available for any inpatient, providing valuable recommendations and monitoring of nutritional needs of patients (and helping on tube feed and TPN orders outside of NICU patient). Care managers (RN and social workers) help facilitate discharge plans and the coordination of care after patients leave the hospital. Internal Medicine (and soon for Pediatrics) has an MA who helps assist with inpatient team to obtain records and schedule outpatient follow-up for hospital discharges. Team-based care is highly valued at MMC. Some units support rounding as a full interdisciplinary team for all patients.
Q: How is resident stress addressed?
A: Residency is hard, but we do our best to help residents find joy during training and stay sane. Residents rarely go over duty hours and we closely monitor resident stress/fatigue. We have a well-established night float system for all four years of training. Graduate Medical Education has developed a website where Wellness resources are compiled included access to a Peer-Peer support program and free counseling services that are available on short notice.
Our support system includes a Faculty Advisor Program in which each resident is paired up with an attending physician who serves as a resource for, and advocate of, his/her advisee at least through internship and beyond as desired. In addition, we have regular scheduled meetings for residents to gather, with food, at least once per month. We schedule a wellness ½ day during the first two months of internship and then several other times throughout residency during ambulatory blocks to allow time for PCP, dentist appointments, etc. The program helps arrange easy access to PCPs at the start of internship.
Each fall we join the Internal Medicine and Pediatric residents and faculty in two off-campus retreats where we participate in team building and learning style activities as well as create a chance for resident bonding away from the hospital. The Med-Peds residents have a 1 day spring retreat, combining program reflection, team building and some fun. In addition, the chief residents organize social functions throughout the year. We have a close-knit group of residents and we consciously encourage this relationship.
Q: Does the program prepare you well for fellowships?
A: Yes. Many of our residents have gone on to fellowships (combined and in either pediatrics or internal medicine) in multiples specialties. Check out our alumni page to see what everyone has done!
Q: What is the housing like in Portland?
A: Portland is both a delightful and safe city in which to live. The hospital is located in a residential district and many of the residents live in homes/apartments within walking distance of the hospital. Rural and smaller coastal communities with affordable housing are only 15-20 minutes away, for those who like to live outside the city. Maine Medical Center pays a competitive salary compared to the cost of living.
Q: What about benefits and vacations?
A: Our residents' salaries have consistently been above the 75th percentile. On top of this we offer a benefits package including medical, dental, and disability care, malpractice insurance, and life insurance. Each resident receives 21 vacation days each year. The department also provides educational funds for our residents so they can attend meetings and/or buy textbooks or journals. The Med-Peds program also pays for resident membership in the American Academy of Pediatrics (AAP) and the American College of Physicians (ACP) – includes PREP and MKSAP.
Q: Are meals provided to me?
A: Residents pay for their own meals from one of our two in-hospital food venues, the Impressions Café (cafeteria) and the Pavilion Grill. The food from the cafeteria is very inexpensive and there is a wide variety of food between the two venues with an emphasis on steering people towards healthy options. Each program is different in how they choose to distribute “meal” money. Based on inpatient blocks each program is allocated money that they can then use to help support resident wellness. Our program provides meals for Med-Peds didactics, monthly meetings, journal clubs, winter get together, etc.
Q: Are residents happy?
A: Without a doubt! Check out our Instagram page, watch our video, come do a rotation at MMC and hopefully interview with us. Because MMC serves as both a community hospital for Portland and a tertiary referral center for Maine, our residents work hard and they learn a lot. Our residents also have ample opportunity to play hard in the wonderful state of Maine, which provides an abundance of outdoor activities as well as more metropolitan experiences in Portland. Our hospital is located in one of the most beautiful small cities in the country, offering unparalleled access to outdoor activities year round. Come and check us out!