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 and have no day-time responsibilities. Senior residents typically do two weeks during 2 of their required 3 senior inpatient months. Day team residents cover the inpatient unit over the weekend. Residents on electives are in the call pool for weekend 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 MHMMC 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, equity and inclusion (DEI)?
A: Our residency program is committed to creating a safe, supportive, and inclusive training environment that allows individuals of all backgrounds and identities to achieve professional and personal success and wellness. We value the experiences and perspectives of all our patients, trainees, and staff, and dedicate ourselves to facilitating bidirectional learning and teaching to promote justice, equity, inclusion and antiracism. Program goals include:
- Resident and faculty engagement in departmental DEI committees/work groups;
- Inclusion of DEI topics in didactics;
- Reflection on bias and social determinants of health through directed questions at pediatrics and internal medicine morning reports;
- Engagement in community activities that support our patients;
- Ongoing work through holistic review to interview a diverse group of applicants
Our residents are involved in pediatrics and internal medicine department DEI committees. DEI subcommittees in the department of graduate medical education, the MHMMC Institute for Teaching Excellence, and the department of medical education (Inclusive Culture Steering Committee) provide opportunities for advocacy, education and growth for individuals throughout MHMMC. We recognize a need to recruit and ensure retention of a more diverse faculty to support residents and the diverse patient population we serve.
One of the ways our residents learn about the importance of DEI is through community clinic rotations. Portland is an increasingly diverse city and a refuge for many asylum seekers. Residents interact with diverse populations, including many recent immigrants. As a program, we strive to learn more about what makes people of all backgrounds unique based on their sex, gender identity, race, ethnicity, disability, socioeconomic or other backgrounds. We also recognize that groups of people have been marginalized, and their health impacted, by these factors. We are committed to educating ourselves and others to improve patient care and community well-being.
MHMMC is actively engaged in recruiting a more diverse workforce, including in our residency programs, so that we can better serve and represent the Portland community. We include perspectives from patients and colleagues of under-represented minorities in our recruitment process and encourage applicants from all backgrounds to apply to our program. MHMMC is also committed to creating an environment where all patients and care team members feel welcomed and included. The MHMMC Director of DEI is supported by DEI ambassadors and committees throughout the organization. And the Vice President of DEI for MaineHealth is implementing a DEI Strategic Plan for the entire health system. MHMMC also offers a Visit Student Diversity Scholarship for interested medical students.
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 - MHMMC "Maine Track" students will spend all of their second and third and most of their fourth years of medical school at MHMMC 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 MHMMC. 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 self-directed learning time. 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 incorporate quality improvement/patient safety and preparation for M&M conferences during these blocks in the first 2 years.
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 MHMMC?
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 Pediatrics both have 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 MHMMC. Some units support rounding as a full interdisciplinary team for all patients.
Q: How is resident wellness addressed?
A: Residency is hard, but we do our best to help residents find joy during training. Schedules are closely reviewed to prevent residents going over duty hours and we closely monitor resident stress/fatigue. We have a well-established night float system for all four years of training so that there is no 24-hour call. X+Y block ensures residents never have more than 4 weeks of inpatient service in a row. Graduate wellness resources are available, including access to a peer support program and free counseling services.
Residents have the opportunity to help identify their own advisors/mentors or have a Med-Peds advisor assigned. Residents help choose four ½ days over each academic year for “wellbeing” 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. MHMMC 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?
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.