Maine Medical Center

Maine Medical Center has 606 licensed beds, and provides comprehensive inpatient services in all medical specialties. Centers of excellence are being developed in cancer care, heart care, children's services, and other areas, building from existing excellence in multi-disciplinary services.

MMC has a large and growing outpatient component, providing day surgery, cardiac catheterization, laboratory services, rehabilitation services, and some three dozen outpatient clinics. There are also preventive and consultation services, including the MMC Diabetes Center, the AIDS Consultation Service, and the Center for Lipids and Cardiovascular Health.

Geriatric Fellowship

The one-year Geriatric Fellowship is designed to be a comprehensive program of learning that will prepare the graduate to pass the Geriatric Board exam and practice Geriatric Medicine in any arena, including but not limited to, patient care, teaching and administration. Administered through the Department of Internal Medicine, the Geriatric Fellowship is intended for graduates of accredited programs in either Internal Medicine or Family Practice.

In addition to the traditional outpatient clinics, nursing homes and assisted living centers, The Maine Medical Center Geriatric Fellowship includes clinical rotations in an acute rehabilitation facility, in both outpatient and inpatient geriatric psychiatry and in geriatric neurology. The Fellowship year also includes 2 elective months in which the Fellow has an opportunity to focus on specific areas of interest, including geriatric cardiology, pulmonary medicine, research, geriatric emergency medicine and intensive care.

Another distinctive feature of the Geriatric Fellowship is its association with The Center for Outcomes Research and Evaluation (CORE) at Maine Medical Center. As the health services research arm of the Maine Medical Center Research Institute, much of CORE's work has been related to geriatrics. CORE researchers have used the Medicare database to understand geographic variations in care and to specifically explore treatment for cardiac conditions. The Research Director for Geriatrics is also the Associate Director at CORE.

Maine Medical Centers Geriatric Fellowship program is accredited by ACGME.

Curriculum

The goal of the Geriatric Fellowship is to conduct an intensive one year program of learning in Geriatric Medicine. The graduate will be prepared to pass the geriatric board exam and to practice geriatrics in any arena including but not limited to patient care, teaching, and administration. The following is a description of the rotations included as part of the fellowship program:

1. Continuity clinic:
This experience consists of the evaluation and following over the residency of ambulatory older persons as they receive primary medical care. It will consist of one 4 hour session per week for the entire residency in a primary care geriatric office. The experience will include new patient evaluations, yearly assessments and interval care. Patients will be selected in a way to insure a broad mix of outpatient geriatric problems. The Fellow will see patients independently and will organize treatment plans under the supervision of the attending.

2. Assisted Living (Piper Shores):
The Fellow will admit and follow over the course of the residency selected older persons living in the assisted living unit of a local retirement community called Piper Shores. The supervising physician is the Medical Director of the facility. The Fellow will also provide some acute illness care, when needed, for the patients of the Medical Director.

3. Nursing Home and Skilled Care (Maine Veterans Home, Scarborough):
Throughout the residency experience the Fellow will spend one four-hour session weekly at the Maine Veterans Home (Scarborough) under the supervision of the Medical Director and the Assistant Medical Director (Drs. Harper and Braun). The Fellow will admit and care for a panel of patients over time and will be an integral part of the teaching of other Internal Medicine and Family Medicine residents at that site.

4. Outpatient geriatric assessment (The Geriatric Center):
The clinic meets weekly and is designed to provide comprehensive geriatric assessment in a multidisciplinary form to elderly patients who are community living and perceived to not be functioning well. The Fellow will work with geriatricians, geriatric psychiatrists and other clinical staff in the evaluation of new patients, provision of early dementia patient and family services and other clinic functions. The Fellow will perform and participate in the physician portion of the assessment and will play a major part in the synthesis of information in order to create a list of diagnoses and a treatment plan. The Fellow will also conduct the family/caregiver meetings. The assessment is supervised by faculty who have experience with Geriatric Assessment in outpatients.

5. Acute Care for the Elderly unit (ACE Unit):
The ACE Unit is a geographically and structurally distinct unit of the Maine Medical Center designed to provide the team concept of care for complicated acutely ill elderly patients. While assigned to the Acute Care Rotation (four months per year) the Fellow will be an integral member of the ACE unit team. The unit and the Fellow are supervised by a member of the geriatric faculty (Dr. Weirman). All patients assigned to the unit are seen daily by the ACE team and the principles of geriatric medicine are utilized to shorten the length of stay, prevent hospital related complications, and to maintain maximal function and independence.

6. Geriatric Consult Service:
The Geriatric Consult Service is a team of geriatricians organized to provide consults to acutely ill hospitalized patients. When assigned to the Acute Care Rotation (four months per year) The Fellow will be a member of the consult team. He/she will perform consults under the supervision of the geriatrician assigned to the consult service at that time. Each patient consult will be reviewed with the faculty member and the care plan will be reviewed on the day the patient is seen.

7. Hospital Elder Life Program (HELP):
HELP is a program designed to prevent delirium in acutely ill, at risk, hospitalized patients through the use of volunteer administrated, validated protocols. The program is administrated by a physician director who is assisted by a masters level recreational therapist and a masters degree nurse. The program also uses principles of geriatrics to maintain maximal levels of patient independence and, therefore prevent nursing home placement. While assigned to the Acute Hospital Rotation, the Fellow will assist the team in the evaluation of patients and will help administer protocols to patients.

8. Geriatric inpatient service:
During this rotation, the Fellow will follow inpatients from the Consult Service, the ACE Unit, and the Hospital Elder Life Program (HELP). Supervision will be provided by the faculty member performing the consults and by the physician who oversees teh ACE Unit and the HELP Program.

9. Outpatient geriatric neurology:
During the Geropsychiatry and Neurology rotation, the Fellow will spend one four to five-hour session per month over the course of the year in the office of a local neurologist. In this time the Fellow will perform neurology consults and revisits under the supervision of the neurologist.

10. Geriatric rehabilitation (New England Rehabilitation Hospital):
This three month experience exposes the Fellow to an intense experience dealing with patients who are recovering from conditions such as hip fractures and replacements, knee replacements, strokes, amputations, spinal cord injury, multiple trauma, brain injury and debility due to various medical conditions, including cancer. The Fellow will admit and manage patients as a member of the rehabilitation team. The supervising physicians are physiatrists or internists and the hospital Medical Director. The Fellow will also take part in a number of outpatient clinics such as the Stroke Clinic and the Amputee clinic.

11. Home visit program:
It is expected that the Fellow will conduct a minimum number of home visits to the homes of patients whose care he/she has had a part in arranging. A member of the faculty will precept the resident in this function. The Fellow will assure that the care rendered through the home visits is coordinated with the other providers of care (especially the appropriate home nursing service).

12. Geropsychiatry:
The geriatric psychiatry rotation will include patient care in both the inpatient and outpatient arenas. Some supervised time will be spent consulting on patients in nursing homes. Some time will be spent on the inpatient geriatric psychiatry service both evaluating and treating elderly patients hospitalized with acute psychiatric illnesses under the supervision of a geriatric psychiatrist. An outpatient geriatric psychiatry clinic is available for additional training. Geriatric psychiatrists will supervise the Fellow in all sites.

Rotation Schedule

Month 1* Acute hospital rotation

Month 2 Geriatric psychiatry rotation (inpatient)

Month 3 Elective

Month 4 Acute hospital rotation

Month 5 Rehab Medicine at New England Rehabilitation Hospital (NERH)

Month 6 Rehab Medicine at NERH

Month 7 Rehab Medicine at NERH

Month 8 Acute hospital rotation

Month 9 Geriatric psychiatry rotation (inpatient)

Month 10 Elective

Month 11 Geriatric psychiatry (outpatient)

Month 12 Acute hospital rotation

*Fellows will need to arrive one week prior to the beginning of rotation to attend orientation.

Research

A distinguishing feature of the Geriatric Fellowship is its Association with the Center for Outcomes Research and Evaluation, (CORE) at Maine Medical Center. The Associate Director of CORE, Dr. Neil Korsen, is also the Research Director for the Geriatrics Division. Through this relationship, there are multiple opportunities for the Geriatric Fellow to engage in research activities pertinent to geriatrics.

The Center for Outcomes Research and Evaluation at Maine Medical Center is the Health Services Research arm of the MMC Research Institute. Much of the research done at CORE involves analysis of large databases, including the Medicare database and a database of injuries created by funding from the Centers for Disease Control. Publications from investigators at CORE frequently relate to geographic variations in care and to the relationship between volume and outcomes of care. Investigators at CORE also produced the Dartmouth Atlas of Cardiovascular Health Care. In addition to the research activities at CORE, personnel at CORE also provide support for attendings, fellows, and residents at MMC in research design and statistical analysis. At present, Dr. Korsen and Geriatric Fellow Dr. Richard Marino are using the injury database to assess suicide in the elderly.

More detail: Geriatric Program

Infectious Disease Fellowship

Maine Medical Center offers an ideal environment in which to train infectious disease fellows. The hospital provides primary care services to the Greater Portland community and is a referral center for the entire state of Maine and adjacent parts of New Hampshire. The daily census for patients admitted to the medical services is more than 240. This stimulates 500-800 infectious disease consultants per year which are available for fellow training, encompassing a wide array of infections that include the complications of bone marrow and renal transplantation, HIV, and diseases of international refugees.

Curriculum

The training program curriculum meets all the requirements of the subspecialty board in infectious diseases of the American Board of Internal Medicine and includes in-depth clinical and laboratory experiences during two years of training. Fellows also participate in research activities concurrent with clinical involvement and are provided block time for their own projects.

Fellows are actively involved in the teaching of medical residents and medical students on the inpatient and consult services, and they provide continuing education programs for nursing and technical staff.

First Year

The first year of training is largely clinical. The fellow has primary responsibility for the infectious diseases consult service and sees inpatient consultations in conjunction with the service attending. The fellow also supervises a second-year medical resident and fourth-year medical student who are taking an infectious diseases rotation. There is a daily attending conference which serves as the primary formal teaching forum for day-to-day diagnosis and management to inpatients, a weekly case conference attended by infectious diseases specialists from throughout southern Maine, a weekly fellows didactic conference, and a monthly journal club. Basic science and research lectures are a regular part of the curricululm.

A major portion of training in infectious diseases occurs in the outpatient setting. First-year fellows participate in weekly infectious diseases and AIDS consultation clinics and less frequently in hepatitis, tuberculosis, and international health clinics. In the infectious disease outpatient clinic, the fellows see referrals from physicians throughout Maine. In the past year this included the outpatient management of common problems such as osteomyelitis as well as unusual diseases such as leishmamasis, leprosy, and schistosomiasis.

The inpatient program includes primary infectious diseases consultative responsibility for a 34-bed critical care unit, a dedicated hematology/oncology unit that supports the bone marrow transplantation program, and a nephrology/renal transplantation unit.

The curriculum for the first year program also includes dedicated time spent in learning basic microbology with a bench level experience in microbiologic techniques of bacteriology and virology. Month-long rotations are spent on the epidemiology services. Fellows can also elect a pediatric infectious diseases rotation.

Second Year

The second year of the training program is dedicated primarily to the development and completion of a research project, which is designed to meet the particular interests of the fellow. However, the fellow continues to spend a total of 2-3 months on the inpatient consultative service and to attend the infectious disease clinics, including HIV and hepatitis C clinics. Fellows are encouraged to fulfill the role of a junior attending both in supervising the clinical service and in supporting the teaching program.

The second year curriculum, in addition to the research project, is tailored to meet the special needs and interests of each fellow. Rotations at other medical centers may be arranged when appropriate. Opportunities exist for involvement in epidemiology and public health, molecular biology and immunology, and specialized areas of clinical infectious diseases.

Research

The division of infectious diseases is involved in an increasing spectrum of research projects. In addition to a long history of involvement in experimental drug treatment trials, the division has developed active research projects in the epidemiology and biology of Lyme disease, the use of molecular probes in the detection of microbial agents and the pharmacokinetics of antibiotic use.

Excellent opportunities exist for research in hospital or public health epidemiology. The Maine Medical Center Research Institute provides supervision and a laboratory setting for the application of molecular biology and immunology to infectious disease research. In addition, the MMC AIDS Consultation Service has embarked on several clinical drug trials and provides a setting for additional research efforts that focus on clinical and immunological aspects of HIV infection.

Second-year fellows are encouraged to develop their own research project with appropriate faculty supervision drawn from the division of infectious diseases or the MMCRI. These projects may be primarily epidemiologic, clinical, or basic research as determined by the fellows' interests. Research support is available from the MMC Research Foundation for fellows' research projects.

More details: Infectious Disease Program

This article is reposted with thanks to Maine Medical Center.