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Emergency Medicine Residency


Messages from the Chief, Program Director and Chief Resident



A Message from our Chief:

Michael Baumann, MD

The mission of the Department of Emergency Medicine at Maine Medical Center is to provide the highest level of compassionate care to acutely sick or injured patients in our region and state, recruit and train the best physicians in our specialty, and produce high-quality clinical research to shape the future practice of Emergency Medicine. We have enjoyed consistent success in these areas and look forward to a very bright future.

While there are innumerable factors that go into choosing a residency, there are a few that are particular strengths here at MMC that I would like to take a moment to highlight.

Our Faculty:  The EM faculty at MMC has grown to more than 27 members, with subspecialty representation in Pediatric Emergency Medicine, Sports Medicine, Toxicology, EMS, Wilderness Medicine, Ultrasound, Emergency Geriatrics and Critical Care.  While our faculty are all dedicated bedside teachers, and we are leading the way in high-fidelity simulation education in our institution and state-wide,   many have earned a reputation for teaching at the national level, serving as faculty at numerous regional, national, and international meetings.  Additionally, members of our faculty are active nationally in leadership positions helping to define the future needs and direction of our specialty.

Our Research:  The research efforts of our department have been extremely successful.  Under the direction of our research division leadership, our department has produced high-quality clinical research that impacts the way emergency medicine is practiced. Over the past five years our faculty have authored more than 130 peer-reviewed publications, acted as principle investigators in numerous ED trials, and authored a great number of editorials, review articles, and major textbook chapters.  The research division is led by an experienced PhD researcher and includes strengths in EMS, Geriatric Emergency Medicine,  Medical Education,  Quality , International EM and Health Services Research.   The Department has increased its focus on collaborative projects and external funding as it continues to advance the research program.

Our Future: With the opening of our new state-of-the-art ED in 2009, we have been able to focus on program development in several important clinical areas. For example, Portland now enjoys the only pediatric emergency department in Maine, and we continue to add new Pediatric Emergency Medicine faculty. . On the opposite end of the spectrum, we have also made significant investments in the care of the elderly; with the recruitment of a double-boarded (EM/IM) emergency physician who has a strong academic interest in Geriatric Emergency Medicine. Our recently opened Clinical Decision Unit offers longitudinal (observational) care to specific population of ED patients in need. Our residents are active participants in all of these clinical programs.

Our Patients:  At the center of this is our most valuable asset....our patients.  They come to us when they are ill, scared and vulnerable.  The pinnacle responsibility  for every member of our department will always be to take care of every patient as if they were a member of our own family.

Our program provides a pinnacle training experience in a collaborative atmosphere and I invite you to come and see what makes Maine Medical Center Emergency Services so special.

Michael Baumann, MD
Chief

A Message from our Program Director:

Andrew Perron, MD

Welcome to the Emergency Medicine Residency at Maine Medical Center.  Our three-year program (PGY-1 to PGY-3) is based at Maine Medical Center, a 75,000 visit per year, level 1 trauma center located in Portland, Maine.  Our educational goal at MMC is simple...we want to recruit, train, and graduate the finest residents in our specialty each and every year.  Everything we do in this residency, from ED clinical work to off-service rotations, from formal classroom didactics to high-fidelity simulation, is done with that singular goal in mind.

Maine Medical Center is an outstanding hospital with a long tradition of dedication to post-graduate training.  MMC is the only ACS-designated Level I Trauma Center in our state and we provide Poison Center services for Maine, New Hampshire and Vermont. MMC is the "academic nucleus" for our state. This means that we serve as both the tertiary referral hospital for the entire state of Maine, while at the same time serving our local community of Portland and the surrounding "south coast" region.  Our 600+ bed facility is routinely recognized nationally with awards such as a "Top 50 Hospital" as recognized by US News & World Report.  At any one time nearly 200 residents and fellows are in training here at MMC, as well as 100+ medical students participating in 3rd year core rotations and fourth year electives.  In our new partnership with Tufts-New England Medical Center, 36 medical students who select the "Maine Track" will do their entire clinical experience at MMC.

We have just finished a 30-million dollar complete renovation to our ED.  We now have 66 patient care beds located in 50,000 square feet.  We have 6 state-of-the-art critical care bays, a dedicated fast-track area, an expanded pediatric ED, and an observation unit.  Every patient-care room is private and the entire ED is well-equipped with the latest in information technology features.

Our EM residents come from across the country, representing 18 different medical schools amongst our 24 residents.  They include former professional athletes, business managers, researchers, teachers, and paramedics.  When not working clinically, they are likely to be found hiking, biking (the residency has its own cycling club), fishing, surfing, skiing, snow boarding, and enjoying all the other great outdoors opportunities the region has to offer.

The feeling of our residency is one of family.  As a single-site training program, there are no "away" rotations.  EM residents see each other daily, whether in the ED, on other rotations, or in weekly didactic conferences. Additionally, residents and attendings enjoy a collegial relationship that extends beyond the walls of the hospital.  As an example, our Journal Club is held monthly in the homes of our attending physicians (both in Portland as well as on the surrounding Island communities).  At any one time, residents and attending physicians may be training for triathalons together, fishing for stripers before working a clinical shift, or participating in a backcountry camping trip in Acadia.

Graduates from our program have succeeded in all aspects of Emergency Medicine.  In all regions of the country, we have placed graduates in their choice of fellowship, academic position, or private practice opportunities.  To date, approximately a third of our graduates have gone into academic practice, while two-thirds have chosen to go into private practice.  Training (clinical, research, and administrative) at MMC is comprehensive, and will give the program graduate the skills to succeed in any practice area they choose. 

The state motto for Maine is "Maine, the way life should be".  For applicants, we look forward to the opportunity to meet you and further demonstrate to you why we think EM training at MMC is a great idea...or to borrow the phrase "MMC, the way Emergency Medicine residency training should be".

Andrew Perron, MD
Program Director

 

A Message from our Chief Residents:

Welcome to the Maine Medical Center Emergency Medicine Residency from the 2013-2014 Chief Residents!

Choosing a residency program can be a tough job. You want to train in a place with excellent faculty, great didactics, plenty of patients to learn from. You want to know that when it's all over, you're well-prepared for whatever is next -  fellowship, academics, or community emergency medicine. You may want research opportunities and good support for an academic project. And you're probably looking for "fit" - a place where you feel at home.

On the academic front, Maine Med has us covered. We've had excellent training, both in the E.D. and off service. Our program director is a dedicated resident advocate inside and outside the department, and regularly seeks feedback to improve didactics, off-service experience, and our on-shift training. Our curriculum is streamlined to make good use of our time and maximize our learning. There's great support for research, and we have no problem meeting and surpassing ACGME requirements for procedures. We are expected by our consultants to be very independent, and we do a lot in our E.D., from joint reductions and taps to complicated resuscitations. Our graduates find themselves comfortable practicing in environments that range from small-town community E.D. to urban academic center. With a high census and a high-acuity population, there's a new challenge every shift.

Here are some of the things we weren't looking for - things we didn't know to look for - but we found here at Maine Med. We love seeing pediatric patients year-round, nearly every shift. Our airway training is world class, taught by national leaders in difficult airway management. Our didactics are awesome - high yield and engaging. We love our Journal Clubs - hosted by our attendings, directed by our seniors, with the perfect mix of social time and lively academic discussion. We have a close working relationship with our EMS providers, with opportunities to gain experience in medical direction and pre-hospital training. And don't forget the lobster - at least twice a summer, and sometimes more, you can score some free lobster!

Portland tends to attract people who love the outdoors, and you'll find that most of our residents and attendings cherish our outdoor time. You can always find someone to join you for a bike rids or a ski, or if grilling on the porch is more your speed, you'll find spur-of-the-moment get-togethers common. Portland's busy tourist traffic in the summer means there are restaurants, shops, and cultural opportunities that are very rich for a city this size - and we have them all to ourselves for most of the year. Just be careful - you may choose to come here for a lot of reasons, but Maine itself will draw you in and make you want to stay.

Those who have rotated with us know that residents, students, significant others and families, and many of our non-physician colleagues are all part of our big extended residency family, providing friendship and support through the challenges and triumphs of residency. That feeling of family, where we have just the right mix of independence and guidance, is something that can't be quantified or entered in a "where should I go to residency" spreadsheet, but it's the thing that makes our program really shine. Come visit us and see for yourself why we think "Maine Med" is a great place to train. And email us any time along the way if you have questions about the program, the interview process, or just where to go eat in Portland! We'd love to hear from you.

Cheers,

Alicia Bond

John Miller

Nick Papacostas

mmcedchief@gmail.com


Life As An Intern

“Dr. McCorvey, please dial 0520” rings out over the paging system in the Emergency Department.  It’s my first day as a resident at Maine Medical Center and I feel completely lost.  I’ve been assigned to work the first 5 nights of residency and, although it’s already 11:10pm, I haven’t even had a chance to introduce myself to my first patient yet.  Instead, I find myself answering an overhead page, for what turns out to be my first patient in residency.  I pick up the nearest phone, enter in the number, and eagerly wait to see who is on the other end.  Low and behold it’s one of our Patient Care Representatives; specialized coordinators of the ED who help make sure we, as residents, can navigate the complex and somewhat daunting world of emergency medicine.  On this night, the PCR wants me to know that the senior resident, John Miller, is requesting my help in the trauma bay for a procedure.

As I quickly hustle back to our dedicated trauma bays, I can’t help but run through a list of possible procedures that I may need to do to help him stabilize a patient.  Would this be an intubation?  Central line?  Wound closure?  The sky was the limit and I was starting to get excited to dive right into patient care.  As the double doors open and I pull back the drape, I am greeted by John, Dr. Hamonko, and a very pleasant elderly patient who is in quite a bit of pain.  After introducing myself as Dr. McCorvey for the first time, I come to find out that “Mrs. Smith,” our elderly patient, is a retired physician of 40 years and has recently undergone a total hip replacement. She was now in the ED because she had dislocated her hip and was in excruciating pain. So, after discussing the different options for hip reduction and giving her conscious sedation, I slipped her hip back into place and successfully treated my first patient at the same time.  As I left the trauma bay to see the patient I originally signed up to see when I arrived, I couldn’t help but reflect on the fact that my first patient as a resident was a physician, who even after retiring was continuing to educate the next generation of doctors, albeit in a different role.

The remainder of the night went by in a flash. By the time the sunrise came and my shift was near completion, I had treated a woman with diabetic ketoacidosis, a patient with a septic knee joint, multiple patients with large lacerations, participated in numerous trauma activations, and even seen little 18-month-old boy with croup.  It’s amazing how much diversity we have in our patient pool and how different each night in the ED feels.  Over the next three weeks in the Emergency Department, I would be tested simultaneously on my medical knowledge and my ability to juggle complex patients, something that makes our specialty so challenging yet fun at the same time.

Humbling would be an appropriate word choice to describe this ongoing experience of residency.  Just as you think you have things figured out, a completely different diagnosis comes along and the way and teaches you an important lesson in medicine- if it walks like a duck and quacks like a duck it may not be a duck. For example, while working the afternoon shift of the “CK side” of our Emergency department, a catch-all area that treats the walking wounded, medically ill adults, and the majority of our pediatric population, I had a particularly humbling case of abdominal pain. My attending for the day was Dr. Earnshaw, a seasoned vet of Emergency Medicine and true asset to our department, when I saw a young woman in apparent extremis while walking towards a different patient’s room.  Her visible level of discomfort led me to stop in my tracks and proceed into her room to see if anyone had been by to see her, which they hadn’t.  Her story sounded familiar – she was mid 30’s with a past medical history of gastric bypass and had experienced an acute onset of severe right flank pain that sounded just like a kidney stone.  I quickly placed orders for an IV, pain medicine, and a urine analysis and stepped out of the room to go see the patient who I had originally set off to see.  When the results came back, the urine analysis confirmed my suspicion, and, since she had responded appropriately to the pain medicine that I treated her with, I was satisfied with my diagnosis and was set to send her home with instructions to return if anything concerning happened.  In that exact moment, I was saved by Dr. Earnshaw.  He felt that her history of bypass warranted a trip to the CT scanner, as gastric bypass is notorious for having multiple complications that can be fatal to a patient in a matter of hours.

I can still remember how I felt when I saw her CT images populate on our imaging software.  There was no kidney stone, no hydronephrosis, or other abnormality that suggested this diagnosis, but there was something much more concerning— mesenteric edema and free fluid.  My patient, who presented like a classic case of kidney stones, had experienced an internal hernia, a somewhat common complication following gastric bypass, and she was actively strangulating her small bowel as she sat in our emergency room.  Less than 30 minutes later, she was on her way to the operating room to undergo a laparotomy and repair of the defect.  It was a humbling experience, to say the least, and one that will stay with me for the remainder of my career.

There is something about the rhythm of the Emergency Department that allows one to fully immerse him or herself in the moment.   Perhaps it is the constant juggling of multiple patients, complaints, procedures, admissions, and discharges that makes the time fly by.  I watch our seniors manage this juggling act with the precision and efficiency that I hope to achieve one day.  I can’t imagine a field of medicine that better suits my personality and professional interests.  There is something incredibly rewarding about being an Emergency Medicine resident here at Maine Medical Center.  I hope that interested medical students from around the country take a strong look at the program here.  We have fantastic faculty, facilities, support staff, and patients, which, when combined with the great city of Portland, amount to a very special location to train for residency.  Hope to see you soon!

Scott McCorvey, M.D., M.S.
Emergency Medicine Intern
Maine Medical Center