Letters to the Editor  |   November 2005
Dynamic Duo: Maine-Dartmouth Family Practice Residency Program and University of New England College of Osteopathic Medicine
Author Affiliations
  • Charles Perakis, DO
    University of New England College of Osteopathic Medicine Biddeford, Maine, Clinical Training Center Maine-Dartmouth Family Practice Residency Augusta, Maine
    Associate Clinical Professor, Director
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   November 2005
Dynamic Duo: Maine-Dartmouth Family Practice Residency Program and University of New England College of Osteopathic Medicine
The Journal of the American Osteopathic Association, November 2005, Vol. 105, 495-496. doi:
The Journal of the American Osteopathic Association, November 2005, Vol. 105, 495-496. doi:
To the Editor:  
This letter is written to describe the increasing collaboration between the Maine-Dartmouth Family Practice Residency (MDFPR), which is Maine's oldest family practice residency program,1 and the University of New England College of Osteopathic Medicine (UNECOM), which is Maine's only medical school.2 It is written from my perspective as an osteopathic physician (DO) who practiced for 20 years in rural Maine and who now serves as a medical educator. 
The Maine-Dartmouth Family Practice Residency program began as a joint project involving community hospitals in the Kennebec Valley region; the Veterans' Administration Hospital of Togus, Me; and Medical Care Development Inc, a rural research and development organization headquartered in Augusta, Me.3,4 The MDFPR program was first accredited in 1973 as the allopathic Central Maine Family Practice Residency program.4 In 1979, the program became affiliated with Dartmouth Medical School in Hanover, NH, and, in 1980, it became incorporated as the MDFPR.4 
In 1994, the MDFPR directors signed a second medical school affiliation agreement, with UNECOM in Biddeford, Me.4 This agreement established a traditional rotating osteopathic internship. In 2005, the American Osteopathic Association (AOA) accredited the MDFPR with an additional two-year osteopathic family practice residency.5 A 1998 article in Family Medicine by Johnson et al6 described the process by which allopathic residency programs, such as the MDFPR program, complete the AOA accreditation process to become approved osteopathic internship sites. 
The MDFPR program expanded from six graduates per year to nine during the early 1990s,4 when a second model practice was added in Fairfield, Me—20 miles north of our Augusta practice-near the Waterville campus of Mid-Maine Medical Center (now MaineGeneral Medical Center).4 The program has always enjoyed a strong reputation, which was bolstered by John McPhee's three-part series, titled “Heirs of General Practice,”7 that appeared in The New Yorker in 1984. McPhee described the daily work of a number of family practice residents in the MDFPR program. 
More than 200 family physicians have graduated from the MDFPR program, and over 60% of these graduates have stayed to practice medicine in Maine, many in small rural practices.8 In a national report released in March 2005 on physician placement for the 1997-2003 academic years, the MDFPR program was ranked as the medical residency program with the greatest number of graduates opening practices in rural areas in the United States.9 
Third- and fourth-year medical students at UNECOM began outpatient family practice clerkships in the MDFPR program in 1994. The University of New England College of Osteopathic Medicine has been eager to find more rotation sites in Maine. In August 2004, four third-year UNECOM students began their core rotations in psychiatry, surgery, internal medicine, and family medicine. In August 2005, seven third-year students began their core rotations, which included rotations in obstetrics and pediatrics, at various sites in the network of MaineGeneral Health. 
The UNECOM students in the MDFPR program attend morning signout, in which they begin to learn the regular routine of the house medical staff. In the family medicine rotation, students see their own patients, with one-on-one precepting by a provider. In the internal medicine rotation, students participate as team members, with each student receiving increasing responsibilities as he or she progresses through the program. 
One afternoon each week in the MDFPR program is set aside for educational sessions on medical ethics, pain management, sports medicine, or other medical topics. Two hours of each session are devoted to hands-on training in the use of osteopathic manipulative treatment. Students also participate in late afternoon informal conferences, in which residents present unusual or difficult cases from their practice experiences. 
As an intern in 1974, I was accepted into the pre-Dartmouth Maine Family Practice Residency program, so I could have been in one of the program's earliest graduating classes. However, I chose to become one of two family practice residents at the former Osteopathic Hospital of Maine in Portland (now the Maine Medical Center-Brighton Campus). Later, I became the codirector of that hospital's residency program for many years. Thus, it seems ironic to me that I ended up back at the MDFPR program. 
I have been associated with UNECOM since its inception, and I have volunteered many hours of precepting and teaching. Now, I am asking my former students, many of whom have established practices in the area, to contribute to the education of the next generation of UNECOM students. This step would help continue the tradition that has led to the impressive growth of the osteopathic medical profession in Maine and throughout New England (S. Strout, oral communication, October 2005). The MDFPR program's first-year residency class for the academic year 2005-2006 includes seven DOs, all of whom are UNECOM graduates. 
We are orienting both the residents and medical students in the MDFPR program on teaching and learning skills so that the educational process can be refined. The residents and medical students are offered opportunities to keep learning new portfolios throughout their years of clinical training. Documentation produced in the program for each resident and student includes information on his or her strengths and weaknesses, education goals, and critical events, as well as reflections on that individual's practice experience. 
The MDFPR program has shown itself to be a family practice residency program in which DOs and allopathic physicians respect each other and work together in a collegial manner. 
 As the premier scholarly publication of the osteopathic medical profession, JAOA—The Journal of the American Osteopathic Association encourages osteopathic physicians, faculty members and students at osteopathic medical colleges, and others within the healthcare professions to submit comments related to articles published in JAOA and the mission of the osteopathic medical profession. The JAOA's editors are particularly interested in letters that discuss recently published original research.
 Letters to the editor are considered for publication in JAOA with the understanding that they have not been published elsewhere and that they are not simultaneously under consideration by any other publication.
 All accepted letters to the editor are subject to copyediting. Letter writers may be asked to provide JAOA staff with photocopies of referenced material so that the references themselves and statements cited may be verified.
 Readers are encouraged to prepare letters electronically in Microsoft Word (.doc) or in plain (.txt) or rich text (.rtf) format. The JAOA prefers that letters be e-mailed to Mailed letters should also be sent electronically, in one of the aforementioned electronic formats on an IBM-compatible CD or a 3½-inch disk, and addressed to Gilbert E. D'Alonzo, Jr, DO, Editor in Chief, American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864.
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 Although JAOA welcomes letters to the editor, readers should be aware that these contributions have a lower publication priority than other submissions. As a consequence, letters are published only when space allows.
The author thanks Dan Meyer, PhD, the Director of Research at the Maine-Dartmouth Family Practice Residency for his assistance with historical information. 
News and Events. Maine-Dartmouth Family Practice Residency Web site. January 1, 2005. Available at: Accessed September 29, 2005.
University of New England College of Osteopathic Medicine Web site. Available at: Accessed September 29, 2005.
Medical Care Development Inc Web site. Available at: Accessed September 29, 2005.
Introducing the residency program. Maine-Dartmouth Family Practice Residency Web site. Available at: Accessed September 29, 2005.
Osteopathic residency information. Maine-Dartmouth Family Practice Residency Web site. Available at: Accessed September 29, 2005.
Johnson KH, Raczek JA, Meyer D. Integrating osteopathic training into family practice residencies. Fam Med. .(1998). ;30:345-349.
Heirs of general practice Web page. John McPhee Web site. 2003. Available at: Accessed September 29, 2005.
Graduates of the program. Maine-Dartmouth Family Practice Residency Web site. Available at: Accessed September 29, 2005.
MDFPR recognized for success in placing graduate residents. Healthcare Review. March 3, 2005. Available at: Accessed September 29, 2005.