Block Clerkship Projects

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Preparation as Prevention – Reducing Morbidity and Mortality in the Vermont Outdoors

Nathan T. Dreyfus

While precipitants and outcomes of wilderness medical emergencies are numerous and diverse, wilderness rescues in Vermont are most often called for individuals or groups inadequately prepared for conditions or contingencies. In many cases, failure to bring one of a few key items such as equipment for navigation or illumination after dark can create a preventable emergency with subsequent requirement for rescue or retrieval.
Barriers to Implementation of Point-of-Care Ultrasound in Primary Care

Jack Dubuque

Point-of-care ultrasound (POCUS) is a safe and rapidly evolving diagnostic tool that has changed the practice of many hospital based specialties and has been introduced into Family Medicine residencies over the last few years.

While the UVMMC Family Medicine residency has introduced POCUS into the curriculum, many practicing physicians have limited knowledge about the technology. This study aims to document the views and concerns of primary care providers about use and implementation of POCUS.
Increasing Bicycle Safety in South Burlington

Sam Epstein

While there are many mixed use lanes in South Burlington, many people still do not use bicycle travel to get to work or the store. This occurs for many reasons, but one reason may be that people are not comfortable riding on roads. There is also a lack of bicycle friendly transportation between Burlington and South Burlington. This simple and easy to read handout provides tips on how to ride bicycles safely as well as a map of the existing bike and pedestrian friendly roads in SB.
Using design thinking to help practitioners and front desk staff schedule follow up appointments

Jhaimy Fernandez

Due to an increase of calls at the front desk, Western Connecticut Health Network has systemized scheduling through call centers. In Newtown Family Medicine, clinical staff become responsible for helping patients navigate between two call centers in order to schedule appointments or schedule imaging. I used design thinking to create stickers that saved practitioners time explaining the process and decrease patient confusion.
Health Care Share: Fighting Food Insecurity with Local Farm Shares

Sarah French

Food insecurity affects 10% of Vermont families annually, up to 15% of families with children. Contributing factors to this include lack of transportation, low wages, lack of affordable housing, unemployment, and limited access to nutritious produce. For children, this issue is even more pronounced during the summer months, without access to free or reduced-price meals at school. Health Care Share is a 14-week farm share distributed to families who have been identified to have food insecurity by their healthcare provider in Vermont. This project’s goal was to promote provider and patient awareness regarding the application process by implementing reminders for providers during the application window, as well as increasing ease of patient education via a dotphrase to provide the patients with additional information to take home with them.
Art Interventions for Seniors in New Milford, CT

Lauren Gaffaney

There is a growing body of evidence that art therapy for seniors has been shown to improve sociability and mood, reduce the risk of dementia, decrease agitation, depression, isolation, and improve the overall quality of life. Recent research conducted in Burlington with the UVM LCOM Public Health Program suggested that art appreciation and history sessions can have similarly beneficial effects while requiring less volunteer/caregiver time, equipment, and with a lower cost. I surveyed the art interventions available in New Milford, CT and found there were limited active art classes available and no art appreciation sessions. I presented an art appreciation session at the New Milford Senior Center for seniors and staff, with the aim of teaching staff so they could continue the sessions once my clerkship was done.
Sleeping Mindfully

Jinal Gandhi

Insomnia is a disorder of hyperarousal that affects up to 30% of adults. Insomnia is based on cognitive dysfunction that causes us to worry and neuroendocrine factors that upregulate our autonomic nervous system. Studies have shown that just 10 minutes of daily mindfulness practice can improve sleep. Mindfulness is able to work at the root of both causes of insomnia. It improves our ability to relax through increasing attentional factors that impart control over stress hormones and helps reduce ruminative thoughts.
Social Stories to Facilitate Preparation for Healthcare Visits

Benjamin Grebber
Promoting Medical Education at Cabot School

Dore E. Grier

As a Cabot School alumni, I returned to Cabot School to talk to the students about opportunities in medicine. Cabot School is considered environmentally disadvantaged by the Agency of Education. By definition, "the individual comes from an environment that has inhibited him/her from obtaining the knowledge, skill and abilities required to enroll in and graduate from an undergraduate or graduate school." The percentage of students achieving proficiency in math and reading/language arts is lower than the Vermont state average for the 2016-17 school year. The goal of this project was to share my journey to medical school with the Cabot students and introduce them to careers in medicine.
Addressing Geriatric Falls in the Outpatient Setting: A Prevention Initiative

Brian W. Gross

With approximately 25% of older aged 65 or greater falling each year, and 20% of these incidents resulting in serious injury, falls are of significant concern for both the geriatric community and the healthcare system at large. In 2017, Vermont ranked 41st in the nation with respect to the percent of older adults with self-reported falls in the past 12 months, according to the United Health Foundation’s “America’s Health Rankings" report. Many patients at risk for falling remain uneducated regarding environmental, pharmacological, and/or behavioral risk factors that may be contributing to their fall risk. In addition, providers often have limited time during office visits to counsel patients regarding strategies to combat these risk factors. The purpose of this work was to develop discharge instruction strategies for geriatric patients at Hinesburg Family Medicine to combat environmental (home hazards), behavioral, and pharmacological factors that may be increasing their risk for falls.
Patient Education on the Association of Hormonal Contraception with Depression

Julia E. Hannigan

Hormonal contraceptive agents are widely used by women during their reproductive years. In recent years, research has been released linking hormonal contraception with the initiation of antidepressant medication and a first diagnosis of depression. More research is still warranted in order to further elucidate the relationship between hormonal contraception and depression, but current evidence prompts the necessity for shared decision making between clinicians and women considering treatment with hormonal contraceptive agents. The goal of this project is to give providers easily accessible patient educational materials in the form of epic smart phrases to aid in informed decision making.
CBD: A Resource for Patients

Ryan G. Harned

An educational resource for patients describing the current body of research on cannabidiol (CBD), the current legal landscape, regulatory and manufacturing considerations, drug interactions, and potential risks.
It's Not TMI: Causes and Risks of Vaginal Discomfort

Olivia Harrison

Many people with vaginas feel uncomfortable discussing vaginal discomfort with their health care providers. Not disclosing symptoms such as pain, itching, dyspareunia, etc can lead to long term complications such as PID and significantly impact quality of life. I designed a pamphlet to help normalize talking about one's vagina to one's health care provider. This pamphlet outlines common causes and risks of vaginitis.
Beyond Acute Lyme

Nicholas Haslett

Vermont has one of the highest rates of Lyme disease infection in the country. There is growing disagreement not only between the medical community and a growing patient population, but also within the medical community itself, around the issue of persistent syndromes that may or may not be related to a Lyme diagnosis. Many patients seek treatment for persistent symptoms outside of physician guidelines for either Post Treatment Lyme Disease or the contentious "Chronic Lyme Disease" via prolonged courses of IV antibiotics, colloidal silver infusions, electromagnetic frequency treatments, and more. Regardless of the debatable extent of spirochete carnage in vivo, there is a need for effective and compassionate communication between providers and concerned patients. The aim of this project is to nudge this inevitably ongoing conversation in a productive direction, and to create a broader shared awareness between populations at growing odds.
Assessing Access to Community Health in Rutland County

Sidney JB Hilker
Promoting Healthy Habits and Active Living for Children and Families at the Well-Child Visit

Jennifer E. Holland

The 2019 Rutland Regional Medical Center Community Health Needs Assessment reported that 16% of adolescents and 30% of adults in Rutland County, Vermont are obese. This exceeds the average numbers for the state. Primary care practitioners in Rutland have struggled to find evidence-based, efficient programs to help address this issue. The 5-2-1-0 Program is an evidence-driven, low cost, and easy to remember intervention that assesses, prevents, and manages childhood obesity by promoting healthy habits and active living for children and their families. Using Brandon Medical Center, a Community Health Center of the Rutland Region, as the pilot site, this project aimed to implement the 5-2-1-0 Healthy Habits Questionnaire at all well-child visits and to propose a strategy for further integration of the 5-2-1-0 message into surrounding community health centers.
Accessing Opioid Use Disorder Resources in Vermont

Wendy Hou

A handout listing contact information for opioid use disorder resources in Vermont.
Domestic Violence (DV) Screening

Wilson Huang

Domestic Violence (DV) is an understated yet significant source of morbidity and mortality for victims. Healthcare providers have a unique opportunity and responsibility to identify patients who may be victims of DV. A formal screening method for DV should be developed and routinely employed in local practices to address this issue.
Availability of Shingrix Vaccine in St. Albans and its Benefits vs Zostavax

Ibrahim Sobhi-Luther Hussein

Across the United States, including St. Albans, Vermont, a shortage of Shingrix Vaccine has left many patients without effective protection from shingles. The purpose of this project was to identify how patients could obtain the vaccine within a reasonable amount of time, and avoid being placed on long wait-lists at pharmacies. Four different pharmacies in St. Albans were contacted. Pharmacists and pharmacy technicians explained what patients can do to receive the vaccine with less hassle. These tips will be given to patients in handouts at NOTCH along with information about the significant benefits of Shingrix vs the previous Zostravax.
Educating Patients on Screening Guidelines and Expectations for Well-Woman Examinations

Cyrus Maxim Jalai

Female patients seeing primary care in rural settings often do not seek out specialized care from a practicing OB/GYN, favoring instead to utilize their family practitioner to respond to their complaints. As such, it would be effective to work to educate these patients at their well-women examinations on routine screenings, immunizations, and health maintenance methods they should expect based on their presenting age. A handout simplifying and synthesizing the main screening and general health guidelines for annual well-women examinations may be helpful for female patients using primary care practitioners as their source for obstetric and gynecologic care.
Conjunctivitis: Patient Information

Nicole Jedrzynski

Conjunctivitis or “pink eye” is a common affliction encountered frequently in family medicine. Most cases are viral and do not require antibiotics, and more accurate information for patients and their caregivers is needed to minimize unnecessary visits to urgent care and the emergency room. This will facilitate better patient care and fewer healthcare costs.
X-Ray Referrals for Uncomplicated Fractures

Gregory P. Johnston

Emergency departments (EDs) in the United States are frequently overutilized for patients in need of an X-ray imaging despite outpatient clinics, ski hills, and express care facilities having the capacity to perform X-Rays and have them read and interpreted by local Radiologists. ED visits are associated with significantly increased wait times and auxiliary costs compared to express care and outpatient facilities. Particularly within the State of Vermont, ski hills provide a reliable population of injured patients with uncomplicated fractures in need of an X-ray examination. Here, we assess potential causes and explanations for ED overuse and lack of express care utilization for uncomplicated fractures that do not require a higher level of care, as well as publish currently available X-ray sites within the State of Vermont as a means of educating local providers and promoting lower healthcare expenditure and decreased wait times for injured patients.
A Community-Focused Approach to Reduce School Bullying in Northeastern Vermont

Istvan F. Kanyo

School bullying affects one in three children in the United States and represents a public health burden as students’ absentee rates increase. It also increases the risk of psychiatric disorders later in life. Public schools often place a major focus on minimizing bullying through educational programs and punishments. However, more work has to be done to educate caregivers within the school system on how they can reduce the effects of bullying. The goal of this work is to provide an educational resource for parents that details a community-oriented approach to intervene with school bullying. Caregivers can find statistics on bullying, what behaviors might be present in a bullied child, and what avenues they can pursue to support their child.
Perceived Barriers and Trends in HPV Vaccination Among Young Men in Newtown, CT

Alexander D. Karabachev

Human Papillomavirus (HPV) is the most prevalent sexually transmitted infection in the United States. Although the HPV vaccine has been proven to be effective and safe, the vaccination rates are significantly less compared to other vaccines. In males, HPV infection may lead to the development of numerous forms of cancer including oropharyngeal, anal and penile cancer, however, the HPV vaccination rate for males is significantly less than it is for females. This project aims to highlight various medical providers' opinions on the barriers to HPV vaccination for young men in Newtown, Connecticut, as well as, address methods for improvement including a brochure that was made and distributed to patients and medical providers in the clinic.
Common Childhood Illnesses: Improving Parent/Guardian Education

Mary Ann Kelly

Providers at UVMMC-Milton Family Medicine have recognized that parent/guardian education around common childhood illnesses may be lacking. The goal of this project was to improve parent/guardian education surrounding common childhood illnesses by distributing educational information in the form of an Epic smart phrase to parents/guardians during both acute and well-child visits at the UVMMC-Milton Family Medicine clinic.