Block Clerkship Projects

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Fighting the flu - Devising a novel approach to address patient concerns with the seasonal influenza vaccine - South Burlington, VT

Theodore Cisu

In Vermont, it is estimated that influenza-like illness is responsible for $8.9 million annually in direct medical costs. The flu vaccination rate ranges from 33% to 56% across the nation, and Vermonters are vaccinated at a rate of approximately 49% each year. This program aims to provide a novel educational material to patients, specifically addressing concerns with the safety of the seasonal influenza vaccine.
Providing Medication Assisted Treatment for Opioid Use Disorder in Family Medicine Clinics in Vermont

Kelley W. Collier

Opioid use disorder is a nationwide issue and a serious problem in the state of Vermont. Medication assisted treatment (MAT) is currently being used to treat individuals with opioid use disorder. In an effort to address the opioid epidemic, more and more family medicine physicians in Vermont are becoming trained medication assisted treatment providers. This project aims to recognize some of the challenges faced by physicians who are currently prescribing MAT in family medicine clinics, as well as to identify the concerns of family medicine physicians who are not currently prescribing MAT. By determining barriers to providing MAT to patients with opioid use disorder in family medicine clinics, additional support and resources can be identified and implemented.
Improving Awareness of Low Health Literacy and Strategies to Overcome It

Sherilyn DeStefano

This project outlines an intervention delivered at a family medicine residency program in Bangor, ME to increase residents' knowledge of the impact of low health literacy and supply them with communication techniques to help improve patient understanding. Over 36% of U.S. adults have basic or below basic health literacy skills and low health literacy has been shown to lead to poorer health outcomes, increased health disparities, and increased cost. Our presentation focused on communication techniques like Teach-Back, an evidence-based strategy that assesses patient understanding by asking patients to repeat back healthcare instructions in their own words, that has been shown to improve health outcomes.
Pertussis Vaccination in Pregnant Women at the EMMC Family Medicine Center

Elizabeth S. Doughty

Pertussis, also known as whooping cough, primarily affects infants less than 12 months of age and frequently requires lengthy hospital stays. Maine has the 3rd highest rate of documented pertussis cases in the nation. Guidelines for prenatal vaccination recommend women receive pertussis vaccination during the third trimester of every pregnancy in order to protect the neonate. A small community project was designed to investigate adherence to prenatal vaccination guidelines. Rates of vaccination and electronic medical record (EMR) documentation for patient refusal were investigated for Jan. 1, 2016 - Aug. 1, 2016. Implementation of interventions focused on improving the rate of pertussis coverage in this population will require further follow up investigation to assess efficacy.
Patient Awareness and Understanding of Intrauterine Devices

Lindsey Marie Eastman

Unintended pregnancy rates in the United States are near 50%, but use of safe and effective long-acting reversible contraception methods, such as intrauterine devices, remain low compared to worldwide rates. Common misconceptions about intrauterine devices likely contribute to this stark contrast in use prevalence. This project aimed to assess patient understanding, awareness, and perception of intrauterine devices at a Family Medicine office in Connecticut. A pamphlet that includes a summary of contraception methods was produced and distributed with the goal of increasing knowledge of intrauterine devices as well as other contraception methods for patients in the primary care setting.
Lyme Disease in Brattleboro, VT: Office Triage and Community Education

Peter Evans

The rates of Lyme disease are rising Vermont, with 710 reported cases in 2015. While preventable, the disease has significant sequelae and primary care offices in Brattleboro, VT are reporting high volume of calls from patients asking for more information about Lyme disease. Formal surveys of Brattleboro Family Physicians and their clinical support staff identify the need for a uniform triage protocol to answer patient calls, as well as further patient education materials, particularly regarding prophylactic antibiotic use following tick exposure.
Psychotherapy: Skills and Resilience Through Self-Knowledge

Gilana Finogenov

At least 20% of all primary care visits are related to mental health. A limited number of patients are being referred to therapy, even though therapy is shown to be as effective as medication for disorders like depression and anxiety. A pamphlet was designed to explain what psychotherapy is to patients and to describe several common therapy modalities.
Prostate cancer: Screening, Current Guidelines and Patient Education

Timothy F. Flanagan

Recent changes in prostate cancer screening guidelines may create an opportunity for patient education. By creating a succinct hand-out on prostate cancer screening, providers enable their patients to understand screening, and provide sites with opportunities for further learning.
LGBTQ+ Health: Creating a Welcoming Environment in the Primary Care Office

Emily Forbes-Mobus

LGBTQ+ patients are at increased risk for discrimination and poor health outcomes. Many LGBTQ+ individuals report discrimination by health care workers, including being denied needed care. Culturally competent care improves overall health outcomes. Creating a welcoming clinical environment is an important component of culturally competent care.
Recognizing and Treating Head Lice: A Guide for Families

Tabitha R. Ford

Proper diagnosis and treatment of head lice is important in decreasing costs and the spread of pediculicide resistance, but many families do not know when or how to treat. The aim of this project was to provide a convenient educational resource on the recognition and management of head lice infestation for Vermont families.
Integrated Care: Improving Coordination of Care Between Primary Care and Psychiatric Services

Eunice Fu

The majority of the highest utilizers of medical care are affected by mental health issues, yet multiple studies have shown that PCPs have mixed success in recognition and management of mental illness on their own. An integrated model of primary and mental healthcare is ideal to increase acceptability and availability of mental health services. However, there is a growing body of research demonstrating high rates of dissatisfaction with primary-specialty communication. Northwestern Counseling and Support Services has implemented a new care coordination model to address barriers to collaboration in Franklin and Grand Isle Counties. This project summarizes results of the 1-year evaluation of the model.
EMR Optimization of Home Health

Rahul R. Gentyala

Home Health is a service that provides a variety of healthcare needs to those who are unable to get out of their home due to an illness, injury, or disability. Currently paper copies are in use for Home Health, which are harder to document, decreases efficiency, and increases error. Incorporating this into EMR will go a long way to solving these issues.
Providing Primary Care to Transgender and Gender-expansive Youth

Maggie Graham

At least 0.3% of the US population identifies as Transgender. Transgender and gender-expansive youth are presenting to primary care providers in increasing numbers. Many primary care providers in Vermont are not armed with sufficient information to care for and guide gender-expansive youth and their families. Trans* patients are at increased risk for discrimination and poor health outcomes. In order to address that problem, a basic guide to providing primary care services to trans-identified youth was created, along with a list of trans-competent providers in the area to whom primary care providers can refer patients.
Attitudes Toward Influenza Vaccination

Miles W. Grunvald

Influenza contributes to millions of dollars in healthcare expenses, lost economic productivity and morbidity and mortality of the Chittenden County, VT population. Despite the dire costs of influenza illness, yearly vaccination rates remain low in Vermont and Chittenden County. This study utilized a survey that aimed to gauge the attitudes toward influenza vaccination of patients at the Hinesburg Family Practice. Results of this study suggest that patients under 35 have lower attitude scores (p= 0.035) and that patients with high school level education or bachelor’s level education are more likely to have a negative attitude towards influenza vaccination. Only 60 percent of the study population knew that they could not contract influenza illness from the influenza vaccination. An educational poster was designed for the sub-population that was most likely to have negative attitudes toward influenza.
Bringing Diabetes Education to your Home via your Smart Phones

Nazey Z. Gulec
Pap Smear Compliance Study at EMMC, Bangor Maine

Do Gwak

Many factors contribute to the accurate reporting of pap smear compliance in patients population. The factors identified during the study are system failure of EMR to track pap smear records and lack of communication among different clinics.
Identifying Barriers to Healthcare Access for the Somali Population at CMMC

Matteen Hakim

The city of Lewiston has a significant Somali population, but that population is very poorly represented in the patient population at CMMC and the Family Medicine Residency (FMR). This project was meant to elucidate the Somali perspective on this discrepancy in order to share it with physicians at the FMR as a first step towards fixing the divide.
Williston, VT: Evaluating Child Lead Screening Rates and a Potential Exposure

Ethan R. Harlow

The CDC recommends that all 1-and 2-year-old children be screened for lead and that the most effective measure for mitigating lead poisoning in children is through primary prevention. This study evaluates lead screening rates at a Family Medicine Clinic in Williston, VT and seeks to gather community perspective on a potential failure of primary prevention in the town.
Increasing Naloxone Distribution in VT Emergency Departments

Olivia M. Harris

Fatalities caused by overdose from opioids are increasing in Vermont. Evidence shows that Naloxone safely and effectively reverses the effects of opioids in overdose. This project aims to determine why physicians in VT Emergency Departments are not consistently distributing Naloxone to all patients with an overdose, and to increase awareness and implementation of this practice.
A Multi-System Approach to Help Prevent Teen Suicide in the Upper Valley: A Focus on the LGBTQ Community

Charlotte V. Hastings

LGBTQ adolescents are at much greater risk of committing suicide as compared to their straight and cisgender peers. This project focused on connecting various community organizations working on teen suicide and compiling a list of resources so that primary care providers might play a more pivotal role in providing mental health support to the Upper Valley’s LGBTQ teens.
Development of Guidelines for Refugee Screening at CMMC Family Medicine Residency, Lewiston, Maine

Catherine Hayes

Lewiston Maine has the second highest number of refugees in the state of Maine, with 191 total intakes in 2015. Refugee populations face unique health concerns, and providing care for refugees requires education and development of a specialized skill set. This project provided a reference for clinic providers to assist with medical intake screening visits for refugees.
Williston, VT: Increasing the Awareness of Hypertension Implications and Sequelae

Tinh Thanh Huynh

Hypertension is the most common reason for health office visits in the US and for the use of prescription drugs. Many patients fail to truly understand the diagnosis of high blood pressure and the various health consequences that comes with poor regulation such as cardiovascular disease, stroke and renal disease. This project was aimed to increase patient education on the implications of hypertension and its complications.
Suboxone Treatment in Caribou, ME: Evaluating Barriers and Engaging with Mid-Level Providers

Michael Ialeggio

The Medication Assisted Recovery (Suboxone) program in Caribou, ME was started in 2004 as a cooperative endeavor by Aroostook County Mental Health Center and "Pines Health Servies". Since its inception, the program has experienced provider attrition. This project aimed to evaluate barriers to becoming and remaining a provider of Opiate Replacement Therapy, and to engage and inform local mid-level providers who will soon be eligible to become providers under the Comprehensive Addiction and Recovery Act passed in July 2016.
Broadening perspectives on the management of chronic pain

Daniel Ianno

Complementary and alternative treatments are often overlooked when managing patients with chronic pain. Given the prevalent problem of prescription opioid abuse, narcotics should be avoided in the treatment of chronic pain if possible. When appropriate, practitioners should ensure patients have explored a wide variety of pain relief therapies prior to initiation of narcotics for the treatment of chronic pain. Increasing awareness and understanding of complementary and alternative therapies among practitioners and patients will hopefully help to mitigate the perceived need for narcotics in the treatment of chronic pain.
Injury Prevention in Adolescent Female Athletes in Western Connecticut

Allicia Imada

Sports are the leading cause of injury in adolescents and can have long-term psycho-social and physical consequences especially in adolescent females. To increase knowledge and awareness of injuries and injury prevention in adolescent female athletes a short workshop was presented to 56 adolescent field hockey players who improved by 31.1% correct on knowledge based surveys from information in the talk and took home pamphlets. Hopefully in the future the workshops can be expanded to other athletes and sports, and specific information about injury prevention programs that have been shown to decrease injury rates an be shared with the community.