Block Clerkship Projects

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Education in Over the Counter Medications, for High School Freshmen

Ian Crane

Over the medications offer numerous benefits, allowing short term treatment of symptoms, and reducing unnecessary Doctor’s visits for things like viral illness. Yet these medications also have potential for misuse. Roughly 10% of Danbury High School students abused OTC medications in 2013.
Bridging the Gap Between the Primary Care Physician and Accessible Resources for Patients with Mental Health Needs

Tracey DaFonte

Mental illness and maintaining mental health is a significant problem in the world, the United States, and here in Vermont. The burden of mental illness can lead to disability, lost work productivity, and at its worst, suicide. Vermont ranks 14th in the United States for rates of death by suicide. Many people struggle every day with mental health needs from depression, anxiety disorders, ADHD, and more. The aim of this project was to create a mental health resource card that can be used in primary care offices to provide patients with information to get the help they need and attempt to increase the percentage of patients who address mental health issues with their primary care provider.
Burnout Prevention in Primary Care Providers

Dylan M. Devlin

Burnout is a pervasive problem in primary healthcare. Mindfulness training has been shown in decrease symptoms associated with burnout and improve overall patient care. This project attempts to evaluate the rates of both burnout and mindfulness in healthcare workers within Rutland County, Vermont. A survey was distributed to both administrative and primary healthcare workers within the Community Health Centers of the Rutland Region system to determine if employees suffer from symptoms of burnout as well as their willingness to participate in mindfulness training.
Radon: The New Carbon Monoxide

Katherine M. Evans

Radon is derived from breakdown of uranium naturally found in the environment all across the globe. Some geographic locations have higher levels of radon than others. Like carbon monoxide, radon is colorless and odorless. It is the second leading cause of lung cancer in the United States. Human exposure happens primarily via buildings: 1 in 8 Vermont homes exceed the recommended level. In Brattleboro, 1 in 5 homes exceed the recommended level, but between January 1993 and January 2014, the Vermont Department of Health received only 329 home testing kits from Brattleboro.
Provider Resources for Smoking Cessation Counselling

Pierre Galea

Tobacco is still the leading cause of preventable death. The Vermont Department of Health has instituted smoking-related goals for "Healthy Vermonters 2020." One resource that is useful for providers who counsel patients to quit smoking is 802quits. Strategic utilization of this resource and implementation within the healthcare center, is invaluable for providers, and is an effective tool to reach patients and support them throughout their journey.
Lyme Disease Awareness in Downeast Maine

Justin L. Genziano

Lyme disease is caused by the bacteria Borrelia burgdorferi and is transmitted by the deer tick (Ixodes scapularis). Lyme disease is endemic in the state of Maine with 1,399 probable and confirmed cases reported in 2014. The rate in coastal Hancock County has doubled since 2012, and has the third highest rate of infection in the state.

Medical providers in Hancock County have observed an increase in anxiety and concern about Lyme disease in the community, and have found that much of this is driven by hearsay or unreliable information from the internet. The goal of this project is to provide patients with concise and accurate information to help alleviate this concern.
Over the Counter Medication Education Approach

Gurpinder Gill and Ian Crane

OTC meds are essential because they give the patient the ability to avoid an unnecessary visit to the doctor's office. They also allow the health care provider to better focus on those with more serious illnesses, and some patients do not have appropriate health care access and rely solely on non-prescription meds. However, patients who use OTC meds do have a tendency to underestimate the serious risks of these meds such as potential for abuse, toxicity, adverse effects, drug interactions, and the delay in seeking a physician's advice.
Determining Barriers to Oral Health Care in Bennington County

Taylor Goller MS-3

Bennington County has some of the worst oral health outcomes in the state of Vermont. A survey was designed to assess current oral health problems, maintenance habits, and barriers to oral health services access. Results are preliminary.
Osteoporosis: Prevention, Screening, and Treatment in the Primary Care Setting

Jeanne T. Gosselin

Osteoporosis, with its related fragility fractures, is largely a preventable disorder, not an inevitable part of aging. Through effective education, screening, and treatement in the primary care setting, it may be possible to curb the impending rise of osteoporosis and costly fractures as the population ages. A time-conserving patient education pamphlet on osteoporosis was developed for a family medicine practice in central Vermont. The educational intervention is sensitive to the time constraints of a busy practice and may provide a much needed foundation for osteoporosis education in the primary care setting.
Added Sugars: Educating the Public on New Guidelines

Michael A. Grant

Added sugars are a non-nutritional source of calories found in many food products where people do not expect to find them. There is ongoing discussion of the healthy amount of added sugars to consume as well as new guidelines and labeling efforts. This project reviews the epidemiology of a small town in VT and considers ways to improve the awareness of added sugars and how to reduce the amount consumed by its residents.
Pediatric Tooth Care and Fluoride Exposure in Maine

Lucas Grover

Maine is a large and rural state with limited access to fluoridated drinking water and consistent health and dental care. There is little information and guidance for parents regarding the importance of home pediatric dental care, early dentist visits, and home testing for fluoridated drinking water. Parents and primary care providers must engage in a dialog regarding proper tooth care to identify child specific risk factors that can lead to childhood caries and chronic tooth decay if not addressed early and aggressively.
Implementing Developmental Screening per AAP Guidelines

Douglas Handley

"Fewer than half of the nation's pediatricians conduct systematic surveillance of young children's development… time and cost are among the barriers." Missing developmental delay leads to further attenuation of the problem and can lead to additional developmental problems. Developmental delay can often be corrected or treated to reduce the impact it has on the child. The AAP suggests "developmental surveillance" at every well child visit and standardized "developmental screening" at WCC 9 months, 18 months, and 24 or 30 month.
Development and Implementation of a Suboxone Therapy Group

David Hermel

Implementing effective opiate detoxification is critical to the health and well-being of the Lewiston-Auburn area, which has the highest rate of admissions for substance abuse (especially non-heroin opiates) and mental health conditions in Maine. The number of Maine residents seeking treatment for prescription drug abuse topped the nation at 368 admissions per 100,000 residents in 2008.
Increasing Awareness of the HPV Vaccine

Jonathan M. Hernandez

Increasing the public awareness and knowledge of HPV complications and prevention through vaccination is an effective intervention to increase vaccination rates and reduce overall public health cost and burden.
Improving Vaccination Rates at UVMMC Family Medicine, Berlin

Emily G. Jones

Practitioners don't know current vaccination rates for their practice. Some current reported rates look incorrect, according to the Medical Director. Other reports show areas for improvement. One problem is that patients no longer in the practice remain in the system and decrease rates; another problem is that paper records were loaded manually by persons without medical training when the electronic medical record.
Substance Abuse Amongst High School and College Students

Herman Kalsi

Substance abuse among young adults is hardly a new trend. About 50% of full-time college students binge drink or abuse prescription drugs, 25% of which meet the definition of having substance abuse or a dependence. That is three times the rate of the general population. Estimated overall total cost of substance abuse in US is $600 billion annually. Ease of access is a main contributor to drug abuse amongst college students.
Implications of Long-term Proton Pump Inhibitor Use: Promoting Step-Down Therapy for Management of Gastro-esophageal Reflux Disease in the Outpatient Setting

Sonam Kapadia

Per the International Montreal Consensus, gastro-esophageal reflux disease (GERD) is defined as a "condition which develops when the reflux of stomach contents causes troublesome symptoms or complications". GERD is the most common disease of the gastrointestinal tract with an estimated prevalence affecting 20% of the Western population. According to the National Ambulatory Medical Care Survey, 38.53 million annual outpatient visits are related to GERD. The ABIM Foundation's "Choosing Wisely" initiative in collaboration with the American Gastroenterological Association draws attention to the evidence based recommendation: "For pharmacological treatment of patients with gastro-esophageal reflux disease (GERD), long-term acid suppression therapy (proton pump inhibitors or histamine2 receptor antagonists) should be titrated to the lowest effective dose needed to achieve therapeutic goals."
Barriers to recovery for Buprenorphine Patients in Bangor, Maine

Erin L. Keller and John McLaren

Opiate addiction is a major public health problem in Maine. Addiction is a chronic disease with high relapse rates. A better understanding of the demographics and barriers to recovery in opiate addicted populations can help to improve the success of buprenorphine treatment programs.
Polypharmacy Management in a Rural Family Medicine Practice: View from Multiple Perspectives

Sarah Anne Kelso

Polypharmacy is a growing problem in the United States. The elderly population is expanding, and the use of specialists to manage their healthcare is increasing. This project looks at the role of the primary care physician at a rural Family Medicine practice in reducing the risks of polypharmacy. The perspectives of patients and the local pharmacist were used to create an education tool about polypharmacy management within this community. Increased awareness of this issue and how it applies to patients within the practice were the results of this intervention.
Promoting Awareness of Hepatitis C in Burlington, Vermont’s Homeless Population

Catherine M. LaPenta

Chronic Hepatitis C infection is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Most Hep C + patients are unaware that they are infected. Chronic HCV infection represents a huge public health and financial burden. While about 1% of the general U.S. population is HCV+, the prevalence is as high as 41.7% in some homeless populations in the U.S. Awareness of Hep C is low and Vermont’s homeless patients who are HCV+ are likely severely underdiagnosed and undertreated.
Better Teeth, Better Health: Identifying Challenges with Dental Care in Lewiston, ME

Mary B. Ledoux

My project aimed to elucidate barriers to dental health care in the Lewiston-Auburn community. Obstacles highlighted included cost of care, lack of education and guidance in preventative oral health, and paucity of resources available to aid patients in identifying affordable programs. The data generated can be used in the future to better direct oral health interventions at CMMC Family Practice Clinic. Additionally, the survey responses were used to assemble educational material to distribute to patients.
An Introduction to Alcohol Use Disorder and Motivational Interviewing at Henry Abbott Technical High School in Danbury, CT

Laura D. Leonard and Dylan C. Hershkowitz

We presented to high school students interested in careers in health about alcohol use and motivational interviewing. We demonstrated effective motivational interviewing skills including asking open ended questions, using non-judgmental language and eliciting change talk from patients. Finally we facilitated breakout sessions which allowed students to practice identifying at risk behaviors and to practice motivational interviewing.
Implementing a mentorship group to encourage long-term treatment of opioid addiction

Shannon Li

In 2012, Maine topped the nation’s list for prescription opioid abuse. For every 100 residents in the state, 22 prescriptions for opioid pain relievers were prescribed by the healthcare providers. There’s approximately 3,876 primary treatment admissions for prescription opioid abuse between 2009-2013. Since 2010, the number of people seeking treatment has increased 15%, but in order for patients to benefit the most from the suboxone/methadone treatment, it's imperative to provide them with the social support they need, so they could stay in the treatment program long enough to have a significant health benefit.
Screening, Brief Intervention and Referral to Treatment for Substance Abuse in Waitsfield, VT

Chi An Liu

Substance abuse is an issue in Waitsfield, VT and currently there is no formal program or intervention at Mad River Family Practice to help patients overcome their addictions. Screening, brief intervention and referral to treatment (SBIRT) is a program to identify at risk patients, raise awareness of their abuse, and help them find support and treatment they need.
Raising Healthy Vermonters: Preventing Childhood Obesity by Establishing Healthy Habits

Melanie Ma

The State of Vermont has one of the lowest rates of childhood obesity in the country. While this statistic is encouraging, it does not make our communities immune. Many Vermonters struggle with obesity and its related illnesses, especially in rural, low-income areas of the state where the ability to afford fresh produce can be challenging.

To keep the rate of childhood obesity low in Vermont, children should be encouraged to establish healthy habits as early as possible. The goal of this project is to provide parents with effective and feasible ways to help their children develop healthy eating habits and stay active.