Block Clerkship Projects

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A healthcare provider perspective in overcoming the psychological and emotional barriers of advance care planning: The need to normalize the conversation

Karamatullah Danyal

Barriers to advance care planning in the patient population were explored. The need to normalize the conversation was identified. A more attention grabbing pamphlet was designed.
The Association of Hormonal Contraception with Depression

Pamela Derickson

Hormonal contraceptives are widely used by women during their reproductive years. Currently, over 100 million women worldwide use the pill, and 82% of sexually active women in the USA will use oral contraceptive pills at some time during their reproductive years (Carrol, 2017). Oral contraceptive use, especially among adolescents, is associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression may be a potential adverse effect of hormonal contraceptive use (Skovlund, 2016). This project focused on educating health care providers at the Community Health Center of Burlington, VT (CHCB) about the association of depression and oral contraceptives. The data was presented to physicians, nurse practitioners, physicians assistants, and pharmacists at CHCB, and subsequent providers were interviewed for more specific reactions to the data.
Providing a Health and Wellness Resource Guide to Senior Patients in Western Connecticut

Pooja T. Desai

Senior patients (>60 years) have a higher prevalence of chronic diseases, physical disabilities, mental illnesses, and other co-morbidities, when compared with younger patient populations. In the Primary Care setting, prevention and control of health problems of elderly patients necessitates a multifaceted approach incorporating active collaboration of health, social welfare, rural and urban development, and legal sectors. Through research and community outreach, I found that identifying available senior resources was an important need in the Western Connecticut community. My interviews and research guided the creation of an informational handout on the available resources for senior patients. Resources incorporate many aspects of health, including fitness and wellness, housing, socialization and recreation, medical needs, medical equipment and technology, support groups, and transportation. This handout was given to all patients ages 60 and older.
Caregiver Stress And Resources for Support

Alex DiSciullo

Caregiver stress is a major problem which can increase morbidity and mortality rates. Caregiver stress is often overlooked and underadvertised. Making individuals aware of resources that can help them provide care can mitigate their stress and improve quality of life for themselves and their loved one.
Ambulance response times in a rural VT town: Is there a role for FEMA’s “Ready” training in Hinesburg, VT?

Kyna Silvana Donohue

The purpose of this project was to examine the ambulance response times in a rural town in Vermont. The goal was to determine if there is a role for FEMA's "Until Help Arrives" campaign to increase bystander ability to provide immediate and life-saving medical care.
Adult Oral Health Access and Advocacy

James Duguay

Many adults lack adequate preventative oral healthcare due to multiple factors. Oral health is important due to its effects on systemic health as well as for quality of life issues.
A Patient Centered Intervention to Promote Primary Care Based Screening for Diabetic Retinopathy

William B. Earle

Diabetic Retinopathy is the leading cause of blindness in patient's age 25-74 in the world. Onset of disease is insidious and early intervention is the only way to reduce morbidity. On average only 60% of diabetic's get an annual eye exam, but in the Western Connecticut Health Network (WCHN) that number is closer to 32%. This project sought to educate and encourage patients to take advantage of a new tele-medicine, primary care based diabetic retinopathy screening program starting at Brookfield Family Medicine (part of the WCHN).
A Patient's Guide to Smart Research

Zachary Winston Ehret

Patients may not know where to look when researching a health issue. This may lead them to resources that are not supported by research and may become an issue for their own health. Some websites may be filled with medical jargon, which can potentially exacerbate anxiety about a particular condition or cause concern for unrelated health issues. A handout compiling a list of resources would be helpful to providers and beneficial to patients.
Routine Immunizations in Chester, VT

Wyll T. Everett
Alcohol Support Groups: Alternative to the AA Model

Tim Fields

Alcohol abuse accounts for 88,000 deaths and $249 billion annually in the United States. At this point there is not a great evidence based model for the best form of group support. While AA and the twelve step model is the most frequently used group format, it has many limitation especially in small Vermont towns. This proposes an alternative model designed to work well in smaller communities.
Shingles & Pneumococcal Vaccines: Recommendations for Older Adults

Benjamin Flinn

As the immune system tends to weaken over time, patients aged 50+ begin having increased risk for certain potentially preventable diseases, especially shingles and pneumonia. Although there are vaccinations to protect against these diseases, there are many significant barriers preventing patients from receiving the vaccines that they need, including potentially confusing guidelines, concerns over risks, and recent changes to vaccine recommendations. This project aims to produce a clear and concise educational brochure to help overcome some of these barriers, and to drive patient-provider conversation about their vaccine recommendations.
A Physician's Guide to Motivational Interviewing

Anthony J. Gallegos

Recommending lifestyle changes to patients is a crucial part of a primary care physician's role. Guiding patients to make behavioral change is a challenge physicians must face on a daily basis, and based on current literature, it can be delivered more effectively in the form of motivational interviewing as opposed to traditional advice-giving. This project aims to provide physician's with a quick reference guide to Motivational Interviewing to display at their desk, as well as a template to be filled out with the patient detailing their plans for change. Together, these tools can improve the delivery of advice, and strengthen physician-patient relationships to more effectively achieve long-term health goals that require a behavioral change from the patient.
PSA Screening in Lewiston Maine

Francis G. Gause IV

PSA Screening Patient Information for 2017 guidelines
Improving Access to Mental Health Care for Trauma Patients

Kassandra Gibbs

It can be difficult to locate a mental health provider in Vermont. Consequently, many individuals with mental illnesses look to their primary care physicians to fill this gap. This project highlights difficulties faced by patients with PTSD and complex PTSD in Chittenden and Addison counties in finding a therapist or psychiatrist. A resource handout was created with instructions on how to find a therapist in VT and a list of practitioners in Addison and Chittenden counties who specialize in trauma. In addition, a patient information sheet that answers some questions about PTSD and complex PTSD and also provides a list of mindfulness exercises that can be used by patients while they are waiting to find a mental health practitioner.
Incorporating Naloxone Education Into Routine Primary Care

Eli Goldberg

Opioid overdoses are a growing public health concern in Vermont and nationwide. Naloxone can save the life of someone who overdoses, if those around them know how to use it. This project investigates the feasibility of offering naloxone education as an element of routine primary care encounters with patients who do not use opioids themselves.
Radon: An Opportunity for Preventative Health

Kathryn Grenoble

Radon is a colorless and odorless radioactive gas produced by the natural decay of uranium in rock and soil. Long term exposure to radon gas is the leading cause of lung cancer among non-smokers, and the second leading cause over all after smoking. Children exposed to unsafe levels of radon are particularly vulnerable because smaller lungs and faster respiratory rates are thought to result in higher radiation doses compared with adults. One in eight homes in Vermont contain unsafe levels of radon gas compared with one in fifteen homes nationally. Radon gas exposure is not currently addressed as a preventative health measure in primary care clinics. This intervention was aimed at creating a radon resource document embedded as a “smart phrase” in EPIC enabling clinicians to rapidly provide clear information for patients without encumbering time constrained appointments. The intent is to equip providers with a tool for introducing the topic of radon at pediatric well visits and give patients access to additional information included in their After Visit Summaries.
ACEs and Resilience: Increasing patient knowledge of Adverse Childhood Experiences and stress coping techniques

Mary Griffin

At The Health Center, a federally qualified health center in Plainfield, Vermont, providers have begun an initiative to screen patients during routine clinic visits for their Adverse Childhood Experiences score. In a population subject to the social, economic, and health-related challenges of rural Vermont, providers have identified the screening process as a vital tool for better understanding their patients' health. To better aid in both provider comfort and patient education during said interactions, a pamphlet was created to guide provider conversations concerning ACEs. The pamphlet details information about ACEs and health consequences, the importance of the relaxation response in dealing with toxic stress, and the ways in which we can help foster resilience in children.
Intimate Partner Violence: Updated Screening Tool and Approach to Screen Positive Patients

Michael J. Hall

Intimate partner violence screening is recommended in all women of child-bearing age. Ensuring validated screening tool utilization and employing strategies to identify risk while providing non-judgmental support is critical to identifying patients and optimizing appropriate resource referral.
Lyme Disease Prevention

Russell D. Himmelstein

This project focused on Lyme Disease prevention, specifically for cub scouts from 5-10 years of age and their families.
Diabetic Eating at the Dollar Store

Lee Hiromoto

Ideas on following a diabetic diet using ingredients from a dollar store.
Postpartum Contraception Education

Erin E. Hunt

The current standard of practice for postpartum contraception in Plattsburgh, NY, as well as much of the United States, is initiation of contraception at the standard 6 week postpartum visit. However, many women may be better suited for immediate postpartum contraception while still hospitalized in labor and delivery. Long acting reversible birth control (LARC), including hormonal IUDs, copper IUDs, and progesterone implants, were the contraception types focused on in this project. Family medicine residents at CVPH reported low confidence in postpartum contraception as a whole. Furthermore, they reported limited knowledge on immediate postpartum contraception. The primary aim of this project was to expand the resident knowledge base on postpartum contraception and encourage them to consider immediate postpartum contraception in certain patients via an educational session.
Seasonal Affective Disorder in Vermont

Hannah Johnson

A large proportion of major depression in Vermont has a seasonal pattern. The most common form of Seasonal Affective Disorder is winter depression. Several evidence-based treatments exist for SAD including light therapy, CBT, and antidepressant medications. Adjunct therapies, like exercise and social interaction, can also help patients feel better during the winter. In the primary care setting, an educational handout/poster will aid in educating patients about SAD and treatment options, and encourage them to seek help.
Shingrix: Educating Patients on the New Shingles Vaccine

Sarah Natasha Jost

Herpes zoster (shingles) is a viral infection that results in a painful rash and has a myriad of long-term complications, including post-herpetic neuralgia- chronic pain that does not resolved despite resolution of the rash. Over the last 20 years, incidence of shingles has increased by nearly 50% and now there are 2 vaccines available to prevent shingles. Shingrix was approved by the FDA in 2017 and has garnered public attention for its efficacy. I developed a brochure that gives patients information about shingles, Shingrix, and answers some frequently asked questions.
Addressing Exercise Education in Clinton County, NY

Amanda M. Kardys

In Clinton County, NY residents state that obesity, chronic disease, physical inactivity and low wages are top concerns. Many of these identified problems are tightly integrated and exacerbated by a lack of exercise education in this population. To address this, an exercise education pamphlet was created to be distributed to individuals in the community. The pamphlet focuses on discussing barriers such as time and cost of exercise, as well as enabling individuals with stretching information and local resources.
Promoting health literacy about added sugars, with a focus on patients with limited English proficiency

Megan Kawasaki

Excess consumption of added sugars has been linked to the development of obesity, diabetes, and cardiovascular disease. The sequelae of such health conditions accrue significant public health costs - both in terms of healthcare spending as well as associated co-morbidities and mortality. Chittenden County, Vermont is home to at least 6,300 new Americans, many of whom have limited English proficiency (LEP). Although office visits can provide crucial advice regarding proper nutrition, written resources available for LEP patients are lacking. This project aimed to meet that need through development of an infographic-rich handout that both promotes healthier grocery store choices and educates patients about added sugar. While it can be useful to those at all literacy levels, the heavy use of visuals was intended specifically to make the handout accessible for those with little to no English proficiency.