Family Medicine Clerkship Student Projects

These projects were completed by students in the University of Vermont Family Medicine Clerkship. Block Clerkship Projects were completed during a five-week period, while Longitudinal Clerkship Projects were completed over the course of a 12-month longitudinal clerkship.

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Reducing Benzodiazepine Use for the Treatment of Insomnia and Supporting Nonpharmacological Therapies

UnChan Pyon
Short-term Project
Most medical organizations recommend against the use of benzodiazepine use for the treatment of insomnia, especially in the elderly. However, the percentage of the adult population on benzos increase with age: 7.5% in adults ages 51-64; 9% in adults over 65. Alternative therapies for insomnia, including online CBT, require more commitment than taking a medication so many patients opt for medication. This project aims to increase awareness of benzodiazepine use for insomnia and provide support for nonpharmacological therapies.
Contraception Health Notes at Brookfield Family Practice

Nana Agyepong
Short-term Project
The Brookfield Family Practice office sees a variety of patients, including women that are of reproductive age. The topic of contraception and contraception choices is always very relevant. My preceptor makes all of his own patient education handouts and expressed the need for an up to date handout on contraception choices for his own use and for the practice in general.
Advantages of Point of Care Ultrasound over Traditional Imaging

Khaled H. Al Tawil
Short-term Project
Ultrasound has been found to be a valuable diagnostic tool for ruling in or out serious and common medical conditions. The advent of Point of Care Ultrasound (POCUS) provides trained primary care providers the technology to gather immediate data for clinical decision making and to move patient care down the correct clinical pathway in a timely and more cost effective manner. This tool has been shown to assist in motivational interviewing by giving real time evidence to the patient. This technology has the potential to significantly enhance access for patients in rural communities where diagnostic centers and specialty care can be geographically and financially challenging.

The purpose of this retrospective study is to identify the benefits of the use of handheld ultrasound versus in the rural Primary Care setting to rule in/rule out specific diagnoses: The scope of diagnoses or ruled out pathologies for the purpose of this study will consist of the following: Deep Vein Thrombosis (DVT)/Abdominal Aortic Aneurysm (AAA)/Joint Effusion/Hydronephrosis/ Tendinopathy/ Thyroid disease/ Cysts--specifically subdural or liver cyst/Rotator cuff injury/ Cholecystitis.

POCUS was introduced in the Hudson Headwaters Network in 2015 when the Network purchased units for their primary and urgent care clinics and trained clinicians began providing this service at no cost to patients. This quality improvement project is a retrospective chart review to document time to diagnosis, time to initiation of intervention if appropriate, any additional diagnostic evaluation, related subspecialty referrals and care and location of any out of office care provided in relation to site where POCUS was performed.
Patient Education: Exercise for Weight Loss

Alexa R. Arvidson
Short-term Project
Evaluating the Effectiveness of a Smoking Cessation Support Group

Holly Bachilas
Short-term Project
Smoking rates nationally have declined over the past several decades, however, tobacco use in the North Country of upstate New York remains higher than the national average. Group discussion programs have been shown to be more effective for smoking cessation than pharmacologic efforts alone. A 7-week smoking cessation support group was started in Glens Falls, New York using the Butt Stops Here curriculum. Participants were encouraged to also use pharmacologic methods as directed by their medical providers. Participants completed a brief survey before and after the program. Participants generally felt less motivated, but more equipped to quit after the seven weeks. One participant out of eight was able to quit entirely and 7/8 participants were able to decrease their level of tobacco use. A larger sample size is needed before conclusions can be drawn about the effectiveness of this smoking cessation support group.
Determination of Return to Play in Infectious Mononucleosis

Tessa R. Barclay
Short-term Project
Splenic rupture is a rare, but potentially life-threatening, complication of infectious mononucleosis. Splenic rupture is generally uncommon four weeks after infection onset, however given the long incubation period and prodromal symptomatology characteristic of infectious mono, it can be difficult to determine an individual patient's risk in the clinical setting. Additionally, diagnostic labs have high false negative rates in the first 1-2 weeks of infection. To help alleviate diagnostic uncertainty and protect patients against outcomes such a splenic rupture, an evaluation and consolidation of the available literature yielded a simplified schematic of advisable activity levels for each stage of infection.
Healthcare Workers Understanding of Food Insecurity in Hinesburg VT

Nate Benner
Short-term Project
Food insecurity is a worldwide public health issue, and is even pervasive among relatively affluent communities in the United States. This project evaluated healthcare workers comfort in the topics of epidemiology and locally available resources with respect to food insecurity before and after an informational presentation. Results showed overall improvement in comfort on these topics following the presentation. Future research should be aimed at understanding if this changes referral rates.
Naloxone Administration: An Educational Video

Jennifer Boccia
Short-term Project
Identification of the need for client education on the use of naloxone opioid reversal kits.
Needs Assessment: Complementary Medicine (CM) Services

Zara S. Bowden
Short-term Project
In 2012, 33.2% of U.S. adults used complementary health approaches, spending over $30 billion. Despite this substantial investment and a growing body of research supporting the use of these approaches, access to them is still limited in the Primary Care setting. While Central Maine Medical Center’s Family Medicine Residency (CMMC FMR) has historically acknowledged the importance of an holistic approach to care, many of the complementary health approaches previously offered are no longer available. To determine specific, patient-identified needs regarding these approaches, a Needs Assessment was performed by surveying established patients presenting for appointments at CMMC FMR. The data collected through this assessment was used to underscore priority needs and to propose action plan items for future incorporation of complementary health approaches into CMMC FMR’s practice.
Prostate Cancer Screening Guidelines: Providing Patient Education

Michael Burton
Short-term Project
The United States Preventative Services Task Force (USPSTF) is planning to update their prostate cancer PSA screening guidelines to a category C from category D grade. This could potentially lead to confusion among both providers and patients as they have become accustomed to the previous guidelines and there has always been much discussion among providers about whether to offer the test. This project seeks to provide information to patients about the upcoming change so that they are more informed and able to better participate in discussion with their doctor about the pros and cons of PSA testing.
Improving Sleep: Promoting Sleep Hygiene Techniques

Katherine Clifford
Short-term Project
About one third of adults in the U.S. get insufficient sleep, defined as less than 7 hours of sleep per 24 hour period, with similar statistics in Chittenden County, Vermont. Poor sleep/insomnia is a common complaint of patients visiting their primary care providers, and has many important consequences for physical and mental health. While sedative hypnotic medications and over the counter sleep aids are commonly used, they have many important side effects. Cognitive behavioral therapy for insomnia (CBT-I), which includes sleep hygiene techniques, is recommended as an effective, first line nonpharmacologic intervention for chronic insomnia. This project sought to create an educational patient handout to promote sleep hygiene techniques, a behavioral intervention aimed to improve sleep in the patient population at Hinesburg, VT.
Smoking Prevention Program for Adolescents: A Hands-on Approach

Sean Closs
Short-term Project
This project is an initial pilot idea for hands-on experiences to reinforce smoking prevention in adolescents. The proposed idea is to have students specifically those identified 'at-risk', being given opportunities to interact with pathology specimens on-site at the hospital, introduce spirometry, and real-world panel discussions. The resources of the hospital provide a unique opportunity for promotion of this public health goal.
Management of Mental Health Illness: an Actionable Non-Pharmacologic Approach

Cody J. Couperus
Short-term Project
Mental health illness is a pervasive and incurs tremendous cost onto society. Patients benefit from a multi factorial approach to treatment including non-pharmacological methods. This project includes development of a handout utilizing compiled resources and motivational interviewing to facilitate patient use of these interventions.
A healthcare provider perspective in overcoming the psychological and emotional barriers of advance care planning: The need to normalize the conversation

Karamatullah Danyal
Short-term Project
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.
Providing a Health and Wellness Resource Guide to Senior Patients in Western Connecticut

Pooja T. Desai
Short-term Project
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
Short-term Project
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.
Adult Oral Health Access and Advocacy

James Duguay
Short-term Project
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's Guide to Smart Research

Zachary Winston Ehret
Short-term Project
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
Short-term Project
Alcohol Support Groups: Alternative to the AA Model

Tim Fields
Short-term Project
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.
PSA Screening in Lewiston Maine

Francis G. Gause IV
Short-term Project
PSA Screening Patient Information for 2017 guidelines
ACEs and Resilience: Increasing patient knowledge of Adverse Childhood Experiences and stress coping techniques

Mary Griffin
Short-term Project
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
Short-term Project
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.
Seasonal Affective Disorder in Vermont

Hannah Johnson
Short-term Project
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
Short-term Project
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.