Family Medicine Clerkship Student Projects

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  Cigarette Smoking Cessation Tool

  Pavan K. Anant

  Short-term Project

  In Vermont, tobacco use disorder is a pervasive problem that closely rivals national averages. The Cigarette Smoking Cessation Tool seeks to identify patients with significant motivation to quit smoking cigarettes' and aims to connect them with appropriate local resources and clinic advocates.

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  Provider Perspectives on Implementation of CDC Guidelines for Opioid Maintenance Therapy

  Anayis M. Antanesian

  Short-term Project

  The opioid epidemic remains a complex and significant public health crisis in the United States, impacting millions with opioid use disorder (OUD). Despite efforts to raise awareness and address individual risks, high rates of opioid overdose persist, underscoring the need for more extensive and integrated prevention and management approaches. Primary care providers play a pivotal role in lowering opioid-related mortality and improving patient outcomes through office-based treatments; however they face numerous challenges in prescribing opioids. To explore these barriers, a survey was distributed to providers, aiming to assess their views, comfort levels in prescribing opioids for chronic pain, and perceived ease of implementing CDC guidelines into their practice. As part of this project, a poster summarizing guidelines was created which could be conveniently referenced and would align with the clinic providers' preferences for prescribing opioids in the setting of maintenance therapy.

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  Safe Storage: prevention of Drug Misuse and Overdose with Locked Medication Bags

  Emily Claire Battle

  Short-term Project

  Safe storage of medications is critical to public health and safety in the state of Maine as well as across the country. Current public health efforts target education and prevention of accidental ingestion of medication by children and animals at home. This has become especially important in Maine with the increasing prevalence of substances used for treatment of opioid use disorder, as well as increasing prevalence of other non-prescription substances including fentanyl, cocaine, and methamphetamine. In Lewiston, Maine, interviews with public health leaders, patients, and providers at the Family Medicine Residency at Central Maine Medical Center reiterated concerns for the security of vital medications which are frequently lost or stolen, especially in those struggling with housing insecurity. This project attempted provide an intervention to promote public education, prevent substance misuse and overdose, and encourage patient-provider discussions about safe storage. This project entailed a didactic session to educate Family Medicine residents on the importance of safe medication storage, dissemination of locked medication bags to residents and behavioral health professionals, and placement of an educational display in the patient waiting room of the Family Medicine residency.

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  Quality Improvement of X-Ray Imaging for Unspecified Chronic Knee pain and Suspected knee osteoarthritis in the Primary Care Setting

  Ty E. Bever

  Short-term Project

  Although a comprehensive history and physical exam are the mainstays of initial evaluation, plain X-rays are clinically indicated for chronic knee pain of greater than 6 weeks duration and acute traumatic pain in patients who meet specific evidence-based criteria, according to the American Academy of Family Physicians (AAFP). However, there remains significant variation in what radiographic protocols are used in clinical practice, specifically in terms of what radiographic views are ordered and whether the imaging is performed with the patient weight-bearing (WB) or non-weight-bearing (NWB). In fact, several studies have shown that non-weight-bearing knee radiographs are frequently ordered by general practitioners for chronic knee pain and suspected osteoarthritis despite evidence that WB images are more sensitive and accurate in the assessment of joint space narrowing. Therefore, evaluation of chronic knee pain with the use of NWB radiographs has the potential to delay diagnosis and management of early osteoarthritis (OA), lead to less accurate grading of the severity of OA and delay in specialist referral, and contribute to an increase in repeat imaging during specialist consultation.

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  Utilizing a Community Resource for Diabetes Lifestyle Management

  Max Breidenstein

  Short-term Project

  Grace Cottage Family Health & Hospital identified diabetes as a level one priority for community health improvement. VeggieVanGo is a program hosted at schools and hospitals hosted by the Vermont Foodbank which provides fresh produce to those in needs. Lifestyles modifications are essential for diabetes management including consuming fresh produce. This project sought to increase awareness of the role of diet in diabetes management for patients at Grace Cottage Hospital who may use the VeggieVanGo program.

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  Empowering Patients Undergoing Speculum Exam

  Sarah Caffry

  Short-term Project
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  Common Skin Rashes

  Jennifer Chen

  Short-term Project

  Common Skin rashes

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  Nutritional Support for Oncology Patients: Role for the PCP

  Annabelle S. Feist

  Short-term Project

  Adequate nutrition is a key prognostic factor in the treatment outcomes of patients with cancer diagnoses. Despite the increased morbidity and mortality of malnutrition, the importance of nutrition for oncology patients is often not well communicated and not well understood by patients. Part of this issue stems from the limited information most patient can absorb at any given doctors appointment, especially regarding their cancer. Primary care providers hold a unique position to fill this gap and have the information be heard and retained given their usual role in addressing overall health. This project compiles resources in an easily accessible and distributable manner so PCPs can provide their patients with cancer diagnoses important information without adding more time to already long and complex visits.

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  Addressing Antifungal Resistance: Using Boric Acid Suppositories for the Treatment of Vulvovaginal Candidiasis

  Isabel Goodrich

  Short-term Project

  Antifungal resistance poses a growing challenge in the treatment of vulvovaginal candidiasis (VVC), necessitating innovative approaches for effective management. This community health project investigates the efficacy of boric acid as an alternative treatment for VVC, particularly in the context of antifungal resistance. Employing a mixed-methods approach, this study integrates interventions aimed at healthcare providers and patients alike.

  Firstly, a targeted in-person presentation was delivered to family medicine residents, focusing on the use of boric acid in VVC treatment and its potential impact on addressing antifungal resistance.

  Secondly, a patient informational pamphlet was developed, providing comprehensive guidance on safe utilization of boric acid suppositories for VVC as well as answers to frequently asked questions while using boric acid.

  Thirdly, an electronic medical record dot phrase was created for physicians to streamline documentation and facilitate easy access to boric acid treatment protocols, enhancing efficiency in clinical practice.

  Through these interventions, the project aims to enhance healthcare provider awareness and patient education regarding boric acid treatment of VVC. By equipping healthcare providers with the tools and knowledge necessary for effective implementation, and providing patients with comprehensive information, this initiative seeks to mitigate the impact of antifungal resistance in VVC management.

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  Improving Care for LGBTQ+ Patients

  Justin Henningsen

  Short-term Project

  LGBTQ+ patients are at higher risks for many health conditions. Providers and staff are not always comfortable supporting conversations about gender and sexuality. In this project, I provided training to staff members of Hardwick Area Health Center on risks and best practices.

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  Increasing Patient Awareness and Education Surrounding Prescription Weight Loss Medications

  Anirudh A. Hirve

  Short-term Project

  Obesity is a growing problem in the United States. While it remains important for clinicians to emphasize health supportive behaviors including dietary modification and exercise when counseling patients, the advent of new weight loss medications has created a need for patient education materials regarding these interventions for a growing number of patients who request them at primary care visits. This project created a smart phrase in the electronic medical record summarizing weight loss medications currently available on the market to transform patient counseling and enable better shared decision making between patients and providers.

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  Movement Matters: Encouraging Activity in Preventive Medicine

  Stefanie Geiger Kelsey

  Short-term Project
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  Extended Release Buprenorphine (Sublocade) Prescribing in Primary Care

  Heather Kettlewell

  Short-term Project

  There are many barriers to accessing opioid use disorder (OUD) treatment, especially for rural communities that may be far away from healthcare providers. There is a need for interventions to increase accessibility of OUD treatment. Extended release injectable buprenorphine (Sublocade) provides an option for patients to receive treatment via once a month injections. This could make OUD treatment more accessible to rural and socioeconomically disadvantaged patients by reducing the number of times they would need to travel to the clinic. Our intervention is to create a protocol for prescribing extended release buprenorphine at Family Medicine Hinesburg.

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  A Pamphlet on Housing and Food Insecurity Resources in Burlington

  Zachary Kramer

  Short-term Project

  A pamphlet consolidating the most used and current resources for housing and food insecurity in Burlington Vermont in the spring of 2024. I collected the list from social workers at my clinic, as well as several unhoused members of the Burlington community. I also corresponded with a provider at the Community Health Center of Burlington who said that information on safe sharps disposal would be useful, so I created instructions on how to safely dispose sharps on the street.

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  Expanding Awareness of TBI Resources in the North Country

  Nicholas W. Krant

  Short-term Project

  Disability, emotional dysregulation and financial stress are only some of the issues that many patients who suffer TBI encounter. While resources are available to alleviate some of these burdens on patients who suffer TBI in New York's North Country, patients often struggle to find these resources. This project endeavors to create a resource for patients, family members and practitioners to find available resources.

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  Towards the elimination of Viral Hepatitis in Clinton County, New York

  Michael H. Le

  Short-term Project

  Chronic viral hepatitis is a major public health issue, affecting approximately 300 million persons globally. In Clinton County, New York, chronic viral hepatitis remains a major concern, with incidence rates for hepatitis C virus infection (HCV) in the top quartile and hepatitis B virus infection (HBV) in the 3rd quartile for the state in 2022. This current study aimed to identify the trends in incidence and prevalence of chronic viral hepatitis in Clinton County, rates of HBV birth dose vaccination, and to reflect on the experiences in treatment and prevention of chronic viral hepatitis at a community health clinic in Plattsburgh, New York.

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  Increasing Equitable Cardiovascular Disease Screening and Prevention for Women of Low Socioeconomic Status: You First

  Isabel N. Martinez Daniel

  Short-term Project

  Cardiovascular disease (CVD) continues to be the leading cause of death in females of all ages and races. Given the potential reduction in risk of coronary events with modifiable behaviors, primary care physicians are in a unique position to be able to use shared decision making and patient education to help dramatically reduce the potential burden of cardiovascular disease. Consideration for social determinants of health, such SES, should not be forgotten when aiming to provide adequate and accessible healthcare. Furthermore, the incorporation of unique programs, such as You First, into primary care offices can increase equitable care for patients and aid in risk reduction for many diseases, including but not limited to CVD.

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  Modernizing Patient Outreach & Analytics

  Laceyahna Munroe

  Short-term Project

  It is challenging for providers to understand how patient's engage with different types of communications from their primary care clinic, particularly on a site-to-site basis. This project leverages a simple link-hosting platform, LinkTree, to direct patients to free publicly funded workshops in Diabetes Management. The platform allows simple data to be collected about engagement with the links that are provided to the patients and gives the host clinic an easier way to understand and hone their communication style to best reach different patient populations. In this project we chose a panel of diabetic patients with A1c's >7% to receive a MyChart message with links to workshops about managing diabetes. We were able to connect with key stakeholders and administrators for these programs and develop a greater understanding of the landscape for referrals to free resources for patients. Of 92 patient messages, 6 clickthroughs to the My Healthy Vermont website were recorded in a 7 day period. There are limitless directions for future development and utilization of this tool to reach patients and engage them with their healthcare needs, but thought should also be given to those who may be less inclined to use mobile devices or computers to communicate.

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  Planetary Health: Helping providers and patients prepare for climate change

  Chellam Nayar

  Short-term Project

  Climate change has been called the greatest global health threat of the 21st century. The effects of changing temperatures and increasing pollution have been shown to increase the incidence and mortality of cardiovascular diseases, affect respiratory health, increase the risk of new infectious disease outbreaks, affect mental health, and exacerbate inequities between those with means and those without. In Vermont, climate change is leading to an increase in average temperatures, more extreme heat events, shorter winters, more storms, poor air quality due to wildfire smoke, an increase in cyanobacteria blooms, and a longer tick season, among others. This project will educate providers on the impacts of climate change on health and provide educational materials for patients on specific planetary health related issues, including tick-borne disease and extreme heat.

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  Health Impacts of Remote Work

  Tin Nhan Nguyen

  Short-term Project

  Remote work has increased in frequency in the past few years with a notable rise in Connecticut. While working from home has certain benefits, it can also increase the risk of certain physical and mental health issues. An educational pamphlet on the health impacts of remote work with suggestions to reduce negative effects was developed and distributed to community members.

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  Barbershop Based Hypertension Intervention

  Dhiraj Patel

  Short-term Project

  Barbershop based hypertension screening and treatment interventions have been substantiated across prior literature as cost-effective and highly efficacious interventions for reducing overall blood pressure in the African American community. Researchers have also begun to explore the applicability of such an intervention to another high risk ethnic group for hypertension: Hispanic and Latino communities. With >30% of Danbury, CT's population being comprised of Hispanic and Latino populations and barbershop interventions for hypertension having already been established in the nearby city of New Haven, CT via Yale Health, this community engagement project aims to take the first step towards establishing similar services here in Danbury via Nuvance Health.

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  Barriers For Patients With Limited English Proficiency On The Usage Of The Electronic Patient Portal

  Sofia Toro Alvarez

  Short-term Project

  99.7% of Vermont’s new incoming residents over the last 10 years were Hispanic, Black or African American, Asian, American Indian or Native Hawaiian, however, despite Vermont’s growing diversity, inequities in all fields, including healthcare, continue to affect minorities the most. At Colchester Family Medicine, 6% of patients have limited English proficiency (LEP) and over 10 languages are spoken by this patient population. While interpretation services are often readily available during these patient’s visits, communication before or after their visit is challenging. The electronic patient portal is one of the main resources for patients to not only stay in touch with their provider but also to access their own medical information. However, many LEP patients face barriers preventing them from making use of this resource. As part of this project, a 7-question survey was distributed to LEP patients assessing usage, accessibility, challenges and assistance for setup regarding MyChart. 5 out of 5 LEP patients marked “no” to using MyChart themselves. Language, technological expertise, and lack of guidance on how to activate it were all barriers identified by these patients on the use of the electronic patient portal. A step-by-step guide was designed in both Spanish and French to address the initial language barrier preventing patients from activating their MyChart account. Providing better patient education, expanding interpretation services, and increasing research on LEP patient’s use of the electronic patient portal may help ensure a more equitable and accessible healthcare for all.

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  Bridging Language Barriers In Clinical Screening: Leveraging Large Language Models (LLMs) to Generate Bilingual Screening Surveys for Patients with Limited English Proficiency (PLEP)

  Tyler VanDyk

  Short-term Project

  This study addresses the critical need for accessible clinical screening in communities with a high incidence of Patients with Limited English Proficiency (PLEP). Recognizing the limitations of existing interpreter services and the scarcity of validated translations for standard clinical surveys like PHQ-9 and GAD-7, we developed a novel approach leveraging Large Language Models (LLMs). Our method utilizes GPT-4 to create bilingual versions of these surveys, which are then formatted into printable PDFs via a Python script and LuaLaTeX compiler. The resulting surveys, validated for translation accuracy and cultural competency, are made accessible through a Google repository. Preliminary results demonstrate that GPT-4 can consistently produce high-quality, culturally sensitive translations in various languages, including Spanish, Arabic, Nepali, and Somali. This innovative approach not only improves the accessibility of clinical screening tools but also enhances the efficiency of medical practice, especially in settings with diverse linguistic needs. Future directions include professional validation of the bilingual surveys and expansion of the repository to encompass a wider range of languages and forms. This study highlights the potential of LLMs in bridging language barriers in healthcare, offering a scalable solution to improve healthcare outcomes for PLEP.

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  EMPOWERING BURLINGTON'S UNHOUSED: DISCOVERING COMMUNITY RESOURCES AND INSIGHTS

  Dario Vanegas

  Short-term Project
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  Promoting spine health for adolescent athletes

  Taylor R. Walker

  Short-term Project

  Based on interviews with local stakeholders in public health and literature review, developed an informational brochure for high school athletes containing prevention and management strategies and resources for low back pain. The aim of this project is to help young athletes stay healthy and live well as they age by promoting spine health.