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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Barriers to Smoking Cessation in Patients Enrolled in Suboxone Treatment Programs

Thomas L. Arnell
Short-term Project
Cigarette smoking is the leading cause of preventable death and disease in the United States, accounting for more than 480,000 deaths every year. The prevalence of tobacco use among substance abuse treatment program enrollees is substantially higher than that of the general population, with recent estimates ranging between 75-97%. The aim of this project was to identify specific barriers to smoking cessation in patients enrolled in suboxone treatment programs in Franklin County, VT. The most commonly cited barriers among survey responders were related to fear of the effects of tobacco withdrawl, while the most important barrier was related to fear of increased desire to use drugs following smoking cessation.
Promoting TIA Awareness: Decreasing Stroke Mortality in Vermont

Nicole Becher
Short-term Project
The death rate from stroke in Washington County, VT was nearly twice that of the state in 2015. Risk of death from stroke can be decreased by timely intervention, however many patients are unaware as to signs and symptoms of stroke, and when to seek medical attention. A brochure was developed and distributed, aiming to shorten the time between experiencing TIA symptoms and point of contact with medical professionals.
Improving Patient Educational Materials for a Suboxone Clinic in Southeastern Vermont

C. Wesley Cubberley
Short-term Project
Access to medical treatment for opioid use disorder plays a significant role in the ability of a community to support a person's recovery. In Springfield, VT, community workers and providers are attempting to organize a Suboxone (buprenorphine + naloxone) clinic in order to bridge the significant geographic and socioeconomic gaps implicit to this rural community's location. In order to garner interest and increase awareness of this forthcoming project, a short, accessible educational flyer was developed with the input of the health center's staff for future use.
Improving patient knowledge of antimicrobial resistance and appropriate antibiotic use in a Rutland county acute care center

Stephen D. Daniels
Short-term Project
Antimicrobial resistant infections are one of the most prevalent global health concerns of our time. It is paramount that action be taken to do all we can to reduce the burden that these “superbug” infections bring in the form of both serious illness and financial strain on healthcare systems. As healthcare professionals, the onus falls on us to educate the public on basic knowledge regarding bacterial/viral illness, as well as proper antibiotic utilization, so that we can all work in coercion with one another to combat this global health concern. The here-in project describes an educational piece with this goal in mind, and provides a projected financial advantage for a successful intervention.
Increasing Advance directive utilization in Hardwick, VT

Maeve Lauren Donnelly
Short-term Project
This project was created to increase advance directive use at the Hardwick Area Health Center in Hardwick, VT. The project was aimed at creating awareness of the lack of advance directive use both to the providers and patients, so persuasive educational flyers were made to hang around the office. This project helped increase the attitude and awareness of the importance of advance directive planning.
Preparation as Prevention – Reducing Morbidity and Mortality in the Vermont Outdoors

Nathan T. Dreyfus
Short-term Project
While precipitants and outcomes of wilderness medical emergencies are numerous and diverse, wilderness rescues in Vermont are most often called for individuals or groups inadequately prepared for conditions or contingencies. In many cases, failure to bring one of a few key items such as equipment for navigation or illumination after dark can create a preventable emergency with subsequent requirement for rescue or retrieval.
Art Interventions for Seniors in New Milford, CT

Lauren Gaffaney
Short-term Project
There is a growing body of evidence that art therapy for seniors has been shown to improve sociability and mood, reduce the risk of dementia, decrease agitation, depression, isolation, and improve the overall quality of life. Recent research conducted in Burlington with the UVM LCOM Public Health Program suggested that art appreciation and history sessions can have similarly beneficial effects while requiring less volunteer/caregiver time, equipment, and with a lower cost. I surveyed the art interventions available in New Milford, CT and found there were limited active art classes available and no art appreciation sessions. I presented an art appreciation session at the New Milford Senior Center for seniors and staff, with the aim of teaching staff so they could continue the sessions once my clerkship was done.
Sleeping Mindfully

Jinal Gandhi
Short-term Project
Insomnia is a disorder of hyperarousal that affects up to 30% of adults. Insomnia is based on cognitive dysfunction that causes us to worry and neuroendocrine factors that upregulate our autonomic nervous system. Studies have shown that just 10 minutes of daily mindfulness practice can improve sleep. Mindfulness is able to work at the root of both causes of insomnia. It improves our ability to relax through increasing attentional factors that impart control over stress hormones and helps reduce ruminative thoughts.
Patient Education on the Association of Hormonal Contraception with Depression

Julia E. Hannigan
Short-term Project
Hormonal contraceptive agents are widely used by women during their reproductive years. In recent years, research has been released linking hormonal contraception with the initiation of antidepressant medication and a first diagnosis of depression. More research is still warranted in order to further elucidate the relationship between hormonal contraception and depression, but current evidence prompts the necessity for shared decision making between clinicians and women considering treatment with hormonal contraceptive agents. The goal of this project is to give providers easily accessible patient educational materials in the form of epic smart phrases to aid in informed decision making.
Domestic Violence (DV) Screening

Wilson Huang
Short-term Project
Domestic Violence (DV) is an understated yet significant source of morbidity and mortality for victims. Healthcare providers have a unique opportunity and responsibility to identify patients who may be victims of DV. A formal screening method for DV should be developed and routinely employed in local practices to address this issue.
Educating Patients on Screening Guidelines and Expectations for Well-Woman Examinations

Cyrus Maxim Jalai
Short-term Project
Female patients seeing primary care in rural settings often do not seek out specialized care from a practicing OB/GYN, favoring instead to utilize their family practitioner to respond to their complaints. As such, it would be effective to work to educate these patients at their well-women examinations on routine screenings, immunizations, and health maintenance methods they should expect based on their presenting age. A handout simplifying and synthesizing the main screening and general health guidelines for annual well-women examinations may be helpful for female patients using primary care practitioners as their source for obstetric and gynecologic care.
Conjunctivitis: Patient Information

Nicole Jedrzynski
Short-term Project
Conjunctivitis or “pink eye” is a common affliction encountered frequently in family medicine. Most cases are viral and do not require antibiotics, and more accurate information for patients and their caregivers is needed to minimize unnecessary visits to urgent care and the emergency room. This will facilitate better patient care and fewer healthcare costs.
Colorectal Cancer Screening Quality Improvement: A FITKit Mailing Initiative

Isabella Kratzer
Short-term Project
According to the American Cancer Society, colorectal cancers are diagnosed in 1 in 22 men and 1 in 24 women in their lifetime. Despite the wide range of effective CRC screening options available in the US, the Hudson Headwaters Health Network (HHHN) has seen little improvement in its CRC screening rates of approximately 60-63% in recent years. This places HHHN, an FQHC in Upstate New York, well below the National Colorectal Cancer Round Table 2018 goal of 80% screening in eligible, average-risk adults. This quality improvement project sought to improve HHHN’s CRC screening rates through a new FITKit direct-mailing initiative. A literature search was conducted, informing the design of a pilot mailing initiative based on recent studies of direct-mailing FITKit outreach in comparable FQHC’s and safety net institutions. In mid-January, 2019, FITKits with return address labels and postage were mailed to 362 HHHN patients’ homes. The cohort represented a population that was age 50-75, currently failing the CRC screening measure, had not seen a PCP in the last calendar year, had BMI ≥ 30, and had 0-5 comorbidities per a network-wide EMR data search in December, 2018. These mailings were preceded by an introductory email and included a second introductory letter along with the network’s usual ‘FITKit Facts and FAQ’s’ sheet. Mailings were followed by two or more automated phone reminders to complete the screening. Only one month after mailings were released, the network received 26 completed FITKits for processing, representing a 7.14% early return rate for the initiative.
An Educational Module for Adolescents on Cannabis Following its Legalization

Anna Lidofsky
Short-term Project
Recreational use of cannabis has been recently legalized in Vermont. One year prior to its legalization, 42% of high school students in Washington County reported at least one-time use of cannabis. An educational module for adolescents was developed to address the increasing potency of cannabis and health risks associated with its use.
Melanoma Surveillance

Samuel Logan
Short-term Project
According to the CDC, in 2015 the rate of melanoma of the skin was 22.1 per 100 thousand people, the sixth most common cancer. In Vermont this rate was 35.8 per 100 thousand, higher than the national average. In Berlin, VT, it was noted that patients often are concerned about their nevi, but often do not know when it is appropriate to bring them to their physician's attention. A pamphlet was developed to assist physicians in educating patients on the characteristics of melanocytic nevi and encourage patients to speak to their physician when they find moles which meet these characteristics.
Substance Use Disorder Treatment Decision Aid for Adults in Chittenden County Vermont

Elizabeth V. McLeod
Short-term Project
Substance Abuse Disorders (SUDs) are a prevalent public health concern in both the national and local arena resulting in millions of dollars in pubic health costs and loss of life. Navigating the treatment options available in Chittenden County can be time consuming, difficult, and delay treatment. In order to help guide adult patients and their families in Chittenden County along their journey towards recovery from SUDs, a treatment decision aid was developed for choosing the right level of care.
Patient Education: Low-Dose CT Screening

Charles Nicoli
Short-term Project
Low-dose computerized tomography scans have come into play as effective screening modality for high-risk patients in the most deadly cancer nationwide. The introduction of this screening option requires a larger amount of patient education on their methodology, benefits and drawbacks, and effectiveness. A patient education brochure was produced for this purpose.
Eat, Sleep, Console for Neonatal Abstinence Syndrome Babies

Kathryn Patton
Short-term Project
Neonatal Abstinence Syndrome (NAS) is a complex disorder that manifests with neurologic, gastrointestinal, and musculoskeletal disturbances and is most often associated with opioid withdrawal. In the US, 6 out of 1,000 babies are born to mothers who used opioids during their pregnancy. These babies go on to develop NAS. Androscoggin County, where Central Maine Medical Center is located, has an even higher rate of babies with NAS: 100 out of 1,000. Most institutions use the Finnegan Neonatal Abstinence Scoring System (FNASS) to guide pharmacologic treatment. This system assigns a score based on 21 clinical signs of withdrawal with a score ≥8 indicating a need for pharmacologic treatment. This system has never been validated nor has its score cutoffs been tested which may lead to over or under treatment of babies experiencing NAS. Eat, Sleep, Console is a novel approach which has shown to decrease average length of stay, pharmacologic treatment, and healthcare costs.
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.
Cyberbullying: A Resource for School-aged Children, Adolescents, and Parents in Milton, Vermont

James K. Rohwer
Short-term Project
Cyberbullying occurs when harmful words or actions by one or more persons are intentionally and repeatedly directed against another person in the digital world through text message, social media, e-mail, apps, online video games, forums, etc. Today, more children and adolescents are connected to the internet than ever before, which puts them at risk of becoming victims of cyberbullying. Many victims, as well as parents of victims, may not be familiar with the resources that are available to them in the areas in which they live when concerns of cyberbullying arise. Therefore, the goal of this project was to create a pamphlet with information about cyberbullying, including local resources for victims of cyberbullying, to be made available to children, adolescents, and parents in Milton, Vermont.
Transportation as a Barrier to Healthcare

Melissa Romero
Short-term Project
Lack of transportation is large barrier to medical care, particularly in rural areas. Many patients decline medical appointments because they do not have access to a personal vehicle or other transportation resources. Consequences include missed appointments and higher healthcare costs for patients and providers in the future. Solutions will involve educating patients on resources available to them, simplifying access to current programs, introduction of new programs, and the collaboration of public and private entities to provide new services.
Interventions for fall prevention in community-dwelling older persons

Gregory S. Roy
Short-term Project
Falls in individuals over the age of 65 is a pervasive problem resulting in significant health and economic burden in our country. Thus, effective fall prevention strategies are an important public health measure, especially in an age group that is growing rapidly. Research has shown a multifactorial approach to fall prevention addressing environmental hazards, strength and balance, medications, and medical comorbidities to be most effective. Despite there being strong evidence to support this, many individuals are unaware of the factors that put them at risk and ways to mitigate them. An educational pamphlet containing evidence-based strategies to reduce fall risk was produced for distribution within the New Milford primary care clinic in New Milford, CT.
Community-Based Exercise Education During Colder Months

Cole S. Shapiro
Short-term Project
Approximately 50% of US adults and 75% of US high school students don't meet recommended weekly physical activity guidelines, and physical activity declines further during colder seasons. Resources describing local suggestions for physical activity should be made broadly available to community members, such as at their primary health care office.
A Provider's Guide to Medical Cannabis: THC and CBD. Putting the Evidence to Work for Improved Patient Care

Danielle Smith
Short-term Project
Please use abstract uploaded with previous powerpoint
Patient Guide to Access Quality Health Information Online

Danielle Wall
Short-term Project
A large percentage of patients use online search engines to access health information. However, there is a large amount of health information online that is unregulated and not evidence-based. As a result patients may acquire health information that is incorrect which may negatively affect patient-provider relationships and patient's healthcare. A brochure was created to highlight safe practices for accessing health information online.