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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Listen to Her Heart: Bridging the Gap in Recognizing, Preventing, & Treating ASCVD in Women

Stephen J. Foley
Short-term Project
Atherosclerotic cardiovascular disease (ASCVD) is traditionally considered a male disease, yet it is the leading cause of death in women. This may be associated with the significant lack of research of ASCVD in women, leading to poor recognition, diagnosis, prevention, and treatment. The American Heart Association reports that a majority of women experience prodromal symptoms more than one month before a heart attack or stroke, and these symptoms are often underestimated. This project intends to help address the question: How can earlier detection of ASCVD risk in women reduce missed signs of acute myocardial infarction/stroke and thereby reduce preventable ASCVD hospitalizations? This project also hopes to increase physician and patient awareness of and engagement with the VT Dept. of Health's "You First" program to provide supplemental heart health screens and services for women.
ADHD Evaluation and Diagnosis in the Primary Care Setting

Sean R. Fox
Short-term Project
Our goal was to develop a comprehensive Epic template for the initial evaluation of ADHD in the primary care setting.
Increasing Awareness of Pharmacologic Interventions for Smoking Cessation

Jeremy Frank
Short-term Project
Smoking is a large cause of morbidity and mortality in the healthcare system. Many patients are interested in quitting smoking but have not found an effective strategy that works for them. There have been times when patients have been receptive to a discussion regarding medication assisted cessation but ultimately were not prescribed any medications from their provider. Despite the fact that it has been proven that pharmacotherapy increases the chances of smoking cessation. The goal of this community health project is to create a change within the healthcare system by providing evidenced based recommendations regarding pharmacologic treatment in smoking cessation for both providers and patients to ultimately decrease the burden of smoking within this community.
Improving IPV Screening & Access to Resources for Patients in Primary Care

Daniel J. Fried
Short-term Project
Primary care providers can improve their screening protocols for intimate partner violence (IPV) and how they connect resources to their patients.
Improving Housing-Insecurity Screening In A Rural Primary Care Setting

Heather G. Giguere
Short-term Project
Housing-insecurity and homelessness have a direct impact on individual health, and are well established causes of premature morbidity and mortality (6). Screening for housing-insecurity leads to earlier identification, and more extensive engagement of services, which can help to mitigate the individual and public health ramifications of these social determinants of health (8). The aim of this project was to improve the screening process for housing-insecurity within an rural primary care setting.
The File of Life: A Lifeline for First Responders in Fairfield County, CT

Brittany Gilmore
Short-term Project
During a medical emergency, it can be difficult for first responders to obtain crucial medical information about their patients for a variety of reasons. The patient may be unconscious, have an altered mental status, or simply not know their medical history. This project aimed to increase awareness of the File of Life program, which many local Fire and EMS departments are implementing to improve their ability to deliver life-saving care.
Tackling Access to a Healthier Life

Edom Alemayehu Girma
Short-term Project
Obesity is a known risk factor for complications during childhood and later in adult life. While numerous factors play a role in the prevalence of obesity, this project focused on better intervention for obesity management in the family medicine clinic located in Plattsburgh, NY. Interviews and literature searches were conducted to determine possible strategies to better assist patients in attaining their sustainable weight loss goals and an overall healthier lifestyle.
Primary Care and The Housing Insecure in Central Vermont

Hunter Goldsmith
Short-term Project
In this project, I performed a literature review of the research regarding the benefits of primary care on population health. I also looked at healthcare utilization and interviewed community members. I then surveyed individuals suffering from housing insecurity to determine if they were connected to primary care homes and if not the reasons they have not been able to be connected. Finally, I attempted to link interested individuals with local primary care offices to establish care.
Increasing Access to Advanced Care Planning Documentation

Amy B. Golinker
Short-term Project
The purpose of this project was to determine the percent of the adult patient population at one family practice in Vermont with completed advanced care planning documentation available to health care providers and work to increase that percentage. The majority of this project was spent completing a chart review to find the advanced care planning documentation present in the current electronic health record, Epic, the previous electronic health record, ECW, or registered with the Vermont Advance Directive Registry. Efforts were also made to increase the percent of adult patients with advanced care planning documentation through conversations with patients during wellness and chronic care visits. Overall, in this practice approximately 14% of adult patients were found to have completed advanced care planning documentation which is less than the national average of approximately 33% of all adults. Discussion of further research on how to increase this percentage is ongoing.
Long Phone Wait Times at Newtown Primary Care

Krystal Gopaul
Short-term Project
Getting an appointment with a PCP has historically always been challenging but at Newtown Primary Care long wait times on the phone when booking an appointment is also frequently cited as a local challenge. This project explores phone wait times as well as patient, staff and provider perspectives on challenges accessing primary care appointments at Newtown Primary Care.
Improving Mental Health Access in a Rural Setting via Telehealth

Timothy W. Greenfield
Short-term Project
There are several barriers patients face when accessing mental healthcare in rural areas including: lack of internet, lack of resources, and stigma.

Local options are limited, and patients face barriers such as access to transportation.

These factors position telehealth as a unique, tangible solution for patients in the community.
Improving Access to Medication Assisted Treatment for Opioid Use Disorder in a Rural Emergency Department

Warren Grunvald
Short-term Project
Opioid Use Disorder (OUD) is a growing epidemic throughout the United States and Maine has not been sparred by this. As the Emergency Department is a frequent location for people with OUD to interact with physicians it has been targeted as an opportunity to initiate Medication-Assisted Treatment (MAT) with Suboxone. This project details an effort to streamline this process and improve outcomes for patients interested in MAT.

Improving access to medication assisted treatment for opioid use disorder in a rural Emergency Department
Improving access to medication assisted treatment for opioid use disorder in a rural Emergency Department

Warren Grunvald
Short-term Project
Opioid Use Disorder (OUD) is a growing epidemic throughout the United States and Maine has not been sparred by this. As the Emergency Department is a frequent location for people with OUD to interact with physicians it has been targeted as an opportunity to initiate Medication-Assisted Treatment (MAT) with Suboxone. This project details an effort to streamline this process and improve outcomes for patients interested in MAT.
Anticipatory Guidance on Breastfeeding Support in Vermont

Ian Guertin
Short-term Project
Breastfeeding is an optimal source of nutrition for babies and has health benefits. Vermont strives to support families in meeting their breastfeeding goals. This project developed anticipatory guidance that can be given to prenatal patients about breastfeeding support resources in Vermont.
Addressing Diabetes Education in Chittenden County

Varun Gupta
Short-term Project
The percent of adults in Chittenden County with diabetes who have received diabetes education was short of national goals. To gather more information about the problem, a NP and 2 diabetic patients were interviewed. A educational handout was created to address some of the concerns brought up that reflect some of the unmet educational needs.
Polypharmacy And Fall Risk Education In Elderly Adults

Mohamad K. Hamze
Short-term Project
The primary care office is often the setting for medication management and risk-reduction and PCPs frequently reconcile and manage the prescriptions of numerous specialists who see a patient separately. For patients >65, one must consider the necessity of prescribed medications that may contribute to increased fall risk in this age group. Patients themselves may be uncertain of the types of medications they may be taking that potentially put them at increased risk for falls or adverse outcomes of falls. Thus, they may benefit from easily accessible educational materials on commonly-prescribed medications in these categories so that they may work with their physician to make informed decisions on their medication regimens.
Addressing Maladaptive Coping Mechanisms in Response to External Stressors and Negative Affective States in Primary Care Settings

Matthew C. Hanna
Short-term Project
Individuals respond to negative affective states, including depression and bipolar disorder, and external stressful events with a wide variety of adaptive and maladaptive coping mechanisms or a mixture of both. Maladaptive coping mechanisms include substance use and binge eating, as well as avoidance or withdrawal behaviors. Understanding how patients respond to external stressors and adapt to negative affective states, including depression and hypomania, via questionnaires seeking to elucidate coping mechanisms is of utmost importance to recognize patients at risk of substance use, binge-eating, and other maladaptive behaviors. Only through explicit identification of these mechanisms can providers work with patients to take steps to mitigate negative health effects of maladaptive coping behaviors via targeted patient education and formation of collaborative partnerships with patients.
Keep an Eye On Your Ocular Health: The Importance of Routine Eye Exams

Kiana Heredia
Short-term Project
When it comes to scheduling preventive health screening exams, eye exams are often overlooked. Individuals may not understand the importance of their ocular health, and many assume a basic vision screening is comprehensive. However, that is not the case and eye diseases are common and can go undetected for a long period of time before symptoms appear. Seeing a licensed optometrist or ophthalmologist for comprehensive eye exams is important for detecting eye disease in the early stages when treatment is available to prevent vision loss is most effective.
Overcoming Barriers to Care in the Treatment of Opioid Use Disorder

Max C. HoddWells
Short-term Project
There are many barriers to care when it comes to the treatment of opioid use disorder (OUD), and patients often require significant resources to achieve success. Patients requiring treatment for OUD at Central Maine Medical Center in Lewiston, Maine are often enrolled in an intensive outpatient clinic (IOP), which requires access to certain technology, transportation to appointments, and time-intensive counseling, among other things. The demands of IOP are important for successful and holistic treatment, but it presents unique challenges to socioeconomically disadvantaged patients who have limited resources.
Anxiety Screening in Pediatric Populations

Shubhankar Joshi
Short-term Project
This project is aimed to elucidate guidelines for addressing newly changed recommendations for pediatric anxiety. Similar to the depression screening PHQ2, we hope to establish/develop a similar questionnaire that would serve as a quick screening tool and then further steps for treatment and recommendations on anxiety diagnosis.
Resources for LGBTQ+ Patients

Elie Kaadi
Short-term Project
Many LGBTQ+ patients face issues when seeking care from their primary care providers as well as specialists. This could be due to lack of information that is taught during medical education as well as lack of information that is available to the public.

This project aims to provide helpful information for both physicians and patients that is relevant for the care of LGBTQ+ patients.
Perceptions of Teleophthalmology

Kisha Kalra
Short-term Project
One of the greatest burdens facing patients with eye-related pathologies is access to ophthalmologists in the area. Teleophthalmology is a way for eye examinations to be conducted in the easily-accessible primary care setting, with images sent to ophthalmologists for interpretation. This project addresses the perceptions of this model amongst patients and primary care physicians.
Benign vs. Malignant: Improving Prevention and Detection of Cancerous vs. Non-Cancerous Skin Lesions Through Inclusive Patient Education

Simran Kalsi and Sam Afshari
Short-term Project
Vermont consistently has one of the highest annual rates of melanoma in the United States. This is likely due to a range of factors including population demographics (predominantly white, aging population), active outdoor lifestyles, intense seasonal bursts of sun exposure, and inadequate Winter sun protection. The COVID-19 pandemic and its associated shutdowns have caused significant delays in healthcare delivery, further exacerbating the incidence and severity of melanoma. Primary care providers are therefore an increasingly essential first line of defense in detecting suspicious skin lesions and expediting treatment of skin cancer, but patients should be aware of when to seek evaluation. I developed a patient-centered educational bookmark (adapted from the American Academy of Dermatology) to improve public knowledge about when a skin lesion is likely to be malignant vs. benign. The bookmark was distributed to Thomas Chittenden Health Center in Williston, VT and the University of Vermont Medical Center Family Medicine clinic in Hinesburg, VT. Qualitative feedback was collected and categorized according to major themes including appearance, utility, and relevance to Vermonters. Future directions for this project include further distribution at local libraries, book fairs, and schools as well as quantitative evaluation of its efficacy as an intervention through population surveys.

I worked in collaboration with Sam Afshari for the distribution of this intervention across clinics and for collection of feedback. I distributed and collected feedback for Sam's presentation "Improving Identification of Dermatologic Conditions in Skin of Color" (see Slide 7 for details).
An Assessment of Skills Before Pills, A Series Promoting Lifestyle Medicine

Kyle J. Kellett
Short-term Project
Lifestyle medicine seeks to treat the root cause of chronic medical conditions through lifestyle medications, including diet and exercise habits, tobacco and alcohol use, and mental health. Skills Before Pills is a novel, multidisciplinary, 8-week group appointment series aimed at promoting lifestyle change to address chronic medical conditions developed by the physicians at South Burlington Family Medicine. The aim of this project was to construct a quality improvement survey to collect patient feedback on the series with the goal of continually improving the course to promote long-term, positive, change in behavior.
Peri-Operative Optimization: Social Determinants of Health

Adam F. Kohutnicki
Short-term Project
This project investigated how clinicians at a rural Vermont family medicine practice observed various social determinants of health (SDOH) of their patient population affected patients' preparedness for surgery. Two clinicians involved in the community, a practicing family medicine physician and a practicing social worker, were interviewed to collect qualitative data on how various SDOH they have observed through their clinical practice have influenced patients' preparedness for surgery. This information was then utilized to create a "dot-phrase" that clinicians can use as part of a patient's pre-operative visit in the outpatient setting to assess SDOH and plan subsequent targeted interventions to address those SDOH. The clinicians identified specific SDOH of primary concern that they believe should be addressed in the pre-operative visit: family dynamics, financial considerations, and transportation. The proposed intervention includes a "dot-phrase" that can be utilized by clinicians during these encounters to specifically address these SDOH and coordinate additional interventions to address areas of need. Further investigation into the specific costs and savings of such an intervention, additional SDOH to be included in such interventions, and additional collateral information from surgical perspectives is warranted.