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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Primary Cardiovascular Disease Prevention

Kaileen Cruden
Short-term Project
Cardiovascular Disease is the leading cause of death in the United States, causing about 1 in 4 deaths. Cardiac rehabilitation is often only suggested to patients AFTER a hospitalization for serious heart conditions such as heart attack or heart failure. Data demonstrates the decrease of a secondary cardiac event for individuals who were enrolled in cardiac rehab as well as an improvement in cardiac risk factors including: decrease in lipid levels and insulin resistance with increased smoking cessation and exercise tolerance. Levels of depression and anxiety also improved in this population. This leads us to ask: How can we take what has been proven to improve heart health and prevent secondary cardiac events to prevent primary cardiac events?
It's a Walk in the Park: The health benefits of exercising in nature and a beginner's guide to hiking in Connecticut

Elena Dansky
Short-term Project
Walking Towards a Healthier Future: A Pocket Guide to Walking Routes in Colchester and the Health Benefits of Walking

Kevin DiBona
Short-term Project
The obesity epidemic is a complex problem necessitating a multifaceted long-term response. While there is no single solution to this decade-evolving issue, exercise remains one of the most important health interventions available. This project aims to serve as a resource for patients seeking to lose weight; outlining some of the walking routes local to Colchester Vermont, as well as the health benefits of a sustained exercise plan.
Emergency Medicine Super Utilizers and the Role of Targeted Community Paramedicine

Nathan E. Dow
Short-term Project
Frequent emergency department (ED) users, colloquially known as “frequent fliers,” are a small population that account for a disproportionately large number of ED visits. Depending on the criteria used, ED super users may constitute as little as 1% of the individuals seen through the department, while accounting for up to 60% of the visit volume. There is an associated stress on the 911 system and a public health concern with burdening of already busy emergency departments. Unsurprisingly, ED super users have an associated financial cost. A 2015 Milwaukee area pilot program provided community outreach to only 39 of their well-known ED utilizers and still managed to return just over one million dollars in cost savings to the healthcare system. This patient population is frequently characterized by chronic illness including cancer, mental health disorders, substance use disorders, chronic kidney disease and chronic obstructive pulmonary disease (COPD).

At the University of Vermont Medical Center (UVMMC), a community outreach program is being assembled. Using both grant and internal funding, HealthNet paramedics and ED nurses will provide community-based care to the top 100 utilizers of the UVMMC Emergency Department. Methods include outreach to patients missing primary and subspecialty appointments, tracking pill counts, monitoring prescription refills, assessing medication adherence at home visits and assessing and addressing social determinants of health including housing and food stability. The program aims to decrease ED and EMS utilization, reduce health system costs and ultimately, improve patient outcomes. A similar program might be considered at CVPH, potentially utilizing CVPH Family Medicine staff for community outreach, as well as the clinic itself as a primary care alternative to frequent ED evaluation for chronic medical conditions.
Kangaroo Care in the Community: Creating antenatal informational resources for providers and expectant parents

Emma Dunne
Short-term Project
Obstetric care providers at the Community Health Centers of Burlington create, implement, and coordinate resources to help support parents through pregnancy, delivery, and child rearing. The COVID-19 pandemic has altered the accessibility of existing resources, exacerbating the need for creative support of prenatal learning, breastfeeding, and postpartum socialization. Regular skin-to-skin contact between newborn infants and their parents is a low-cost, low-risk intervention with demonstrated benefits to breastfeeding, infant and parent physiology, emotional health, and bonding. This project aimed to establish antenatal informational resources for providers and expectant parents about the potential benefits of skin-to-skin care in the community setting.
Addressing Rational Barriers to Lifestyle and Behavioral Modification

Ahmed Eldakroury
Short-term Project
Rational barriers contribute to resistance towards initiating, restarting or maintaining lifestyle/behavioral modification. Such barriers include lack of confidence in the proposed intervention(s), exaggerated perspectives, unsubstantiated beliefs and feelings of futility/hopelessness in the setting of past failures or relapse. Lifestyle and behavioral modification are core elements of preventative health and mental health—identifying and addressing erroneous thought processes, perspectives or beliefs that contribute to hesitancy may empower patients to trust the process and put an honest effort towards making those changes. Thus, a motivational pamphlet was created for patients with the goal of addressing hesitancy/resistance towards initiating or maintaining lifestyle/behavioral modification. The pamphlet attempts a different approach to motivational priming using mechanisms such as (1) informing and emphasizing the tangible changes in brain architecture that result from continued effortful thinking and reorientation, (2) surveying different demotivating thoughts while providing examples of cognitive techniques to reorient dissonant thought processes towards more rational and evidence based analyses. Additionally, the pamphlet attempts a discussion on relapse with the goal of restructuring the thoughts of defeat and hopelessness that impede progress and prevent effortful persistence. Future work should be targeted at evaluating the efficacy of this approach and fine tuning elements in the clinical motivational process.
Preventative Health Care Shortage

Jenna A. Elkhoury
Short-term Project
The primary care shortage is major problem that impacts people in rural and often low income communities. Our project seeks to address the primary care workforce shortage affecting the Vermont and Connecticut communities by better understanding current medical school student perspectives on primary care as a career of interest. Attractors and deterrents of primary care were highlighted through a survey distributed to all medical students at the Larner College of Medicine at the University of Vermont.
Nutritional Habits: Encouraging Simplicity and Consistency

Alim Esemenli
Short-term Project
Nutrition plays a crucial role in development of diseases that are the leading causes of morbidity and mortality in the Unites States. However, due to reasons such as time limitations, lack of clear guidelines, and what seems like a sense of hopelessness felt by providers and patients alike upon lack of results, discussions around nutrition may lack in frequency, consistency, and/or adequacy of duration, Research shows that flexibility of mindset, as well as achievability and sustainability of nutritional goals, play a key role in achieving success in weight This project proposes a three-page document that can potentially help primary care providers support and monitor nutritional behavioral changes determined by their patients.
Skin Cancer, Skin Biopsies and Mohs Surgery: Patient Education

Negar Esfandiari
Short-term Project
Skin cancer is the most common cancer in the United States. There are three main types of skin cancer: Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma. While Melanoma is less common than Basal Cell and Squamous Cell Carcinoma, it has a higher mortality rate. If diagnosed in earlier stages, Melanoma has a significantly better prognosis and lower patient costs. Most skin cancers are diagnosed through skin biopsies. Vermont has one of the highest rates of skin cancer. The goal of this project was to develop a patient handout to bring patient awareness to skin cancer and describe the different types of skin biopsies (shave, punch and excisional), as well as Mohs surgery.
DASHing into a Healthier Life

Megan N. Eubank
Short-term Project
Almost half of all US adults have hypertension (high blood pressure), which is a major risk factor for heart disease and stroke. Hypertension can be controlled through a combination of diet, exercise, and medications. The DASH diet has been proven to lower blood pressure in as little as two weeks. I created a brochure and Epic SmartPhrase that explains and simplifies the DASH diet for patients.
Frequently asked questions by patients about exercise

Julie Evans
Short-term Project
A significant portion of patient visits at Milton Family Practice are related to one or multiple aspects of metabolic syndrome. Exercise is a common topic during these visits either brought up by patients or providers. This project focused on creating a handout for patient education with answers to commonly asked questions pertaining to exercise and resources in the community.
The Use of Technology for Mental Wellbeing in the Era of COVID-19

Adam Fakhri
Short-term Project
Prevalence of mental health issues has increased during the time of COVID-19. There are many contributing factors to consider, the main one reported has been social isolation due to quarantine precautions. Members of the community have spent extended periods of time at home and away from their loved ones during this pandemic. Many patients have reported many life events occurring including deaths in the family without the ability to even mourn with their family members. This has taken a toll on the community, especially in Vergennes where this small tight knit community that has relied on its tight social bonds for wellness. There has been a trend of depressive symptoms rising in the community as well as an increase in reported anxiety. There is a shortage of mental health services through therapists and psychiatrists during this time, and a possible solution is the use of technology, specifically phone apps to aid with mental health concerns for members of the community who are unable to meet with a specialist. This project consists of a handout containing 7 apps for mental wellbeing reviewed by the Anxiety and Depression Association of America (ADAA).
Helping schools support transgender and non-binary students

Nina Feinberg and Naomi Koliba
Short-term Project
According to the 2019 Youth Risk Behavior Survey, LGBT middle and high school students are twice as likely to be bullied and are five times more likely to attempt suicide.

Coping with a stressful environment at school puts LGBT youth at risk of detriment to mental health, educational inequities, and even physical harm.

Adults at school who have relationships with youth are in a position of power to uplift and advocate for LGBT youth, and to educate those around them to create a safe environment for everyone to learn.

While teachers and other staff may offer students support, they may be unable to answer healthcare related questions that gender questioning adolescents have.

A document was created integrating resources centered on LGBT+ youth in Chittenden County, in Vermont, and across the country.

The document contained a series of questions and answers that adolescents may have about gender and what a doctor’s appointment would include.

An online version of the document was given to Milton High School and Champlain Valley Union High School to distribute to all students via email.

Both interviewees agreed that Milton High School staff are well-versed in the basics of pronoun use, but could use more training to apply their knowledge to support students.

Both interviewees also agreed that additional staff-wide training has been challenging during the COVID-19 pandemic but would be beneficial in following years.
Learning Empowerment & Advocacy Together: A School-Based Youth Empowerment Program

Sheridan Finnie
Short-term Project
LEAT is a virtual skills building leadership group for female identifying high school age students grades 9-12. Program objectives are to empower youth to develop their sense of self esteem, identity and to develop leadership skills to be active leaders in their community. Due to the impact of COVID-19 on youth, opportunities to build community and engage in skill building activities are lacking and this group aims to fill that gap.
Waist Circumference as a Vital Sign

Brad R. Fiske
Short-term Project
Conversion of research protocol into QI project at Norwalk Community Health Center. Goal is to implement waist circumference as a vital sign.
How PrEPped Are Our Providers?: Assessing Vermont Primary Care Providers’ Knowledge and Awareness of Pre-Exposure Prophylaxis (PrEP) Options for HIV Prevention

Christopher Flynn
Short-term Project
In recent years, a number of pre-exposure prophylaxis (PrEP) medications and dosing strategies have become available to patients to help prevent human immunodeficiency virus (HIV) infection. The primary objective of this research was to assess current PrEP awareness and prescribing practices of family medicine providers at the Hinesburg Family Medicine practice in Hinesburg, VT.
Herbs and Natural Supplements for Treatment of Anxiety

Agatha Forstein
Short-term Project
In the primary care setting, patients frequently bring in a list of various supplements or herbs that they are taking for a variety of medical conditions, including anxiety, with the hope to engage in a conversation with their PCP about whether these various supplements are safe and worth the cost. Physicians are often limited by a lack of training on the topic and/or by time constraints in the clinic. Thus, this aspect of care is not well addressed. This project includes the creation of a patient education sheet containing information about common herbal/natural supplements used for anxiety. It highlights the current evidence for efficacy, adverse effects, and drug/medication interactions. By providing some basic information on natural anxiety treatments, this aspect of care that is important to patients may be better addressed.
Addressing COVID-19 Vaccine Hesitancy Part 2

Akua Frimpong
Short-term Project
This project is a continuation from the Addressing COVID-19 Vaccine Hesitancy project. As time has progressed since the Pfizer, Moderna, and Johnson & Johnson vaccine were first distributed in the United States, more individuals are getting vaccinated. However, there is still many individuals who are hesitant to get the COVID-19 vaccine. CDC has been addressing this by encouraging medical providers to educate their patients about COVID-19 and the COVID-19 vaccines. With the recall and resumption of Johnson and Johnson, engaging in conversations about the mRNA vaccine technology, efficacy, and safety of the vaccines may help reduce public hesitancy. An educational handout that was created by a prior medical student was distributed at the Brookfield Family Practice. A survey was created and distributed to the patients. The survey looked at patients’ demographics, if patients were vaccinated, and whether the handout provided guidance in understanding more about COVID-19 and the vaccines.
How to Have the “Vape Talk” with Adolescent Patients

Helen Gandler
Short-term Project
Recent years have shown a dramatic increase in the popularity of electronic vapor products, which include e-cigarettes, vapes, vape pens, e-cigars, e-hookahs, hookah pens, and mods. While emerging data shows that adolescents are becoming more aware of the dangers posed by these products, more than 3.6 million US youth still use e-cigarettes. As of February 18, 2020, a total of 2,807 hospitalized e-cigarette, or vaping, product use-associated lung injury (EVALI) cases or deaths in the United States have been reported to CDC.

This project had two goals: to create a tool to help facilitate discussions between providers and their adolescent patients around vaping, and to create an infographic that would simply and clearly provide adolescents with information about the dangers of vaping as well as resources to quit.
Addressing COVID-19 Vaccine Hesitancy

Aram S. Garewal
Short-term Project
COVID-19 vaccine hesitancy in the United States is a major roadblock in the fight against a raging pandemic. Education on mRNA vaccine technology, efficacy, and safety may help reduce public hesitancy. An educational handout was created and distributed at the Brookfield Family Practice to help alleviate COVID-19 vaccine hesitancy in the local community.
Supporting Patient Education on Bladder Cancer and Risk Factors Specific to Vermont

Evan Gaston
Short-term Project
Physician and patient education materials regarding the incidence of bladder cancer in Vermont, the absence of recommended screening, and discussion of risks of bladder cancer with emphasis on private well water testing through the Vermont Department of Health.
Safe Sleep for Newborns: An Addition to the Infant Care Guide

Charlotte B. Gemes
Short-term Project
Many parents at Community Health Center of Burlington have questions about infant care after their baby is born and do not know where to turn to find the answers, An Infant Care Guide is therefore being developed to help new parents on basic topics. The section "Safe Sleep for Newborns" was developed and added to already developed chapters to provide parents the basics on safe sleep.
Updating Evidence-Based Patient Education Resources for Sleep: Sleep Hygiene and Benzodiazepine Discontinuation

Carolyn Geraci and Madeline Fritz
Short-term Project
There is a major need for patient education around the topics of sleep hygiene and benzodiazepine sleep aid discontinuation in the family medicine clinic setting. Current patient-focused educational materials need updating and are not comprehensive enough. We therefore created new handouts and smartphrases which integrate into the electronic medical record system with the goal of educating patients on these topics.
Patient Education: Low-Carb Substitutes for Pre-diabetes Management

Keira L. Goodell
Short-term Project
At Milton Family Practice in Milton, VT, individuals diagnosed with pre-diabetes are referred to a clinical nutritionist and sent home with patient instructions about blood sugar and carbohydrates. For those who decline a meeting with the clinical nutritionist, the patient instructions are not an adequate substitute. This project focused on the creation of a SmartPhrase to be added to patient instructions outlining common high-carbohydrate foods and options for lower-carb alternatives.
The Design and Impact of a Rural Community Supported Doula Program

Kalin Jean Gregory-Davis
Short-term Project
The purpose of this study is to describe the design and impact of a rural community supported doula program. The Washington County Mental Health Doula Project is a unique collaboration between the Central Vermont Medical Center and Washington County Mental Health Services, whereby doula support services are offered for at risk patients during their pregnancy, through the birth process and the post partum period, and up to one year post delivery. Many more typical doula programs are of significant cost to the patient, making this support inaccessible to those that may need it the most. This program is unique in that not only are the doula services free for patients in need, but also the program is funded by a collaboration between a hospital and a community organization. What further sets this program apart is the case management background of the doulas and the significant logistical support offered to these clients who have a host of needs that go beyond just birth support. The WCMHS Doula Project has been a crucial element of women’s healthcare services in this rural community over the years, but no formal research has been conducted to evaluate the impact of the program. Through a qualitative analysis, this project seeks to give voice to the clients receiving the services in order to demonstrate the unique design and impact that such services have in the lives of patients facing numerous hardships during their pregnancy and early parenting period in rural Vermont.