Family Medicine Clerkship Student Projects

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  The Primary Care shortage in Vermont and Medical Student Interest in Primary Care

  Kenneth Michael Palanza

  Short-term Project

  The state of Vermont is currently faced with a primary care workforce shortage. There are currently not enough primary care physicians to meet Vermont's needs and the problem is expected to get worse. The primary care physician workforce is aging, there is an inability to recruit primary care providers to Vermont, and there is stagnant interest of medical students in fundamental primary care fields such as family medicine. The aim of this project is to examine the barriers medical students identify that decreases their interest in pursuing a career in primary care, specifically family medicine, and how systematic changes can be implemented to lead to increased interest in the field and future practice in Vermont.

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  The Primary Care shortage in Vermont and Medical Student Interest in Primary Care

  Kenneth Michael Palanza

  Short-term Project

  The state of Vermont is currently faced with a primary care workforce shortage. There are currently not enough primary care physicians to meet the states needs and the problem is expected to get worse. The primary care physician workforce is aging, there is an inability to recruit primary care providers to Vermont, and there is stagnant interest of medical students in fundamental primary care fields such as family medicine. The aim of this project is to examine the barriers medical students identify that decreases their interest in pursuing a career in primary care, specifically family medicine, and how systematic changes can be implemented to lead to increased interest in the field and future practice in Vermont.

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  Healthcare Provider Awareness of Food Insecurity Resources in Berlin, VT

  Melanie P. Parziale

  Short-term Project
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  Migrant Farm Workers Flu Clinic

  Alice Peng

  Short-term Project

  Vermont's dairy industry relies heavily on migrant workers. These migrant farmworkers are mostly Latino and undocumented thus ineligible for health insurance. The Open Door Clinic in collaboration with UVM Extension Bridges to Health and Colchester Family Practice provided free satellite flu clinics to Northern Vermont Latino dairy farmworkers. This project served 12 dairy farms and vaccinated 48 farmworkers.

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  A Motivational Interviewing Approach Toward Mask Wearing in Franklin County, Vermont

  Ashleigh N. Peterson

  Short-term Project

  COVID-19 has caused significant morbidity and mortality in Vermont and worldwide since the start of the pandemic. Wearing cloth face masks has been proven to limit viral spread, but few studies have quantified how many people are wearing masks or what their reasons are for doing so. This study aimed to assess and encourage mask use in Franklin County, Vermont by piloting an in-office motivational interviewing intervention at a primary care office.

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  Physical Activity Level in School-aged Children during COVID-19

  Tran Phuong

  Short-term Project

  Due to COVID-19 restrictions, school-aged kids are not engaging in normal physical activities per usual, such as physical education class and team sports. This paper addresses the health concerns and community perspectives of decreased physical activity in pre teens and teens during this pandemic. Further, it provides recommendations to stay active for 60 minutes a day of moderate to vigorous exercise.

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  Increasing Oral Health Care for the Elderly in Plattsburgh, NY

  Megan E. Prue

  Short-term Project

  Poor oral hygiene can have many adverse systemic effects in the elderly, including aspiration pneumonia. This project explored ways to increase dental care in the elderly, with the aim of decreasing rates of pneumonia along the way.

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  Improving Community Understanding of Lyme Disease Prevention and Treatment in the Age of Misinformation in Digital Media

  Olivia E. Quatela and Samuel Raszka

  Short-term Project

  Approximately 30,000 cases of Lyme disease are reported to the CDC annually, but the CDC estimates that 300,000 individuals in the US become infected. The average cost of Lyme disease is $3,000 per patient over the course of the disease costing the US healthcare system approximately $1 billion per year ($712m – $1.3b). An additional $1 billion is spent annually on treating post-treatment Lyme disease syndrome. Despite the prevalence of Lyme disease and the availability of credible patient education materials, misconceptions and knowledge gaps are still evident among community members, media sources, and some providers. There is a need for continued community education and recommendations for evidence-based treatment for this disease.

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  Coping Skills for Daily Life: Cost-Effective Strategies to Prevent and Address Mental Health Disorders

  Shae Ian Rowlandson

  Short-term Project

  Mental health disorders, along with their associated cost and negative outcomes, have continued to persist in Vermont and have become one of the largest, growing challenges to public health in the United States. Unfortunately, Vermont does not appear to have enough resources or providers to optimally address it. Concurrently, coping strategies of minimal cost that have the potential to prevent or address mental health disorders may often be underutilized or misconstrued by the population. A pamphlet providing information on evidenced, cost-effective coping strategies was designed and distributed to providers and patients to enable patients with the skills to help themselves and adapt to their mental health needs, independently.

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  Adverse Childhood Experiences: Raising Awareness & Creating Easier Access to Resources

  Christina Sanchez-Grew

  Short-term Project

  Adverse Childhood Experiences (ACEs) such as abuse, neglect, and witnessing household dysfunction are common throughout the United States and are occurring in our own communities. ACEs impose immediate health risks to children but also are associated with poor health outcomes in adulthood including higher rates of cancer, heart disease, chronic lung disease, obesity, depression and substance use. The goal of this project was to contribute to prevention strategies for ACEs. This was accomplished by using flyers to raise awareness and educate the community on the prevalence and outcomes of ACEs, and by using QR codes to make parenting resources easily accessible.

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  Improving Hepatitis C Screening in Vulnerable Populations

  Connor Scagnelli

  Short-term Project

  A one-time HCV test has been recommended for all individuals in the Baby Boomer generation. National data shows an increase in HCV rates among younger generations, especially those with substance use disorder. In this quality improvement project, HCV screening rates were collected and analyzed from Hudson Headwaters Health Network (HHHN) and The Ryan White Program in Glens Falls, NY. A survey was disseminated to all HHHN providers to assess current screening practices and to identify barriers to screening and strategies to increase screening. From this analysis, it was determined that HHHN would benefit from and be able to increase screening rates in at risk populations by adopting a universal HCV screening policy. Weeks after this presentation was delivered, the AMA announced it was supporting the USPSTF's draft recommendation for universal HCV screening in all adults over the age of 18, in accordance with this projects conclusion.

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  Safe Disposal of Unused Pharmaceuticals in Vermont

  Sarah E. Sherman

  Short-term Project

  This community project aimed to research local infrastructure for the safe disposal of unused pharmaceuticals and provide a user friendly summary to be made available to patients. In doing so, the long term goal was to increase participation in drug disposal programs to improve the health of the community by decreasing drug diversion, use of expired medications, and improper disposal resulting in environmental accumulation.

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  The Green House Project: Accessible, Empowering and Sustainable Communities for the Elderly

  Jessica Sikka

  Short-term Project

  Many members of our geriatric community face challenges in attending appointments with their healthcare providers. The many barriers to healthcare that these patients face can range from financial to physical ones. Home health visits have become an invaluable resource for these patients. However, home healthcare is an expensive resource that many patients cannot afford. The Green House Project aims to empower elders and patients with barriers to healthcare, who thrive in the home health setting, by building communities where patients are treated with equality and mutual respect regardless of economic status.

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  Transportation is a barrier to accessing primary care in Vermont

  Max L. Silverstein

  Short-term Project

  Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. Rural patients are especially vulnerable to transportation barriers; in Chittenden County specifically, older adults surveyed reported difficulty with transportation, with 69% delaying medical appointments due to transportation barriers. Based on data collected in this study, even among patients at South Burlington Family Medicine, distance from the office is correlated with declining important medical appointments.

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  Transportation is a barrier to accessing primary care in Vermont

  Max L. Silverstein

  Short-term Project

  Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. Rural patients are especially vulnerable to transportation barriers: In Chittenden County specifically, older adults surveyed reported difficulty with transportation, with 69% delaying medical appointments due to transportation barriers. Based on the data collected in this study, even among patients at South Burlington Family Medicine, distance from the office is correlated with declining important medical appointments.

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  Transition of Care for Newly Homed Individuals

  Kayla Sturtevant

  Short-term Project

  Homeless individuals often do not receive the appropriate level of health care to manage multiple otherwise controllable medical conditions. Continuity of care is often a challenge. Individuals may temporarily establish care with a provider but become lost to follow up when they move away or establish permanent housing. They can become lost to follow up for other reasons as well, including relapse, an inflexible work schedule, mental illness and many others.

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  Reducing No Show Rate In the Primary Care Setting

  Heng Tan

  Short-term Project

  Healthcare systems consumed 17.7 % of the U.S. GDP. Efficiently using clinical resources is critical. No-show appointments decrease the provider’s productivity, increases healthcare costs, and limits the health clinic’s effective capacity. Address patients with history of no show with targeted questionnaire and provide corresponding support can not only decrease the rate and improve the efficiency of health care but also decrease unnecessary emergency and urgent care visits

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  Barriers to Exercise: Patients with Diabetes in Washington County

  Joshua Bruce Taylor

  Short-term Project

  According to the Vermont Department of Health physical inactivity is one of the three main behaviors that predisposes patients to cancer, heart disease/stroke, lung disease, and type 2 diabetes, which result in over 50 percent of deaths among Vermonters. Washington County has a higher rate of overweight adults than the statewide average, making exercise an important component to healthier living. Barriers to exercise, especially among patients with diabetes, impose serious health ramifications for the residents of Washington County, and avenues must be made available to circumvent these barriers.

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  Managing Chronic Low Back Pain

  Joseph Michael Teague Mr.

  Short-term Project

  Chronic Low Back Pain remains a leading reason for ambulatory care visits, a leading primary diagnosis for ambulatory care visits, a leading cause of global burden, and the leading cause of lost workdays in the US. US Health expenditures for adults with chronic low back pain total over 102 billion. Chronic low back pain increases the risk of unemployment, poverty, obesity, smoking, and depression. Physical therapy (PT) and cognitive behavioral therapy (CBT) have been proven to reduce chronic low back pain intensity and duration, improve function, reduce healthcare utilization and cost, and reduce sick time. This project investigated community resources to promote patient education and participation in PT and CBT, with an emphasis on low cost at home options.

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  PPI Deprescribing Practices for GERD in Primary Care Offices In Western CT

  Angela Troia

  Short-term Project

  Proton pump inhibitors (PPIs) are considered the mainstay of medical therapy for gastroesophageal reflux disease (GERD). PPIs have become widely accessible to patients as many of them are currently available over the counter and require no prescription. While PPIs are highly effective at reducing stomach acid, they are not without risks. Short term uses of PPIs are generally well tolerated and involve little risk; however, chronic use of PPIs is associated with significant side effects including diarrhea, impaired B12 absorption, hypomagnesemia, clostridium difficile infection, hip fractures and pneumonia. Currently, the American Academy of Family Physician recommends that PPIs be used only when there is an appropriate diagnosis, at the lowest effective dose and shortest duration of therapy, with a typical regimen lasting 2-12 weeks. Yet even with these guidelines patients are often kept on PPIs for months or years without adequate diagnostic reason. To promote improved PPI management a better understanding of deprescribing and tapering practices amongst primary care physicians must be rendered. The aim of this project is to determine the barriers that prevent PPI deprescribing in cases of GERD.

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  Addressing Barriers to Physical Activity in Vermont's Geriatric Population

  Stephanie Udawatta

  Short-term Project

  A wide array of barriers exist which prevent many geriatric patients from engaging in regular physical activity. This project addresses the barriers unique to Vermont's population of geriatric patients and explores potential solutions.

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  Resource to address pandemic-related anxiety and depression for pregnant patients in Vermont

  Mohammed Wali

  Short-term Project

  The 2019 novel coronavirus (COVID-19) has led to patient deaths, strained health care systems, and economic uncertainty. Distress during pregnancy can lead to adverse outcomes for both parent and baby. A patient-friendly handout was created for pregnant patients to offer reassurance, incorporate mind-body recommendations to address stress, and offer screening tools to empower them to address mood concerns with their obstetric providers in the COVID-era.

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  Implementing an Educational Resource on Cannabidiol (CBD) for Patients in Western Connecticut

  Michael H. Weber

  Short-term Project

  An educational handout on cannabidiol (CBD) was created and implemented into a family medicine practice in Western Connecticut. The handout described the basics of CBD including production, legality status in Connecticut, efficacy in treating certain conditions, and consumer considerations when purchasing CBD.

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  Pilot study: healthcare cannabis assessment

  Nicole Wershoven

  Short-term Project

  Due to state legalization and increased access to cannabis, there is increasing use of cannabis in Vermont and nationwide. Cannabis is used medically for certain qualifying conditions in Vermont in addition to recreationally. In a recent study they found 45% of adult primary care patients in Vermont had used cannabis in the last year and only 18% of patients reported their clinician as being a good source of information regarding cannabis. Educating clinicians about cannabis is critical for quality comprehensive patient care. The objective of this project was the development of a short survey to deploy to primary care clinicians throughout the state to get a baseline assessment of their medical understanding of cannabis, in order to create specific learning opportunities to expand their knowledge of medicinal cannabis.

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  The "Best Snacks EVER" Series

  Catherine M. Westbom

  Short-term Project

  Vermont rates of obesity jump from 15.1% 10-17 year-old children to 27.5% in adults. In addition, studies show that keeping weight off is incredibly difficult with low success rates. Of the many factors that contribute to obesity, nutrition is among those that can be altered with great results. Taken in combination, this information speaks to the great change that can be made in targeting healthy eating habits in the youth population prior to the jump in obesity rates. This project aims to provide education to the child population in Montpelier, Vermont through the local Step 2 after-school program. A class series was started to provide nutrition education through reading, craft projects, and healthy snacks for a fun-filled and educational experience in hopes of encouraging healthy habits at a young age.