Family Medicine Clerkship Student Projects

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  Narrative Medicine: Perspectives on Opioid Maintenance

  Noorin Damji

  Short-term Project

  People who experience opioid addiction often feel marginalized by healthcare workers, or stigmatized by the medical system. Additionally, there are not enough medical providers to meet the needs of people who struggle with opioid addiction. These factors create barriers that prevent the medical establishment from effectively meeting the needs of people who experience addiction. This project compiles rich perspectives of patients on opioid maintenance treatment to share with medical students and providers to foster greater empathy for these patients, and positive attitudes toward managing substance use disorder among future medical providers.

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  Creating a standardized workflow for providers at South Burlington Family Practice, South Burlington VT for documenting and diagnosing attention-deficit/hyperactivity disorder in pediatric patients aged 0-17

  Racquel Sales De Castro

  Short-term Project

  An initiative of the Vermont Child Health Improvement Program (VCHIP) is to improve the attention-deficit/hyperactivity disorder (ADD/ADHD) pediatric diagnostic process in both family medicine and pediatric practices in the state of Vermont. This project specifically on improving this process at South Burlington Family Practice in South Burlington Vermont but is generalizable to all practices caring for pediatric and adolescent patients. For this project emphasis was placed on creating a standardized workflow that is followed by all providers in the practice, creating educational material for caregivers who present with a behavioral concern for their child or adolescent, and establishing an efficient way to deliver screening tools to caregivers as well as teachers/guidance councilors in a fashion that will promote completion and return to the practice in a timely manner.

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  Educating Patients on Flu Shot Importance in the Covid-19 Era

  Nicole Delgado and Shayan McGee

  Short-term Project

  As fall approaches in 2020, it is even more important than previous years for patients to receive the influenza vaccine. The CDC believes that influenza and Covid-19 will both be spreading in the fall and winter of 2020. For this project, educational pages were designed for display in patient exam rooms at Milton Family Practice in Milton, Vermont. Information included the symptom overlap of Covid-19 and influenza, the distinct features of Covid-19, an epidemiological comparison of 2019 influenza statistics vs. Covid-19 statistics, and an emphasis on the importance of getting a flu shot to prevent a dangerous co-infection with both viruses.

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  Addressing Exercise Accessibility in Winter Conditions in Milton, Vermont

  Liam du Preez

  Short-term Project

  Exercise is a critical aspect of health maintenance, especially in the context of chronic medical problems such as diabetes, heart disease, and obesity. Weather and climate conditions in Vermont directly impact Vermonters' ability to exercise, and this results in negative impacts in their health maintenance and healthcare costs nationally and locally. This project explores the direct and indirect impact of decreased exercise and explore a modality for informing patients on how to stay active safely in the winter.

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  Addressing Common Concerns About HPV Vaccination

  Gia R. Eapen

  Short-term Project

  The HPV vaccine is the only vaccine that can prevent the formation of cancer, and yet it is sometimes refused by parents due to misconceptions and misinformation. This project addresses some of the common barriers to HPV vaccination and provides information about why the HPV vaccination is an essential part of adolescent preventative medicine.

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  Improving HPV Vaccination Rates

  Emily Eichner

  Short-term Project

  HPV is a very common infection and can cause multiple types of cancers. The HPV vaccination is effective at preventing these infections and subsequent cancers. The HPV vaccine is most effective when given to adolescents; however, the vaccination rates for girls and especially boys remain low. Many reasons exist for parent's choice not to have their kids' vaccinated against HPV. Identifying and addressing these barriers through educational materials for parents will hopefully help improve HPV vaccination rates and reduce rates of these preventable cancers.

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  Hepatitis C Education and Screening in a Rural Northern Vermont MAT Clinic

  Jack Fitzsimons

  Short-term Project

  Increases in hepatitis C infection rates have mirrored increases in opioid use disorder. This project attempted to determine screening rates of HCV in a medication assisted treatment clinic for opioid use disorder. Additionally it attempted to provide education to patients that had not been screened for HCV.

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  Easily Digestible: Addressing Food Literacy with Short Educational Videos

  Kalle J. Fjeld

  Short-term Project

  Food literacy is the knowledge and skills needed to select and prepare food as well as determine food intake. These skills are necessary for a healthy diet, which is a major contributing factor to chronic disease prevention and management. People with diseases such as diabetes and cardiovascular disease can have great benefit from improving diet quality through increasing at-home food preparation and consumption of fruits and vegetables. In partnership with a Food Farmacy pilot program at Hudson Headwaters Health Network in Glens Falls, NY this project sought to use web-based food literacy education for a population of 40 patients with diabetes. Short, simple videos on basic fruit and vegetable preparation were created and published on YouTube. Follow-up interviews with patients were conducted to assess the reach and efficacy of this intervention.

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  Raising Awareness About the Vermont Donor Milk Center

  Rosie Friedman and Emi Eakin

  Short-term Project

  The Vermont Donor Milk Center (VDMC) is an emerging community resource that provides donated, pasteurized breast milk to new parents for their infants. Upon questioning, we identified that many providers did not know about the VDMC or how to prescribe milk. In addition, VDMC expressed that they have not been able to complete the community outreach they had initially hoped for. We chose to dedicate our project to disseminating information about VDMC to perinatal care providers in Vermont.

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  Hepatitis A Vaccination in Adults

  Francesca Garofalo

  Short-term Project
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  Promoting Healthy and Active lifestyles with Home Exercises in South Burlington, VT

  Jonathan Gau

  Short-term Project

  The barriers to exercise that patients face are often multi-factorial. Whether its due to weather, financial costs, lack of time, or if the individual simply isn't a gym person, we see a number of patients everyday who are not regularly exercising. This brochure is meant to provide patients during office visits with a tangible source of information that provides examples of in-home exercises, categorized by difficulty, that they can perform without any additional equipment.

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  Blood Pressure Management Education

  Lauren G. Gernon and Cara Rathmell

  Short-term Project

  The expansion of telehealth with COVID-19 and recent recommendations to use at-home blood pressure monitoring to diagnose and monitor hypertension have increased the need for materials and education for clinicians and patients. A pilot project in Primary Care Internal Medicine UVM in Essex, VT, produced an electronic medical record dot phrase and compiled educational materials to initiate nurse visits for at-home BP measurements. Materials and experience with this pilot was researched for initiation of a similar program at UVM Family Medicine Hinesburg.

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  Harm Reduction in the Emergency Department

  Alexa J. Golden

  Short-term Project

  The number of overdose deaths in Vermont has been trending up over the past several years. A majority of these fatalities involved synthetic opioid fentanyl. The Emergency Department (ED) at Central Vermont Medical Center delivers medication assisted treatment (MAT) through the Rapid Access to MAT (RAM) program. This program has connected many people in the region to treatment for opiate use disorder. However it was identified that we lacked connection to harm reduction services for those not interested in MAT. Harm reduction education was provided for recovery coaches and ED nursing staff. Harm reduction kits containing life-saving supplies such as naloxone and fentanyl test strips, safer use information, and local harm reduction services were developed for distribution through the ED.

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  Assessing the Need and Desire for Nutritional Education

  Marc Robert Hammond

  Short-term Project

  Many people suffer from health conditions that may be affected directly by diet and nutrition including diabetes, hypertension, hyperlipidemia, iron deficiency anemia, obesity, coronary artery disease, and cerebrovascular disease. Education of providers and patients alike may help decrease the prevalence of these health issues and their sequalae. The St. Albans Community has slightly poorer health and nutrition when compared to the entire state of Vermont. Patients in an outpatient primary care clinic in St. Albans, VT were provided with a survey that would assess:

  The patient’s confidence in their nutritional skills and knowledge

  Their willingness to go to a nutrition appointment Their preference in who would provide the nutritional education to them Results from the survey were used to attempt to understand some of the driving forces for poor nutrition.

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  Integrating Oral Health in Primary Care to Reduce Early Childhood Caries (ECC): Evidence-Based Guidelines and Recommendations

  Alyssa Heiser

  Short-term Project

  Early childhood caries (ECC) is the most common chronic disease affecting children, despite being almost 100% preventable. ECC has become associated with a multi-factorial etiology including poor feeding practices, enamel hypoplasia, oral colonization by cariogenic bacteria, and demineralized tooth structure due to metabolism of sugars by tooth-adherent bacteria. ECC can lead to school absences, poor school performance, difficulty sleeping, attention problems, slower social development, and poor overall health. According to U.S. Preventative Services Task Force (USPSTF) guidelines, all children are at potential risk for developing ECC beginning at the time of first tooth eruption. While there are no validated multivariate screening tools to determine which children are at higher risk for ECC, there are a number of individual factors that elevate risk, including lack of preventative oral health care and screening before the age of 3 years old. The American Academy of Pediatrics (AAP) recommends fluoride varnish in the primary care setting every 3-6 months starting at tooth emergence. Thus, primary care providers can play a major role in screening for and preventing ECC by initiating fluoride varnish and providing parents and/or caregivers with information on proper oral hygiene for their children at routine well-child visits.

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  Identifying Barriers to Sunscreen Use and Sun Safety Education

  Seneca Hutson

  Short-term Project
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  Using your phone as a weight-loss tool

  Sidika Kajtezovic

  Short-term Project

  Over one-third of the population in the United States is obese. Obesity is a risk factor for many chronic diseases, such as type 2 diabetes, cancer, hypertension, asthma, myocardial infarction, stroke, osteoarthritis and other psychological disturbances. Patient often find it challenging to make dietary changes in order to lose weight. This project focused on the use of a smart phone application to track daily caloric and nutritional intake, as well as exercise, to help patients lose weight.

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  Type 2 Diabetes Medication Breakdown

  Kristen Keene

  Short-term Project

  There are many new medications for treatment of type 2 diabetes and these medications have many positive effects that go beyond lowering blood glucose. However, many of these medications are expensive and some insurance plans don’t cover them. Many patients struggle to pay for their diabetes medications and providers often are unsure of which medications will be covered by insurance. This project was designed to enhance patient education regarding diabetes medications and potential costs associated.

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  Type 2 Diabetes Medication Breakdown

  Kristen Keene

  Short-term Project

  There are many new medications for treatment of type 2 diabetes and these medications have many positive effects that go beyond lowering blood glucose. However, many of these medications are expensive and some insurance plans don’t cover them. Many patients struggle to pay for their diabetes medications and providers often are unsure of which medications will be covered by insurance. This project was designed to enhance patient education regarding diabetes medications and potential costs associated.

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  Utilization of Student Community Health Projects in an Outpatient Primary Care Office

  Diane Kim

  Short-term Project

  Clinical sites for family medicine clerkship have accumulated several years of student community health projects, many of which are written patient education materials. Anonymous surveys elicited the perspectives of medical professionals and faculty on the utilization of these projects in their medical practice. Medical professionals thought the community health projects were valuable educational experiences but cited lack of time as a barrier to utilization in patient care.

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  A Health Resource List for transgender patients in Vermont

  Kathryn Kurchena

  Short-term Project

  Transgender folks encounter barriers to accessing healthcare for a multitude of reasons. Recent surveys have found that 28% of the transgender people delayed care due to past discrimination within healthcare. In an effort to improve upon this issue in the Burlington area, a list of affirming and effective healthcare resources, services, and providers was created to be distributed at the Community Health Centers of Burlington.

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  Attitudes Towards Telehealth at the South Burlington Family Practice

  Alexandra Elizabeth Kuzma

  Short-term Project

  In this project, we explore the attitudes of the patient population of South Burlington Family Practice concerning telehealth. To assess the attitudes towards telehealth in the South Burlington Family Medicine Practice patient population, we distributed a brief anonymous survey following telehealth appointments to patients. I focused my intervention on what patients mentioned the most for concerns about a telehealth visit- lack of a physical exam. I made an infographic addressing how to do a thorough physical exam over telehealth to educate providers and ultimately improve patient satisfaction.

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  Telemedicine in Rural NY: What Comes After COVID-19

  Sylvia Lane

  Short-term Project

  Despite ever increasing access to technology, prior to the COVID-19 2020 pandemic, telehealth has had a slow uptake. This pandemic has shown that telehealth can break boundaries and provide access to healthcare in non-traditional ways. In the rural community of Clinton County, NY, there are higher than average rates of ED visits, obesity, and chronic preventable illnesses. Despite greater than average insurance coverage, this population is not accessing preventative healthcare. Though telehealth appears to be a cure to these issues, the ever-evolving system has found many barriers that were not previously considered. 1 in 5 of these patients does not have access to broadband internet and a large majority cannot afford smart devices. This project aimed to collect telemedicine initiatives that creatively address these barriers and allow for use of technology to improve healthcare for all patients of this community. A comparison of different initiatives in the fields of transitional care, pediatrics, mental health services, and high risk chronic care was created for the health care administrators of the CVPH Family Medicine Clinic.

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  Genitourinary Effects of Smoking in Men: An Alternative Approach to Smoking Cessation Through Patient Education

  Michael J. Lawrence

  Short-term Project

  Smoking remains a prominent problem in Vermont, especially outside Chittenden County. The genitourinary effects of smoking tend to be poorly appreciated among patients. This presents an opportunity for further patient education and incentivization to quit. This project focused on the genitourinary effects of smoking in men, specifically highlighting how smoking increases risk of bladder cancer, poorer outcomes in prostate cancer, and a higher risk of erectile dysfunction. The project culminated in creation of an educational poster intended for display in patient bathrooms in a medical setting.

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  Vaping: What Are the Risks?

  Matthew Eric Lebow

  Short-term Project

  In recent years there has been a precipitous rise in the number of individuals using e-cigarettes or vaping devices. According to the Vermont Department of Health, in 2016, there were 22,000 adults who used e-cigarettes. However, even more, concerning was that there were approximately 3,000 high school Vermonters who used electronic vaping products. The dangers around vaping products are multifactorial, including the lack of perception of harm by youth, the risk of nicotine addiction, ease of access, and the potential harms including chemicals, contaminants, and metals.

  Even more concerning has been the rise of E-Cigarette and Vaping Produce Use- Associated Lung Injury Outbreak (EVALI). To date, there have been nearly 2,700 hospitalized cases of EVALI, including 34 in Vermont. While there are several hypotheses for what causes EVALI, what is known is that most cases involved vaping products with THC, particularly from informal sources.

  The goal of this project was to set the foundation for information dissemination regarding vaping in Vermont and the risk factors for EVALI.