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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Perceived Barriers and Trends in HPV Vaccination Among Young Men in Newtown, CT

Alexander D. Karabachev
Short-term Project
Human Papillomavirus (HPV) is the most prevalent sexually transmitted infection in the United States. Although the HPV vaccine has been proven to be effective and safe, the vaccination rates are significantly less compared to other vaccines. In males, HPV infection may lead to the development of numerous forms of cancer including oropharyngeal, anal and penile cancer, however, the HPV vaccination rate for males is significantly less than it is for females. This project aims to highlight various medical providers' opinions on the barriers to HPV vaccination for young men in Newtown, Connecticut, as well as, address methods for improvement including a brochure that was made and distributed to patients and medical providers in the clinic.
Common Childhood Illnesses: Improving Parent/Guardian Education

Mary Ann Kelly
Short-term Project
Providers at UVMMC-Milton Family Medicine have recognized that parent/guardian education around common childhood illnesses may be lacking. The goal of this project was to improve parent/guardian education surrounding common childhood illnesses by distributing educational information in the form of an Epic smart phrase to parents/guardians during both acute and well-child visits at the UVMMC-Milton Family Medicine clinic.
Meditation for Depression and Anxiety

Max Knapp
Short-term Project
Mental health is a major burden on residents of Vermont. Access to care is the most commonly cited cause. An evidence-based pamphlet was designed to empower providers to quickly and easily help patients start a meditation practice to help address such concerns.
Low Back Pain in Family Practice

Marc R. Kostrubiak
Short-term Project
Low Back Pain (LBP) is the worlds leading cause of disability and the second most common reason for visiting a physician in the US. LBP is the second only to heart disease in healthcare costs. In most cases a definitive cause is never found, however most cases are also self-limited. Patient education in this area is currently insufficient and many people expect to receive advanced imaging and treatments. Most of the time these are not indicated and may be harmful to patients. To address the gap in patient knowledge and improve health literacy a patient focused educational trifold pamphlet was created for use in the primary care setting. The pamphlet addresses common causes, evaluation and treatment of LBP and stresses the importance of physical therapy and physical activity to prevent recurrence.
What's in your Cup? Increasing Transparency and Confidence in Alcohol Use Screening and Brief Intervention

Dylan C. Koundakjian
Short-term Project
19% of Vermonters report drinking alcohol at levels which puts their health at risk, but many healthcare providers do not feel confident in addressing their patients' usage. This can stem from lack of experience with alcohol use, worries about stigma, and time constraints. However, data has shown that even 5-15 minute interventional conversations can significantly reduce a patient's risky drinking. This project aims to provide real-world, practical advice for having conversations around alcohol, and provides a conversion chart converting popular alcoholic beverages into standard drink equivalents.
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.
Treatment Referrals for Substance Use Disorders at BFA Fairfax (Vermont)

Adam Lacayo MPH
Short-term Project
Nearly 4 of every 100 adolescents age 12-17 in our region had a substance use disorder in 2017, yet only 39% of these individuals received treatment for misuse of alcohol or illicit drugs that year. In many schools, only those students who find themselves in legal or school disciplinary trouble for substance misuse, or who request help, receive treatment referrals. The need to establish contact with students struggling with substance use problems, but who have remained “below the radar,” remains largely unmet, particularly in BFA Fairfax (Vermont), where the Substance Abuse Professional (SAP) position was vacated in early 2019 when grant funding expired.
Caring for an Aging Loved One

meredith ann lackie
Short-term Project
Caregivers serve as a critical extension of US health care system. Approximately 80% of adults requiring long-term care currently live at home in the community, and unpaid family caregivers provide 90% of their care. Among caregivers, 81 % feel inadequately trained for the skills they perform and those who report the highest burden are more likely to be less educated, to live with the care recipient, and to perceive they had no choice in assuming the caregiver role. The goal of this project was to identify local resources available for caregivers and to understand the barriers to accessing these supports. An educational booklet was created to increase awareness of these resources, to address frequently asked questions from caregivers of elderly individuals, and to connect them with local organizations.
Enhancing Patient Access to Chronic Care Management in Brandon, VT

Olivia Grace Larkin
Short-term Project
Although providers at Community Health Brandon and other Community Health Centers of the Rutland Region (CHCRR) locations are enthusiastic about the Chronic Care Management program, with tight schedules and an increasing number of 15-minute visits, it can be difficult to discuss the program with every eligible patient and find time to formally refer patients. The patient questionnaire aims to examine the efficacy of a standardized screening modality in referring patients directly to Chronic Care Management.
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.
Increasing Healthcare Providers’ Awareness and Utilization of Vermont’s Universal Developmental Screening online Registry

Collin Love
Short-term Project
Caregiver Burnout

Elizabeth Anne Lynch
Short-term Project
Caring for someone with advanced health care needs, dementia, or a difficult diagnosis can take a mental, physical and financial toll on the caregiver. It is important for providers to recognize, address and assist caregivers in as many ways as possible. Providing physicians with a readily available patient-education template in Epic may improve outreach and communication with increasingly isolated patients and caregivers and improve care for all without burdening physicians more.
Family Medicine Resident Education on Perioperative Management of Patients on Anticoagulation

Hanna Mathers
Short-term Project
Family Medicine residents at CMMC in Lewiston, Maine manage patients in an outpatient clinic as well as on an inpatient family medicine teaching service. Many patients in the community are anticoagulated for native valve atrial fibrillation and undergo surgical procedures both in the inpatient and outpatient setting. Residents are often asked on to determine the necessity and timing of anticoagulation discontinuation for patients that they see. With patients on newer oral anticoagulants and various degrees of risk, it can be a challenge to make an informed choice. Residents have found that they would feel more confident in perioperative management of anticoagulated patients if they have a solid foundation in the principles guiding these decisions.
Retinopathy Screening: Assessing Knowledge & Educating Diabetic Patients in Caledonia County, Vermont

Ian J. McClain
Short-term Project
Diabetic retinopathy is the most common cause of severe vision loss in US adults. It is estimated that less than 50% of patients with diabetes consistently receive annual eye exams. Diabetic patients in rural communities may face additional barriers towards receiving recommended eye care as these communities generally have lower incomes, lower insurance rates and older populations. This project sought to educate diabetic patients about eye disease in a rural Vermont primary care practice using an active learning modality.
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.
Health Incentive: Reducing Waist Size while Expanding Wallet Size

Sean Meagher
Short-term Project
Over 10% of Adults and 18% of children are Food insecure in Franklin County and nearly a third of the population lives in households with incomes at or below 200% of the federal poverty level, an indicator which offers a glimpse of individuals who may lack resources to meet basic needs. The implications of food insecurity and access to healthy food are significant. Diets low in healthy foods, such as fruits and vegetables, contribute to the high rates of chronic diseases and impact mental health. The Health Incentive Program(HIP) of Massachusetts was created to increase access to fruits and vegetables by providing a 100% reimbursement for SNAP users at participating locations. However, the program is grossly underutilized, thus the aim of this project was to create an educational brochure to improve utilization of HIP and increase access to healthy foods.
Suicide Outreach in teenagers

Alexander Miller
Short-term Project
Suicide is the second leading cause of death in young people aged 15-19. Vermont has a higher suicide rate than average. My project was focused on making a pamphlet to provide teenagers information as well as foster a discussion of mental health. I also looked at the community perspective on the issue.
Oral Health Tips, Myths and Resources: A Guide to Lewiston Dental Care

Bridget Moore
Short-term Project
In a 2016 study, only 61.5% of Androscoggin County, Maine residents had visited a dentist in the past year. Barriers such as access and education limit residents' ability to obtain proper dental care. Most dental problems can be prevented through education on how to properly take care of one's teeth such as using a toothbrush twice a day. In order to increase patient education, a pamphlet was designed to explain proper dental hygiene and misunderstandings about dental health as well as provide resources for obtaining dental health in Lewiston, ME.
Real-time Flu Tracking at South End Community Health Center

Brian Muchmore and Jacob Shaw M.D.
Short-term Project
There is no real-time tracking of influenza or influenza vaccination in the United States. This project is to prototype and grow a real-time flu and flu vaccination tracking system for the state of the Vermont. This will help providers be more aware of the vaccination status of their patients and will allow for important real-time analysis of a burgeoning epidemic was it to occur.
Tobacco Cessation Support in New Milford, CT

Laura R. Nelson
Short-term Project
Smoking tobacco is one of the most significant risk factors for several deadly diseases; nevertheless, roughly 13% of Connecticut residents smoke cigarettes. Most people who smoke cigarettes realize that it is bad for their health, but many don't understand why it is unhealthy, or just how unhealthy it truly is. Furthermore, quitting smoking is often extraordinarily difficult, due to the addictive nature of nicotine, and the increasing content of nicotine inside cigarettes over time. This project created supportive and educational pamphlets about tobacco use and cessation, and proposes that primary care doctors can help their patients quit smoking by providing pamphlets to patients who are tobacco users.
Social Support Groups Focused on Substance Abuse and Addiction Available to Patients in Franklin County, Vermont

Michael Nilo
Short-term Project
Substance abuse/addiction, especially of opioids, is a major problem in Franklin County, where resources are not easily accessible to patients struggling/in recovery. Educating patients about the availability of peer support groups/recovery centers and clinics in the community may provide an attractive resource for patients who need additional help.
Disseminating Bipolar Disorder Guidelines

Vincent Nocera
Short-term Project
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.
Motivation to Prevent Chronic Disease or Complications

Ashton Hideki Pike
Short-term Project
Motivational interviewing has been used with relatively positive success in behavioral interventions as a way to stimulate change in patient's habits and attitudes, yet there is little information available as to how to design and implement a plan of action. This becomes even more difficult for a patient who might be resistant to large changes in their behavior and habits. One approach that has potential promise is the use of a SMART goal intervention in conjunction with motivational interviewing to change unhealthy habits while assessing the progression and degree of commitment to those goals.