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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Educating Patients on Cannabidiol (CBD)

Catherine G. Pratt
Short-term Project
As the popularity of cannabidiol (CBD) increases, more patients are interested in trying a "natural" adjunct to more standard medications. But with no current FDA oversight, an estimated 70% of CBD products could be mislabeled. In Vermont, federal regulation requires hemp products to contain less than 0.3% THC, but this has only been tested one time at one location since the 2018 Farm Bill was passed. The goal of this project was to address common questions, recommend specific dosing, identify what to look for when purchasing, and list local and online resources for patients about CBD. An educational handout and a "smartphrase" were created to address these concerns.
Emergency Medical Services in Hinesburg, VT

William Tyler Prince
Short-term Project
Ambulance transport in Hinesburg, VT is currently provided by a service over 20 minutes away and will cease in June 2020. Town officials are currently trying to decide whether to expand local first response to include ambulance transport or to contract with Richmond Rescue, which is a well-established 911 transport service in a nearby town. Through literature/budget reviews and interviews with involved community members, it is apparent that although an independent Hinesburg EMS may have shorter response times, its volunteer corps is insufficient to sustain a transport service. Richmond Rescue can provide a higher level of medical care at a lower cost and should be contracted to provide ambulance transport.
Reducing Benzodiazepine Use for the Treatment of Insomnia and Supporting Nonpharmacological Therapies

UnChan Pyon
Short-term Project
Most medical organizations recommend against the use of benzodiazepine use for the treatment of insomnia, especially in the elderly. However, the percentage of the adult population on benzos increase with age: 7.5% in adults ages 51-64; 9% in adults over 65. Alternative therapies for insomnia, including online CBT, require more commitment than taking a medication so many patients opt for medication. This project aims to increase awareness of benzodiazepine use for insomnia and provide support for nonpharmacological therapies.
A Better Night’s Sleep: Improving Sleep Without Medication Through Behavioral Modification

Kyle Remy
Short-term Project
Approximately 40 million Americans experience insomnia each year, defined by the American Academy of Sleep Medicine as unsatisfactory sleep that impacts daytime functioning. Sleep quality and duration affect daily functioning, quality of life, and overall health. Poor sleep quality/duration, increasing usage of technology before bedtime, and a growing reliance on medications for sleep have contributed to a nationally-recognized public health issue; The American Academy of Sleep Medicine has estimated annual costs of insomnia to be around $63.2 billion in worker productivity. Sleep hygiene is recommend by the American Academy of Family Physicians as a first-line approach to improving sleep. Patient education helps patients learn about healthy habits they can acquire for better sleep.
Cyberbullying: A Resource for School-aged Children, Adolescents, and Parents in Milton, Vermont

James K. Rohwer
Short-term Project
Cyberbullying occurs when harmful words or actions by one or more persons are intentionally and repeatedly directed against another person in the digital world through text message, social media, e-mail, apps, online video games, forums, etc. Today, more children and adolescents are connected to the internet than ever before, which puts them at risk of becoming victims of cyberbullying. Many victims, as well as parents of victims, may not be familiar with the resources that are available to them in the areas in which they live when concerns of cyberbullying arise. Therefore, the goal of this project was to create a pamphlet with information about cyberbullying, including local resources for victims of cyberbullying, to be made available to children, adolescents, and parents in Milton, Vermont.
Transportation as a Barrier to Healthcare

Melissa Romero
Short-term Project
Lack of transportation is large barrier to medical care, particularly in rural areas. Many patients decline medical appointments because they do not have access to a personal vehicle or other transportation resources. Consequences include missed appointments and higher healthcare costs for patients and providers in the future. Solutions will involve educating patients on resources available to them, simplifying access to current programs, introduction of new programs, and the collaboration of public and private entities to provide new services.
Interventions for fall prevention in community-dwelling older persons

Gregory S. Roy
Short-term Project
Falls in individuals over the age of 65 is a pervasive problem resulting in significant health and economic burden in our country. Thus, effective fall prevention strategies are an important public health measure, especially in an age group that is growing rapidly. Research has shown a multifactorial approach to fall prevention addressing environmental hazards, strength and balance, medications, and medical comorbidities to be most effective. Despite there being strong evidence to support this, many individuals are unaware of the factors that put them at risk and ways to mitigate them. An educational pamphlet containing evidence-based strategies to reduce fall risk was produced for distribution within the New Milford primary care clinic in New Milford, CT.
Fostering Competent Healthcare for Transgender and Non-binary Patients

Alden York Sacco
Short-term Project
Many transgender and non-binary individuals are hesitant to seek medical due to past traumatic encounters with physicians and medical staff, having to educate providers about their bodies, perceived bias, and fear of mistreatment. This reluctance to seek medical care, and even to disclose their transgender status, can result in poorer health outcomes due to delays in diagnosis, treatment, and prevention. An in-office training was designed to introduce clinicians and office staff to health care disparities facing transgender and non-binary people, appropriate pronoun-use and key terminology, strategies for creating a welcoming and gender-affirming environment for trans and non-binary patients, and useful resources and guides that can be used in clinical settings.
Improving Awareness of Transportation Services in Lamoille County

Sienna Searles
Short-term Project
This project was aimed to identify and address transportation needs of patients in Lamoille County to their medical appointments. A handout was created, which lists all of the transportation resources in the county that are available to patients. This handout was hung up in patient rooms and in the waiting room at Stowe Family Practice. This intervention was met with support from patients and staff at the clinic.
To Juul or Not To Juul: What We Know About The Health Effects of Vaping

Chad Serels
Short-term Project
E-cigarette use, also known as Vaping, has garnered national attention over recent years due to its rapidly rising popularity. While some claim it is the healthier alternative to cigarette smoking we need to reduce the 480,000 deaths in the US from smoking-related diseases each year, others warn that its popularity among teens has the potential to undo years of progress combating nicotine addiction and is just another attempt by the tobacco industry to lure a new generation of customers. Given this ongoing public conversation, it is up to health care providers to stay informed on the health effects of vaping and to educate their patients appropriately. This project aimed to synthesize what we currently know about the effects of e-cigarette use for health care providers and to equip them with ways to minimize the harms, while maximizing any potential benefits, of vaping. This presentation demonstrates the effectiveness of that intervention.
Acute Respiratory Tract Infections and How to Treat Them

Shivani Seth
Short-term Project
Acute respiratory tract infections (ARTIs) are one of the most common clinical encounters in primary care settings and they often lead to antibiotic prescriptions. However, more than 90% of ARTIs are caused by viral syndromes. Evidence has showed that interventions addressed at antibiotic prescription practices for ARTIs are critical to combatting the widespread overuse of antibiotics and increase in antibiotic resistance infections in the US. Providers report pressure from patients to prescribe antibiotics even when they are not clinical indicated and patients have several misconceptions surrounding the clinical course of ARTIs that lead to this behavior. A brochure was developed to address the symptoms and duration of various types of ARTIs, the supportive treatment that can provide relief, and the dangers of antibiotic overuse and resistant infections. This brochure can be used in primary care settings to reduce pressure from patients to provide antibiotics by educating them on antibiotics are rarely indicated for ARTIs.
Screening for Developmental Delays During the Well-Child Visit

Ellen Walker Seyller
Short-term Project
Due to recent staffing transitions, family medicine physicians at Newtown Primary Care in Danbury, CT are now managing the care of an increasing number of pediatric patients. The goal of this project was to develop a screening tool to allow practitioners to assess for developmental delays during well-child visits. The tool includes 10-question surveys for ages 1mo, 2mo, 4mo, 6mo, 12mo, 15mo, 2yo, 3yo, or 4yo with a scoring guide and a list of some concerning signs at each stage.
Community-Based Exercise Education During Colder Months

Cole S. Shapiro
Short-term Project
Approximately 50% of US adults and 75% of US high school students don't meet recommended weekly physical activity guidelines, and physical activity declines further during colder seasons. Resources describing local suggestions for physical activity should be made broadly available to community members, such as at their primary health care office.
Food Label Made Easy

Hanaa Shihadeh
Short-term Project
The use of food labels and adherence to dietary recommendations are important, especially for those with chronic diseases due to the well known relation between chronic disease and poor nutritional habits. Although food labeling has been introduced since 1994 with the aim of combating obesity and diet-related chronic disease in the USA, the rates of food label use among US adults have decreased over the past decade.
A Provider's Guide to Medical Cannabis: THC and CBD. Putting the Evidence to Work for Improved Patient Care

Danielle Smith
Short-term Project
Please use abstract uploaded with previous powerpoint
Initiating healthcare agent education in time limited settings

Alan Su
Short-term Project
Most patients are willing to have advanced care planning (ACP) discussions with their medical team, even if they may be young and healthy. Yet, time constraints, perceived stigma of conversations surrounding death, and the educational requirement of documentation are known barriers for care providers to have these discussions. Identifying a health care agent (HCA) can be an important first step to continued ACP in the primary care setting. The purpose of this project is to propose a systemic approach to having HCA discussions in a time-efficient manner that can be easily implemented as part of a routine medical interview.
Social Media's Impact on Mental Health in Children & Adolescents

Georges Tahhan
Short-term Project
FACTORS INFLUENCING SUBOXONE RELAPSE: A SURVEY IN A NORTHWESTERN VERMONT RURAL PRIVATE FAMILY PRACTICE

Derek W. Tan
Short-term Project
The opioid crisis has warranted nationwide attention towards not only the current prescribing patterns of pain medications, but also towards rehabilitating affected members of the community. Current interventions include the use of Suboxone (buprenorphine + naloxone) as well as Subutex (buprenorphine). As the implementation of partial opioid antagonists increase on a statewide level, investigating factors such as drivers of substance relapse are worth considering to further improve adherence to currently available treatment regimens.
Education and expectations for patients with viral upper respiratory infections

Kathryn Thomas
Short-term Project
Non influenza viral upper respiratory illnesses are responsible for a significant percentage of sick visits to primary care physicians. Patients who expect antibiotics are more likely to be given them, and this contributes to growing antibiotic resistance. Setting appropriate expectations for the course of a typical upper respiratory infection can reduce repeat visits, and reduce the number of antibiotic prescriptions. Additionally, many over the counter cold and flu remedies do not have a significant impact on cold duration or symptoms. The flyer produced in the course of this project details the average time course for an upper respiratory infection, instructs on what symptoms do warrant a visit to the physician, and describes effective symptom treatments and proven preventative strategies.
When to Bring Your Child to the Emergency Room: a pamphlet for parents

Trina Thornburgh
Short-term Project
For decades, emergency departments (EDs) have struggled with overuse. Children who receive their primary care at a community health clinic or who are Medicaid-insured are twice as likely as private practice patients to seek care in the ED. Additionally, many New American families do not have a comprehensive understanding of the US healthcare system. A pamphlet was created as a health literacy intervention for parents to better understand when to call 911, visit the ED, or go to a primary care provider. The pamphlet is being translated into 8 languages commonly spoken by New American families in Chittenden County, VT.
Intermittent Fasting as an Early Intervention in Diabetes and Obesity

Nam Trinh
Short-term Project
Intermittent fasting has been a popular diet over the last decade. New research during the last 3 years have been promising and show that it can be an effective diet for patients with diabetes.
Patient Education on Sweetened Beverages: an Interactive and Module-based Approach

Matt Tsai
Short-term Project
As sugary beverages continue to contribute to negative health outcomes, there remains a need for efficient, effective patient education in this area. A custom, interactive and reflective web-based module on sugary beverages for adult participants (n=42) was introduced at a rural Vermont outpatient clinic. Built-in quizzes evaluated learning through a pre and post-intervention design. On average, participants improved significantly from a pre-module mean score of 3.00 to a post-module score of 4.33 (p<0.0001). Additionally, participants' average rating of the module's effectiveness was 8.3 out of 10. A module-based approach may be one efficacious solution to improve patient education on sugary beverage consumption.
Increasing the use of Probiotics concurrently with Acute Antibiotic Treatment: A Community Perspective in Newtown, CT

John Vandenberge
Short-term Project
Acute antibiotic courses are known to cause gastrointestinal side effects including nausea, bloating, and diarrhea. Patients at Newtown Primary Care in Newtown, CT being treated with antibiotics for upper and lower respiratory infection often present with these side effects. These symptoms may deter patients from taking the full course and promote bacterial resistance, delayed recovery, and increased patient healthcare costs. Safely tolerating antibiotic regimens is important especially in those at high risk for Clostridium difficile colitis. Probiotics have been shown to prevent antibiotic associated diarrhea and effectively balance bacterial species within the gut microbiome. An educational, easy-to-read handout was developed for Newtown patients starting an antibiotic to help maintain gut microflora via naturally fermented foods such as yogurt, kefir, kimchi, and sauerkraut.
Let's put the Kibosh on Cardiovascular Disease

David Viscido
Short-term Project
Heart disease is the #1 cause of death in the US. Coronary heart disease (CHD) is the most common form of heart disease. The age-adjusted rate of death due to heart disease is no longer on the decline, and Vermont is not meeting its statewide goals for reducing the death rate due to CHD. The purpose of this project was to reinforce decades-long efforts to educate Vermonters on the modifiable risk factors of heart disease. The hope is to remind people that, though heart disease isn't going away any time soon, we can each make healthy lifestyle changes to reduce our risk of heart disease.
Patient Guide to Access Quality Health Information Online

Danielle Wall
Short-term Project
A large percentage of patients use online search engines to access health information. However, there is a large amount of health information online that is unregulated and not evidence-based. As a result patients may acquire health information that is incorrect which may negatively affect patient-provider relationships and patient's healthcare. A brochure was created to highlight safe practices for accessing health information online.