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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Standardizing Asthma Management in Primary Care

Michael Vernon Chmielewski
Short-term Project
Asthma is a chronic, relapsing-remitting inflammatory airway disease that continues to increase in prevalence in the United States. When properly managed, patients with asthma experience less morbidity than those whose asthma is poorly controlled. Although the National Heart, Lung and Blood Institute (NHLBI) has published guidelines regarding the evidence-based diagnosis and management of asthma, many primary care practices do not fully utilize these best-practices. The purpose of this project was to develop a system of standardized protocols and a reference guide to promote adherence to evidence-based guidelines in asthma management for the Champlain Valley Physician’s Hospital Family Medicine residents and faculty.
Intimate Partner Violence: Improving Screening Rates in the Primary Care Setting

Alexandra E. Churchill
Short-term Project
The high prevalence of intimate partner violence (IPV) has led to recommended screening for all women of child-bearing age. Implementing validated screening tools within routine wellness visits at primary care offices facilitates awareness and patient support through identification and resource referral.
Implementing Easy-to-Read Advance Directives at the CMMC Family Residency

Elizabeth Congdon
Short-term Project
Advance directives have been shown to improve patient End-of-Life satisfaction, reduce surviving family depression and anxiety, and save money on end of life costs. Patients, especially low income patients and those on public health insurance, are often limited in their ability to complete Advance Directives due to low health literacy and complicated forms. This patient population is the bulk of the patient population seen at the Family Medicine Residency Clinic at Central Maine Medical Center. Residents at the Family Medicine Residency were educated on the PREPARE for your Care method of Easy-to-Read Advance Directives and online guidance for patients.
Improving Patient Educational Materials for a Suboxone Clinic in Southeastern Vermont

C. Wesley Cubberley
Short-term Project
Access to medical treatment for opioid use disorder plays a significant role in the ability of a community to support a person's recovery. In Springfield, VT, community workers and providers are attempting to organize a Suboxone (buprenorphine + naloxone) clinic in order to bridge the significant geographic and socioeconomic gaps implicit to this rural community's location. In order to garner interest and increase awareness of this forthcoming project, a short, accessible educational flyer was developed with the input of the health center's staff for future use.
Educating Parents on Newborn Health and Safety

Jenna Rose Dafgek
Short-term Project
More than 90% of unintentional injuries in children aged 5 years or younger occur in and around the home. Recommended infant care practices are below national target goals. Adherence to these recommendations increases when parents receive appropriate advice from multiple sources, including physicians. The goal of this project was to identify major newborn health and safety concerns. These concerns included car safety, safe sleep practices, and lead exposure. Educational handouts specific for age ranges spanning from first week of life to 1 year old were created for parents to address these issues.
Improving patient knowledge of antimicrobial resistance and appropriate antibiotic use in a Rutland county acute care center

Stephen D. Daniels
Short-term Project
Antimicrobial resistant infections are one of the most prevalent global health concerns of our time. It is paramount that action be taken to do all we can to reduce the burden that these “superbug” infections bring in the form of both serious illness and financial strain on healthcare systems. As healthcare professionals, the onus falls on us to educate the public on basic knowledge regarding bacterial/viral illness, as well as proper antibiotic utilization, so that we can all work in coercion with one another to combat this global health concern. The here-in project describes an educational piece with this goal in mind, and provides a projected financial advantage for a successful intervention.
Implementation of the Vermont Mini-Cog

Hillary E. Danis
Short-term Project
Cognitive impairment screening is important for early detection, diagnosis, and treatment of cognitive impairment and dementia. Additionally, screening is mandated as part of the Medicare Annual Wellness Visit. Colchester Family Medicine providers were surveyed about their current screening behaviors and then provided a training session on cognitive impairment screening and the Vermont Mini-Cog screening tool. Post-training, providers were surveyed about their likely future screening practices.
Development of a Desktop Reference for Medication Assisted Treatment (MAT)

Andrew L. Darling
Short-term Project
This project was to develop a physician desktop reference to assist with medication assisted treatment (MAT) for opioid use disorder. It was developed in conjunction with MAT team members and family medicine physicians to serve as a reference of both commonly needed medical information and local contact information for community resources.
Addressing Food Insecurity in the Clinical Setting

Annabelle Davey
Short-term Project
Food insecurity is defined as having inadequate resources to ensure that everyone in a household has enough food to be properly nourished, without disruptions. 12% of the population in Clinton County, NY is food insecure. The aim of this project was to identify barriers to clinicians addressing food insecurity, and to provide information for both patients and providers to improve utilization of food assistance resources among food-insecure patients.
What To Expect: Patient Education to Improve Follow-up for Well Child Visits in Rutland, VT

Christina A. Dawson
Short-term Project
Well-child visits (WCVs) are the cornerstone of pediatric preventative care. Attendance at these visits may prevent illness, reduce adverse side-effects associated with some conditions, and improve health behaviors. Despite this fact, many patients are still missing routine visits, particularly in lower income communities across the United States, like Rutland, VT. The goal of this project is to implement the creation of parent educational handouts distributed at routine visits at CHCRR Family Practice in Rutland, VT, to provide anticipatory guidance and improve attendance of pediatric well visits from birth to 5 years old.
Promoting LGBTQ+ Inclusivity in Sex Education

Alexis Dela Cruz
Short-term Project
LGBTQ youths report less satisfaction with their sex education curriculum than their heterosexual counterparts. The discrepancy between heterosexual sex education and that of LGBTQ is alarming. Currently, as it is reported within the Unites States, students feel as though LGBTQ sex education and resources are not readily available. A brief handout of LGBTQ inclusive practices was created for educators to reference when creating future lesson plans. The aim of this presentation was to create a more open and inclusive dialogue surrounding LGBTQ+ health.
Falling Through The Digital Cracks: An EHR-Focused Approach to Promote Social History and Mental Health in the Outpatient Setting

Daniel De Los Santos
Short-term Project
Although they may not call prevention centers, people considering suicide usually do seek help; for example, 64% of people who attempt suicide visit a doctor in the month before their attempt, and 38% in the week before. Given the recent suicide of a father in Newtown, CT whose daughter was killed in the Sandy Hook Massacre, it needs to be asked if his suicide could have been prevented by having his physician discuss his mental health with him at his most recent check-up. Of equal importance, it must be asked if there are flaws within the EHR platform that make it more difficult for physicians to access or document a recent major life event while reviewing a patient’s chart. This project's goal was to remind providers about a recent stressful life event for a patient by implementing a specific problem list entry on the EHR titled “History of Recent Stressful Life Event".
Increasing Advance directive utilization in Hardwick, VT

Maeve Lauren Donnelly
Short-term Project
This project was created to increase advance directive use at the Hardwick Area Health Center in Hardwick, VT. The project was aimed at creating awareness of the lack of advance directive use both to the providers and patients, so persuasive educational flyers were made to hang around the office. This project helped increase the attitude and awareness of the importance of advance directive planning.
Preparation as Prevention – Reducing Morbidity and Mortality in the Vermont Outdoors

Nathan T. Dreyfus
Short-term Project
While precipitants and outcomes of wilderness medical emergencies are numerous and diverse, wilderness rescues in Vermont are most often called for individuals or groups inadequately prepared for conditions or contingencies. In many cases, failure to bring one of a few key items such as equipment for navigation or illumination after dark can create a preventable emergency with subsequent requirement for rescue or retrieval.
Barriers to Implementation of Point-of-Care Ultrasound in Primary Care

Jack Dubuque
Short-term Project
Point-of-care ultrasound (POCUS) is a safe and rapidly evolving diagnostic tool that has changed the practice of many hospital based specialties and has been introduced into Family Medicine residencies over the last few years.

While the UVMMC Family Medicine residency has introduced POCUS into the curriculum, many practicing physicians have limited knowledge about the technology. This study aims to document the views and concerns of primary care providers about use and implementation of POCUS.
Increasing Bicycle Safety in South Burlington

Sam Epstein
Short-term Project
While there are many mixed use lanes in South Burlington, many people still do not use bicycle travel to get to work or the store. This occurs for many reasons, but one reason may be that people are not comfortable riding on roads. There is also a lack of bicycle friendly transportation between Burlington and South Burlington. This simple and easy to read handout provides tips on how to ride bicycles safely as well as a map of the existing bike and pedestrian friendly roads in SB.
Using design thinking to help practitioners and front desk staff schedule follow up appointments

Jhaimy Fernandez
Short-term Project
Due to an increase of calls at the front desk, Western Connecticut Health Network has systemized scheduling through call centers. In Newtown Family Medicine, clinical staff become responsible for helping patients navigate between two call centers in order to schedule appointments or schedule imaging. I used design thinking to create stickers that saved practitioners time explaining the process and decrease patient confusion.
Health Care Share: Fighting Food Insecurity with Local Farm Shares

Sarah French
Short-term Project
Food insecurity affects 10% of Vermont families annually, up to 15% of families with children. Contributing factors to this include lack of transportation, low wages, lack of affordable housing, unemployment, and limited access to nutritious produce. For children, this issue is even more pronounced during the summer months, without access to free or reduced-price meals at school. Health Care Share is a 14-week farm share distributed to families who have been identified to have food insecurity by their healthcare provider in Vermont. This project’s goal was to promote provider and patient awareness regarding the application process by implementing reminders for providers during the application window, as well as increasing ease of patient education via a dotphrase to provide the patients with additional information to take home with them.
Art Interventions for Seniors in New Milford, CT

Lauren Gaffaney
Short-term Project
There is a growing body of evidence that art therapy for seniors has been shown to improve sociability and mood, reduce the risk of dementia, decrease agitation, depression, isolation, and improve the overall quality of life. Recent research conducted in Burlington with the UVM LCOM Public Health Program suggested that art appreciation and history sessions can have similarly beneficial effects while requiring less volunteer/caregiver time, equipment, and with a lower cost. I surveyed the art interventions available in New Milford, CT and found there were limited active art classes available and no art appreciation sessions. I presented an art appreciation session at the New Milford Senior Center for seniors and staff, with the aim of teaching staff so they could continue the sessions once my clerkship was done.
Sleeping Mindfully

Jinal Gandhi
Short-term Project
Insomnia is a disorder of hyperarousal that affects up to 30% of adults. Insomnia is based on cognitive dysfunction that causes us to worry and neuroendocrine factors that upregulate our autonomic nervous system. Studies have shown that just 10 minutes of daily mindfulness practice can improve sleep. Mindfulness is able to work at the root of both causes of insomnia. It improves our ability to relax through increasing attentional factors that impart control over stress hormones and helps reduce ruminative thoughts.
Spirometry in Primary Care

Megan Garrido
Short-term Project
Prevalence of COPD in the United States is rising, yet many people with Chronic Obstructive Pulmonary Disease (COPD) diagnoses do not have diagnoses. In Vermont 18% of adults are current smokers and 27% are former smokers. The lack of provider and nurse training regarding indications, mechanism, interpretation and benefit of spirometry have limited it's use. Spirometry is recommended for both asthma & COPD diagnoses and management, and may provide better disease management.
Quality Improvement: Cervical Cancer Screening Rates within Hudson Headwaters Health Network

Dylon K. Gookin
Short-term Project
Nearly 8 out of every 100,000 people are diagnosed with cervical cancer each year. However, powerful screening tools exist that enable us to detect and manage cervical changes before they develop into cervical cancer. In spite of this, cervical cancer screening rates remain low for many providers. This public health project sought to identify and address a cause for low cervical cancer screening rates within the Hudson Headwaters Health Network. A literature review determined that education and mailed invitation letters were proven methods for improving cervical cancer screening rates. Following a review of the local population demographics, West Mountain Health Center within the Hudson Headwaters Health Network was targeted for a mailing campaign. The letter provided education about cervical cancer and an invitation for screening. This letter was mailed to 1075 eligible patients, with intent to compare the screening rates among patients who received this letter with screening rates among patients from previous years.
Social Stories to Facilitate Preparation for Healthcare Visits

Benjamin Grebber
Short-term Project
Promoting Medical Education at Cabot School

Dore E. Grier
Short-term Project
As a Cabot School alumni, I returned to Cabot School to talk to the students about opportunities in medicine. Cabot School is considered environmentally disadvantaged by the Agency of Education. By definition, "the individual comes from an environment that has inhibited him/her from obtaining the knowledge, skill and abilities required to enroll in and graduate from an undergraduate or graduate school." The percentage of students achieving proficiency in math and reading/language arts is lower than the Vermont state average for the 2016-17 school year. The goal of this project was to share my journey to medical school with the Cabot students and introduce them to careers in medicine.
Addressing Geriatric Falls in the Outpatient Setting: A Prevention Initiative

Brian W. Gross
Short-term Project
With approximately 25% of older aged 65 or greater falling each year, and 20% of these incidents resulting in serious injury, falls are of significant concern for both the geriatric community and the healthcare system at large. In 2017, Vermont ranked 41st in the nation with respect to the percent of older adults with self-reported falls in the past 12 months, according to the United Health Foundation’s “America’s Health Rankings" report. Many patients at risk for falling remain uneducated regarding environmental, pharmacological, and/or behavioral risk factors that may be contributing to their fall risk. In addition, providers often have limited time during office visits to counsel patients regarding strategies to combat these risk factors. The purpose of this work was to develop discharge instruction strategies for geriatric patients at Hinesburg Family Medicine to combat environmental (home hazards), behavioral, and pharmacological factors that may be increasing their risk for falls.