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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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
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.
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.
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.
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.
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.
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.
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.
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.
Community Lyme Disease Education

Tim Woodin
Short-term Project
Lyme disease education is lacking in the primary care setting. Proper patient education lowers healthcare costs, and helps clear confusion surrounding this disease.
Barriers to Smoking Cessation in Patients Enrolled in Suboxone Treatment Programs

Thomas L. Arnell
Short-term Project
Cigarette smoking is the leading cause of preventable death and disease in the United States, accounting for more than 480,000 deaths every year. The prevalence of tobacco use among substance abuse treatment program enrollees is substantially higher than that of the general population, with recent estimates ranging between 75-97%. The aim of this project was to identify specific barriers to smoking cessation in patients enrolled in suboxone treatment programs in Franklin County, VT. The most commonly cited barriers among survey responders were related to fear of the effects of tobacco withdrawl, while the most important barrier was related to fear of increased desire to use drugs following smoking cessation.
Ensuring Adequate Recognition and Care for Lyme Disease

Menna Awadalla
Short-term Project
Lyme disease is a common issue in the Northeast United States, particularly in New Milford, Connecticut. Lyme is a readily treatable condition generally requiring a simple 2-3 week course of antibiotics. However, if patients cannot identify their symptoms and thus, do not come in for treatment, then that puts them at risk for developing chronic Lyme disease and fatal sequelae as a result. This project focuses on informing the local public about this issue by providing essential information regarding signs/symptoms, treatment, prophylaxis, and complications of Lyme disease.
The Truth About Vaccines

Ramin Badiyan
Short-term Project
Shedding light on childhood vaccinations
An exploration of the benefits and challenges associated with introducing point-of-care ultrasound to a rural primary care setting

Daniel Bak
Short-term Project
Castleton Family Health Center serves the western portion of Rutland County, which is designated as both rural and medically underserved. The regional Community Health Needs Assessment set goals to increase primary care visits, decrease inappropriate utilization of the emergency department, and work towards seamless care transitions without loss of information or gaps in care. Additionally, the Vermont Department of Health (Rutland region) identified both transportation limitations and a shortage of medical specialists as significant barriers to accessing care in the region. Point-of-care ultrasound may serve to address these community needs by improving the quality and continuity of care provided by primary care physicians.
Influenza Vaccine Participation in South Burlington, VT

Rio Beardsley
Short-term Project
Influenza vaccination rates in Vermont have declined each year between 2013 and 2016. This study aims to understand why patients decline the annual influenza vaccine. The project was deployed via survey for all adult patients (18 years and older) at the South Burlington UVM Family Medicine practice in 2019. Further information about the influenza vaccine authored by the CDC was then provided to all participating patients, regardless of immunization status.
Promoting TIA Awareness: Decreasing Stroke Mortality in Vermont

Nicole Becher
Short-term Project
The death rate from stroke in Washington County, VT was nearly twice that of the state in 2015. Risk of death from stroke can be decreased by timely intervention, however many patients are unaware as to signs and symptoms of stroke, and when to seek medical attention. A brochure was developed and distributed, aiming to shorten the time between experiencing TIA symptoms and point of contact with medical professionals.
Improving Awareness of Opiate Support Programs In Lamoille County

Samantha Bissonette
Short-term Project
Despite Vermont having doubled the rate per 10,000 people ages 18 to 64 receiving Medication Assisted Treatment (MAT) for Opiate Use Disorder (OUD) since 2012, there are still numerous barriers preventing patients from seeking treatment, including confusion about how to go about entering a treatment program, fear of stigma, and many others. Lamoille County has started to expand outreach to people struggling with OUD by having emergency services personnel, outpatient medical offices, and recovery centers hand out a county-specific information card with clear information about how to enter treatment and support programs. This project builds upon this existing initiative.
Osteoporosis: What to be aware of as a patient

Jonathan H. Borden
Short-term Project
The prevalence of Osteoporosis is increasing with the growing elderly population in our nation. Studies show that the incorporation of osteoporosis risk screening into primary care intake protocols significantly decreases the rate of osteoporotic fractures in patients. This project aimed to increase osteoporotic screening within a primary care office in St. Albans VT via the development and distribution of an “Osteoporosis: What to be aware of as a patient” brochure to patients that met the criteria for being at risk of being osteoporotic (women ages 65+, women who are post-menopausal but younger than 65, men ages 70+).
Counting Sheep & Counting ZZZs: A Therapeutic Approach to Better Sleep Hygiene

Cameron Burke
Short-term Project
Many adults present to primary care clinics with concerns that they are not getting sufficient sleep. In an effort to address this problem, I created an informational brochure educating patients on current sleep recommendations, instructing them on how to improve sleep hygiene, as well as describing how to keep a sleep diary to improve sleep efficiency.
Exercise Promotion for Patients with Mental Health Conditions in Milton, VT

Pirapon Leo Chaidarun
Short-term Project
Depression and anxiety are two highly prevalent mental health conditions and can often occur together. Research shows that sustained low-intensity exercise releases chemicals that promote nerve cell growth in the brain, which helps regulate mood and relieve symptoms. Exercise may seem like a logical solution for mental health to those with a medical background, but may be a new idea to many patients who are unaware of the added benefits of staying active.
Lyme Disease in Fairfield County, Connecticut: The Need to Know

Jack Chen
Short-term Project
There has been a steady rise in number of cases reported of Lyme disease in the past 25 years. In fact, it is the 7th most common reportable infectious disease in US with an estimated over 300,000 people diagnosed and treated each year. The total medical cost attributable to Lyme disease has been estimated to be as much as $1.3 billion a year with the total cost of Lyme disease testing estimated to be $492 million. Moreover, Lyme disease is associated with higher total health care cost and more outpatient visits over a 12-month period. According to the Connecticut Department of Public Health, the most number of cases of Lyme Disease in Connecticut is in Fairfield County. Therefore, education especially awareness and prevention is crucial to decrease the number of cases of Lyme each year, keep the cost down and have a healthier patient population without Lyme Disease.
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.