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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Patient Education on the Association of Hormonal Contraception with Depression

Julia E. Hannigan
Short-term Project
Hormonal contraceptive agents are widely used by women during their reproductive years. In recent years, research has been released linking hormonal contraception with the initiation of antidepressant medication and a first diagnosis of depression. More research is still warranted in order to further elucidate the relationship between hormonal contraception and depression, but current evidence prompts the necessity for shared decision making between clinicians and women considering treatment with hormonal contraceptive agents. The goal of this project is to give providers easily accessible patient educational materials in the form of epic smart phrases to aid in informed decision making.
CBD: A Resource for Patients

Ryan G. Harned
Short-term Project
An educational resource for patients describing the current body of research on cannabidiol (CBD), the current legal landscape, regulatory and manufacturing considerations, drug interactions, and potential risks.
It's Not TMI: Causes and Risks of Vaginal Discomfort

Olivia Harrison
Short-term Project
Many people with vaginas feel uncomfortable discussing vaginal discomfort with their health care providers. Not disclosing symptoms such as pain, itching, dyspareunia, etc can lead to long term complications such as PID and significantly impact quality of life. I designed a pamphlet to help normalize talking about one's vagina to one's health care provider. This pamphlet outlines common causes and risks of vaginitis.
Beyond Acute Lyme

Nicholas Haslett
Short-term Project
Vermont has one of the highest rates of Lyme disease infection in the country. There is growing disagreement not only between the medical community and a growing patient population, but also within the medical community itself, around the issue of persistent syndromes that may or may not be related to a Lyme diagnosis. Many patients seek treatment for persistent symptoms outside of physician guidelines for either Post Treatment Lyme Disease or the contentious "Chronic Lyme Disease" via prolonged courses of IV antibiotics, colloidal silver infusions, electromagnetic frequency treatments, and more. Regardless of the debatable extent of spirochete carnage in vivo, there is a need for effective and compassionate communication between providers and concerned patients. The aim of this project is to nudge this inevitably ongoing conversation in a productive direction, and to create a broader shared awareness between populations at growing odds.
Assessing Access to Community Health in Rutland County

Sidney JB Hilker
Short-term Project
Promoting Healthy Habits and Active Living for Children and Families at the Well-Child Visit

Jennifer E. Holland
Short-term Project
The 2019 Rutland Regional Medical Center Community Health Needs Assessment reported that 16% of adolescents and 30% of adults in Rutland County, Vermont are obese. This exceeds the average numbers for the state. Primary care practitioners in Rutland have struggled to find evidence-based, efficient programs to help address this issue. The 5-2-1-0 Program is an evidence-driven, low cost, and easy to remember intervention that assesses, prevents, and manages childhood obesity by promoting healthy habits and active living for children and their families. Using Brandon Medical Center, a Community Health Center of the Rutland Region, as the pilot site, this project aimed to implement the 5-2-1-0 Healthy Habits Questionnaire at all well-child visits and to propose a strategy for further integration of the 5-2-1-0 message into surrounding community health centers.
Accessing Opioid Use Disorder Resources in Vermont

Wendy Hou
Short-term Project
A handout listing contact information for opioid use disorder resources in Vermont.
Domestic Violence (DV) Screening

Wilson Huang
Short-term Project
Domestic Violence (DV) is an understated yet significant source of morbidity and mortality for victims. Healthcare providers have a unique opportunity and responsibility to identify patients who may be victims of DV. A formal screening method for DV should be developed and routinely employed in local practices to address this issue.
Availability of Shingrix Vaccine in St. Albans and its Benefits vs Zostavax

Ibrahim Sobhi-Luther Hussein
Short-term Project
Across the United States, including St. Albans, Vermont, a shortage of Shingrix Vaccine has left many patients without effective protection from shingles. The purpose of this project was to identify how patients could obtain the vaccine within a reasonable amount of time, and avoid being placed on long wait-lists at pharmacies. Four different pharmacies in St. Albans were contacted. Pharmacists and pharmacy technicians explained what patients can do to receive the vaccine with less hassle. These tips will be given to patients in handouts at NOTCH along with information about the significant benefits of Shingrix vs the previous Zostravax.
Educating Patients on Screening Guidelines and Expectations for Well-Woman Examinations

Cyrus Maxim Jalai
Short-term Project
Female patients seeing primary care in rural settings often do not seek out specialized care from a practicing OB/GYN, favoring instead to utilize their family practitioner to respond to their complaints. As such, it would be effective to work to educate these patients at their well-women examinations on routine screenings, immunizations, and health maintenance methods they should expect based on their presenting age. A handout simplifying and synthesizing the main screening and general health guidelines for annual well-women examinations may be helpful for female patients using primary care practitioners as their source for obstetric and gynecologic care.
Conjunctivitis: Patient Information

Nicole Jedrzynski
Short-term Project
Conjunctivitis or “pink eye” is a common affliction encountered frequently in family medicine. Most cases are viral and do not require antibiotics, and more accurate information for patients and their caregivers is needed to minimize unnecessary visits to urgent care and the emergency room. This will facilitate better patient care and fewer healthcare costs.
X-Ray Referrals for Uncomplicated Fractures

Gregory P. Johnston
Short-term Project
Emergency departments (EDs) in the United States are frequently overutilized for patients in need of an X-ray imaging despite outpatient clinics, ski hills, and express care facilities having the capacity to perform X-Rays and have them read and interpreted by local Radiologists. ED visits are associated with significantly increased wait times and auxiliary costs compared to express care and outpatient facilities. Particularly within the State of Vermont, ski hills provide a reliable population of injured patients with uncomplicated fractures in need of an X-ray examination. Here, we assess potential causes and explanations for ED overuse and lack of express care utilization for uncomplicated fractures that do not require a higher level of care, as well as publish currently available X-ray sites within the State of Vermont as a means of educating local providers and promoting lower healthcare expenditure and decreased wait times for injured patients.
A Community-Focused Approach to Reduce School Bullying in Northeastern Vermont

Istvan F. Kanyo
Short-term Project
School bullying affects one in three children in the United States and represents a public health burden as students’ absentee rates increase. It also increases the risk of psychiatric disorders later in life. Public schools often place a major focus on minimizing bullying through educational programs and punishments. However, more work has to be done to educate caregivers within the school system on how they can reduce the effects of bullying. The goal of this work is to provide an educational resource for parents that details a community-oriented approach to intervene with school bullying. Caregivers can find statistics on bullying, what behaviors might be present in a bullied child, and what avenues they can pursue to support their child.
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