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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Increasing Completion of Advance Directives in the Primary Care Setting

Emily A. Vayda
Short-term Project
In the state of Vermont we have an increasing senior population that is greater than the national average. with this increase comes a greater need to end of life care planning. Completion of advance directives in the primary care setting reduces costs in end of life care, but also reduces stress and anxiety for family members of the patient receiving care. To increase completion of advance directive patients and providers will be educated on advance care planning and informed of community resources that aid in completion of the many forms available to patients.
Out-of-Pocket Cost for Individuals Being Treated for Opioid Dependence in Rutland County, Vermont

Christopher T. Veal
Short-term Project
Each day more than 140 Americans die from drug overdoses, 91 specifically due to opioids. In Vermont, more than 50 people die each year from opioid poisoning. With insurance coverage being a critical component of Opioid Dependence Recovery, many people seeking treatment are unaware of the financial barriers to recovery- namely the out-of-pocket costs associated with treatment. This study sought to provide insight on the financial impact of Opioid Dependence Treatment on the patient, and provide financial assistance information to the Rutland County community.
Attitudes towards Complementary Medicine in Patients with Musculoskeletal Pain

Caroline Vines
Short-term Project
The epidemic of opiate use-related deaths has become a public health crisis and has highlighted the potentially lethal effects of opiates. Vermont has adopted new laws to address the prescription of opiates, which has reduced the number of prescriptions by 41% between 2013 and 2017. However, there has been sparse research how the decrease in prescriptions has influenced the use of non-pharmacologic and/or complementary methods of pain management, such as acupuncture, chiropractic manipulation, yoga, massage, meditation, and psychotherapy. In October and November 2018, patients with musculoskeletal pain were surveyed about current methods of pain management, experience with complementary medicine, likelihood of using complementary methods in the future, and potential barriers to use. Interviews were conducted at the Community Health Centers of Burlington - Riverside. Nine patients completed the survey, 5 of 9 had chronic pain (>3 months). Most patients had used either medications or physical therapy for musculoskeletal pain in the past. Participants expressed most interest in using chiropractic manipulation, massage, and acupuncture for future pain management. Barriers included cost, lack of time and/or scheduling, and lack of knowledge about the benefits of complementary therapy. Future interventions should address these barriers, and should also focus on educating providers about the efficacy and local availability of complementary medical services.
HPV vaccine

alejandra vivas
Short-term Project
Human Papilloma virus has been related not only to 98% of cervical cancers but also to mouth and throat cancers. There is a vaccine that prevents contraction of this virus: HPV vaccine. This vaccine although proven effective and safe there are still children who have not received the vaccine, mainly due to myths and misconceptions that parents have about the vaccine. The purpose of this project was to demystify the myths and provide parents with real knowledge about the vaccine.
Combatting Opioid-Related Deaths in Rural Vermont Through Community Partnership

Brianna F. Waller
Short-term Project
Substance abuse continues to be a public health crisis. With legislative changes and creation of MAT programming in Vermont, access to behavioral health services for substance abuse treatment has shifted community response and perceptions. As Little Rivers Health Care houses both a MAT program and is a naloxone distribution site, a community event was organized to help train community leaders on how to administer naloxone and provide an avenue to form community partnerships.
Marijuana and the Teenage Brain: Public Health Impact

Katie C. Warther
Short-term Project
This project explores the neurobiological impact of teenage marijuana use, and the ways that public health interventions can help educate adolescents and delay the onset of use.
Screening for Food Insecurity, Accessing Healthy Foods, and Resources for Patients

Andrew J. Wick
Short-term Project
Food Insecurity and access to healthy food is a large health care issue in the United States, Vermont, and Chittenden County. This project aimed to educate health care providers at Colchester Family Practice about food insecurity to increase the amount of patients screened for food insecurity. The project also investigated local resources for people with food insecurity and made this information available to providers so they are better able to help people struggling with food insecurity.
Increasing Awareness of the Risks Associated with Juuls in High School Students

Daniel JD Wigmore
Short-term Project
The use of Juuls and other e-cigarettes has increased in Vermont high schools over the past year. Many students are not aware of the risks associated with the use of these products and believe that they cause no harm. This project focused on increasing communication between high school students and their healthcare providers to improve dialogue and learn the facts about using these projects.
Improving Advance Directive Use Through Provider Education at Newtown Primary Care

Timothy Wong
Short-term Project
Nationally, there seems to be a discrepancy between a patient's desire to talk about end-of-life care and their act of doing so. An advance directive is a legal document that enables an individual facilitate an end-of-life care discussion with someone. For many patients, primary care is their first contact with healthcare on many occasions. Educating primary care providers about common misconceptions of advance directives and advance care planning may increase the amount patients that have talked to someone about their goals and desires at end of life. This project uses a handout and an oral presentation to educate providers with the goal to encourage more advance care planning discussions and advance directive completion.
Behavior Health Integration: Depression

Garyn Worrall
Short-term Project
Integration of Behavioral Health Specialists and mental health education is an important goal for the Community Health Center of Burlington (CHCB) Vermont. An educational brochure on depression was created with symptoms, definitions, self care, and ways to receive support from both CHCB, local, and national resources.
Depression Screening and Prevention Among VT Bosnian Refugees

Mushtaba Yuridullah
Short-term Project
Mental health and mental health disorders are stigmatized in our society today. Many people suffer from mental health disorders but are not willing to seek treatments due to various concerns. One big factor is lack of awareness about mental health disorders and brushing mental health issues as something “non-medical” or “all in your head.” This view is especially prevalent among our refugees and new immigrant communities. This project aims to bring about awareness regarding mental health in our local Vermont communities and will emphasize the availability of treatments.
Hepatitis C Screening in the Baby Boomer Population

Pedram Zargari
Short-term Project
Peer-Led Smoking Prevention in Winooski, Vermont

Grace Culley Adamson
Short-term Project
Smoking is the number-once preventable cause of death, contributing to more than 1 in 5 deaths per year in the United States. Statistics indicate that 90% of adult smokers tried their first cigarette before the age of 18. In Vermont, the rate of youth smoking dramatically increases between middle school and high school, and individuals in the State with lower incomes have significantly higher smoking rates than those with middle and upper class incomes. Whether a youth decides to try smoking is strongly influenced by their peers’ smoking behavior and beliefs, and several studies have shown that peer-led tobacco prevention strategies may be more effective in curbing youth smoking rates than formal, classroom interventions led by teachers and other adults. This project focused on training middle-school youth leaders in Winooski, Vermont, the lowest-income community in its county, to learn about the harms of tobacco use and to become ambassadors of smoking prevention efforts within their school district.
Patient Education: Sodium Awareness in Bomoseen, VT

Ashley D. Adkins
Short-term Project
Many patients in the outpatient setting are placed on diets with sodium restrictions by their primary care physician for management of a variety of chronic diseases. Patients often have difficulties adhering to these diets, a primary reason being unawareness of the sodium content of many foods that make up the American diet. This project aims to increase awareness for these patients and to provide education for them to make more informed decisions about their health. A poster was made for providers to display in their practice that illustrates the sodium content of various food groups. The foods were selected based on recommendations and research from the CDC and American Heart Association. Future evaluation of the efficacy of this project would be elicited by a patient and provider questionnaire after the posters have been displayed for 6 months or more. This questionnaire could then be used to modify the posters to better fit this specific population and assist providers in this facet of patient education.
TOP PEW

Dexter C. Allen
Short-term Project
Problem: Patients on Suboxone (buprenorphine-naloxone) therapy break compliance by taking higher Suboxone doses, by supplementing with Suboxone purchased illicitly (“off the street”), or by taking other opiates and illicit drugs (cocaine), excluding marijuana. Need: Physicians and Medication-Assisted Treatment (MAT) counselors would benefit from an approach to counseling and treating their patients that would better address the specific vulnerabilities that Suboxone patients face that threaten their compliance.
Lyme Disease: Prevention, Recognition & Treatment

Kristen J. Bartlett
Short-term Project
Cases of Lyme disease have been steadily rising in Vermont every year. Though the public is becoming more aware of its presence, there is a great deal of misinformation regarding its prevention and treatment.
Medical Aspects of Transitioning - A Guide for Transgender Youth

Amy M. Berkman
Short-term Project
Interacting with the medical system can be intimidating for all youth, including those who are transgender. The goal of this project was to provide information about community resources and medical terminology and treatments that transgender youth may encounter during the medical transition process. The target audience is those that attend a community center dedicated to LGBTQ youth.
Education on Tickborne Diseases and Prevention Strategies

Christopher Bernard
Short-term Project
Research suggests that around 300,000 people are diagnosed with Lyme disease each year and that around one billion dollars is spent on healthcare for Lyme disease alone. Vermont has the highest rate of incidences of Lyme disease per 100,000 persons in the United States. While Lyme disease is certainly a major community health issue in Berlin, VT there are many other tickborne diseases that are becoming increasingly prevalent such as Anaplasmosis, Babesiosis, Powassan virus disease, and Borrelia miyamotoi disease. An educational handout was created providing helpful information for both community members as well as healthcare providers. For community members the information focuses on tick bite prevention strategies, how to safely remove a tick and common symptoms of tickborne diseases seen in Vermont. For the providers the information focuses identification of ticks, in-depth signs and symptoms of tickborne disease, lab tests and results, diagnostic testing and appropriate treatment methods. This handout was provided to Berlin Family Medicine for distribution to patients and providers in hopes of combatting the rising incidence of tickborne diseases in Vermont.
Familial Hypercholesterolemia in Lewiston/Auburn, ME: Directed Education Towards Improving Community Awareness

Omkar Betageri, Dervilla McCann, and Bethany Picker
Short-term Project
There is a need for an improved awareness about Familial Hypercholesterolemia to promote prompt treatment and long-term management amongst a population disproportionately affected by the disease, namely Franco-Americans in Lewiston-Auburn, Maine
Influenza Awareness in Berlin and Montpelier, VT

Nathan L. Centybear
Short-term Project
Influenza vaccinations have changed over the years and many patients have concerns regarding the vaccine, such as safety and effectiveness. The goal of this project was to help educate patients regarding common concerns identified in the communities of Berlin and Montpelier, VT surrounding the influenza vaccine. Community members were interviewed to identify commonly asked questions. These questions were used to create an educational flyer, which was made available to patients at the Berlin Family Practice.
Implementing a Community Bipolar Screening Questionnaire in VT

Suven Cooper
Short-term Project
The National Institute of Mental Health estimates the number of adults with a diagnosed mental disorder is nearly 1 in 5, this equates to about 43 million Americans. The national shortage of psychiatrists has hit Vermont particularly hard. There has been both a lack of funding and a lack of psychiatrists. For example there is often a waiting line for acute level 1 beds at the Vermont Psychiatric Care Hospital since it opened after the flooding of the state hospital in 2011. In light of the shortage of resources and psychiatrists in Vermont it is important to maximize the limited time that family practitioners have with patients with mental illness. With regards to diagnosing bipolar spectrum disorder the best method is using the Mood Disorder Questionnaire (MDQ) which is a 17 question survey and practical for an outpatient setting. A study examining the validity of the MDQ found that it provided good sensitivity (0.73, 95% [CI]=0.65–0.81) without sacrificing specificity (0.90, 95% CI=0.84–0.96). Another study was conducted in a community setting and it was found that the MDQ had a sensitivity of 0.28 and a specificity of 0.97. The MDQ has been proven to be effective in a psychiatric outpatient setting and been proven to be less effective or limited in the outpatient setting. However we must weigh the risks and benefits. In a setting like Vermont, with restricted resources, limited inpatient beds, lack of psychiatrists and a population of individuals with undiagnosed bipolar spectrum disorder the MDQ can prove to be more useful than harmful and can aid in identifying patients who potentially have bipolar spectrum disorder.
The Aging LGBTQ Population

John P. Corbett
Short-term Project
Although being LGBTQ is more accepted than it was in previous times, there are still barriers that exist which keep some LGBTQ people from accessing quality healthcare. In the middle-age and older LGBTQ population, there are further issues that arise. Health care providers should be aware of some of these issues so that they can be addressed during an office visit if necessary.
Improving Access to Healthcare for LGBTQ Individuals in Burlington

Andrew Corse
Short-term Project
Studies consistently show that LGBTQ individuals are at higher risk for substance abuse, tobacco use, suicide, HIV, and chronic health conditions. The Community Health Centers of Burlington recently created a specialty clinic called the Be You Clinic, which will focus on delivering healthcare to LGBTQ persons, by LGBTQ-affirmative and –knowledgeable providers. This project sought to spread awareness of this new clinic by advertising.
Educating Providers on the Value of Community Health Outreach Workers in the New Mainer Population

Julia Lane Cowenhoven
Short-term Project
Lewiston, Maine has seen a recent surge of asylum seekers, refugees, and migrants, mainly from African Countries, termed New Mainers. Community health outreach workers (CHOWs) are front line public health workers who are trusted members of the community being served, which enables them to serve as a liaison between providers and their patients. Educating providers on the role of CHOWs may increase their utilization in the clinical setting and improve the quality of care for the New Mainer population in Lewiston.
Strategies for Clinical Management of Hypertension: Understanding Community Perspectives

Patrick Cruden
Short-term Project
Survey analysis of hypertensive patients in an outpatient family medicine practice aimed at efficiently improving clinical management and health literacy.