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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Halting Progression of Stasis Dermatitis: Community Perspectives and Strategies for Prevention

Allison B. Robbins
Short-term Project
Complications of stasis dermatitis including venous ulcers, osteomyelitis, and cellulitis all significantly increase morbidity and mortality of disease. Progression beyond stasis dermatitis and avoidance of the aforementioned complications are preventable with patient education and adherence to basic therapies including compression stockings and lifestyle modification. Therefore the goals of this project were to: assess the community’s understanding of stasis dermatitis and their awareness of its complications; use this information to help healthcare providers tailor their preventative health counseling accordingly; and provide education for patients on stasis dermatitis, its complications, and therapies/behavioral changes to prevent disease progression.
Bridging the Gap: Putting Nutrition Knowledge into Practice

Monica Rodgers
Short-term Project
Obesity is highly prevalent and has overwhelmingly been shown to negatively impact health outcomes for patients. Poor dietary habits are an important contributor to obesity. Formal interviews with local healthcare providers and informal interviews with patients indicated a need for resources for patients who have already completed nutrition education classes or already have the knowledge they need but are unable to implement it to regularly prepare nutritious meals at home. A book of nutritious, filling recipes adapted to include many vegetables, low added sodium, and relatively inexpensive ingredients was compiled for health care professionals to provide to this target population to facilitate and inspire the preparation of healthy meals at home.
Patient Education about Influenza Vaccination

Michael Rodriguez
Short-term Project
Only 37% of adults in the US received the influenza vaccine in 2017-18. Clearly there is a gap between the known benefits of the influenza vaccine, the risks of influenza, and the number of patients obtaining influenza vaccine. An educational flyer was created to address common concerns or myths about the influenza vaccine in order to encourage vaccination at Brookfield Family Practice.
Optimizing Inhaler Technique

Ruby L. Russell
Short-term Project
Studies show that correct patient technique using inhalers is correlated to the number of times they are taught and reminded by a health care professional. As a step toward addressing this problem, I propose increasing inhaler use teaching, utilizing EMR tools as well as online modules, and increasing the comfort of providers with teaching inhaler use. This may be achieved through the use of PRISM dot phrases titled .INHALERNAME, accessing teaching videos during a patient visit, and having patients demonstrate technique at each visit.
Early and Current Educational Information is Key in Preventing Smoking in Massachusetts Youth

Shawn Sanford
Short-term Project
Among adult smokers, 88% started smoking before the age of 18. This challenge is complicated by the effective advertising efforts of the tobacco industry, which have been shown to cause the onset of smoking in adolescents. Franklin County, MA has not been immune to this problem, as 42% of 12^th graders reported trying a cigarette and 51% of 12^th graders reported trying electronic vapor products. This project focused on the need for early and current tobacco prevention information to keep up with the promotional campaigns of the tobacco industry. Reaching youth with fresh information before their first puff is vital to smoking prevention.
Getting Ahead of the Curve: Screening and Early Detection of Scoliosis in Adolescents to Prevent Progression of Spinal Deformity

Patrick Saunders
Short-term Project
Scoliosis is a spinal deformity that affects approximately 7 million people in United States. The most common age of onset of idiopathic scoliosis is between 10-15 years old. If left untreated, there is a possibility that scoliosis can progress to a severity that requires surgery to correct spinal curvatures. However, if detected early enough, scoliosis can be managed via noninvasive techniques, which research has shown to be extremely effective in halting the progression of curvatures and preventing the possible need for surgery. In order to detect scoliosis early enough to begin noninvasive treatment, screening programs are essential. Screening for scoliosis in the primary care setting is often provider dependent, and not all states have guideline that require mandatory screening in schools. This project investigates the possible health impacts of scoliosis, attitudes towards screening and early detection, and presents an intervention to help raise awareness and provide education about scoliosis and the benefits of screening to parents of Burlington youth.
Using Relief From Mental Health Symptoms as Motivation for Exercise and Lifestyle Changes. Brookfield Family Medicine, CT

Nicholas Selig
Short-term Project
There is a high prevalence of mental illness in the Brookfield CT community mostly anxiety, depression and insomnia. These are often comorbid with other chronic disease. There is a lack of knowledge about exercise's benefits on mental health symptoms as well as chronic disease.
The Shingrix Vaccine: Information for Patients About Current Recommendations & the National Shortage

Purvi Shah
Short-term Project
In the US, herpes zoster and related complications have been estimated to result in 1.3 billion dollars of medical costs alone annually. In order to combat this significant public health burden, efforts have been made to vaccinate susceptible populations for herpes zoster. In 2017, the FDA approved Shingrix, a recombinant zoster vaccine that is more effective than its predecessor, Zostavax. Now, patients are being vaccinated for shingles at a higher rate than previous years. As a result, the demand for Shingrix has exceeded supply, leading to an inconsistency in supply. This, in combination with changing recommendations for vaccination has generated confusion and frustration among patients at South Burlington Family Medicine. A patient-centered brochure was created that addresses these concerns and may serve to alleviate some of these sources of stress.
Gender Nonconforming Children: Education for Rural Vermont Families

Zachary Silberman
Short-term Project
Trans and Gender Nonconforming children and adolescents make up an increasing percentage of today's youth. Many of their families, parents, and healthcare providers lack information on how to address the topic. Additionally, the lack of research in the field, and the ever changing definitions, can make it difficult to navigate and, as a result, there are several persistent myths and misconceptions. This project seeks to address these myths, the terminology as currently used, and local community resources from a patient and family perspective, specifically targeted at rural Vermont.
Skill-Based Cooking Class with the Health Care Share

Conner R. Soderquist
Short-term Project
Food Insecurity is a significant public health concern in Vermont. 64,370 Vermonters (10%) live in food insecure households. There are many contributing factors to food insecurity including lack of affordable housing, a decrease in affordable grocery stores, low wages, and lack of public transportation. One of the many strategies for addressing food insecurity in Chittenden County, Vermont is the Health Care Share (HCS). The HCS is a partnership between the Vermont Youth Conservation Corps farm and UVMMC that connects Vermont families experiencing food-insecurity with farm-fresh foods through a weekly farm share that includes skills and recipes to prepare healthy meals at home. Participants pick up their share weekly at their family practice. In this project, a skill-based cooking class was conducted with HCS participants where we worked together to cook a dish using produce from their share. Cooking confidence was assessed using a pre-class and post-class survey.
Using online Behavioral Health Modules to expand care in Rural New York State

Matthew Sommers
Short-term Project
There are substantial barriers to receiving behavioral health in rural areas such as Upstate New York. Online modules are an evidence-supported option that could exist within a primary care focused stepped-care model, expand access, and increase efficiency of existing resources.
Developing sexual health informational materials for college students

Eleanor Stedman
Short-term Project
Lewiston, Maine is home to Bates College, an undergraduate institution of about 1800 students. Bates Health Services provides primary healthcare for most of these students. Among the most common issues that bring students to health services are concerns related to sexual health. The college health services lacked appropriate informational materials for students related to STI testing and HIV Pre-Exposure Prophylaxis, so these materials were created to assist with sexual health education on campus.
Fight Sitting with Movement

Harris Syed
Short-term Project
Today, Americans spend an average of 13 hours per day sitting. Sitting for as little as two continuous hours increases the risk of heart disease, diabetes, metabolic syndrome, cancer, back and neck pain, and other orthopedic problems. This project contains 8 YouTube videos presented in an engaging, educational and detailed manner to show individuals what they can do to combat prolonged sitting. The videos focus on moving the body’s joints through their normal ranges of motion & improving an individual’s NEAT (non exercise activity thermogenesis)
Promoting Bone Health through Weight-bearing, Resistance Training, and Balance Exercises

Kinjal Thakor
Short-term Project
Osteoporosis and low bone density affect 54 million Americans. Advanced age, female gender, an underweight BMI, lack of estrogen, smoking, and sedentary lifestyle all increase one’s risk of developing osteoporosis or experiencing bone fractures from minor trauma. In addition, residents of northern states, like Vermont, experience an increased risk of bone loss over time due to limited exposure to sunlight and decreased physical activity over winter months. Although screening, calcium and vitamin D supplementation, general exercise, and treatment are largely discussed, patients are unaware of the specific exercise routines that can be done to strengthen their bones. In response, I created a handout outlining simple and safe weight-bearing, strength training, and balance exercises patients can perform to promote good bone health and prevent osteoporosis and fragility fractures.
Preparing Patients and Providers for Serious Illness Conversations

Laura Thompson-Martin
Short-term Project
There is an unmet need for early, high quality, and well-documented conversations about goals of care between patients with serious illnesses and their primary care providers. Colchester Family Medicine, as part of the University of Vermont Medical Group, is implementing a program to train its providers in structured goals of care conversations for patients with serious illnesses. However, there remains a need to prepare patients for these difficult conversations and provide appropriate resources. This project created a SmartPhrase to provide to patients, containing language and resources to help them prepare for serious illness conversations.
Evaluation of Patient-Centered Tool for Measuring Opioid Addiction Recovery

Laura A. Till
Short-term Project
Vermont has expanded access to medication assisted treatment (MAT) since the onset of the opiate epidemic. This has included the use of family medicine clinicians as waivered prescribers of buprenorphine. In the absence of clear expectations or knowledge of discontinuation and detox, patients and providers must now reframe the traditional understanding of addiction recovery success as simply abstinence, maintenance medication detox, and survivorship. A 20-question, interactive “POWERS Form” has been developed by Stowe’s MAT team as part of routine counseling and clinical visits. Tracking score changes with patients allows reflection on the broader life changes during recovery process. This activity can perhaps challenge harmful perceptions of pharmacotherapy and destigmatize patients' potential need for long term or indefinite bupenorphine treatment. This project began the process of evaluation and validation of this questionnaire and analyzed its preliminary results.
Treatment & Management of Acute Sinusitis in the Primary Care Setting

Vanessa Trieu
Short-term Project
Sinusitis is a leading cause of primary care visits. The majority of cases are due to a viral infection, which can be self-treated with supportive care. Many patients are unaware of this and seek medical attention prematurely, incurring significant healthcare costs and resulting in antibiotic misuse. On the other hand, a prolonged infection or the presence of atypical symptoms does warrant medical attention and can potentially lead to untoward consequences if inadequately treated. The purpose of this project is to provide patient education on the expected course of an acute sinus infection and how to proceed with management.
Discouraging Use of Benzodiazepines for Anxiety and Insomnia

Jackie Tsao
Short-term Project
Benzodiazepines are commonly prescribed for anxiety and insomnia because patients respond quickly to them. Although they are meant to be short-term solutions, patients often use them for more than ten years. Long-term use is associated with tolerance, dependence, rebound anxiety and insomnia, painful withdrawal symptoms, and higher rates of falls and motor vehicle accidents. The purpose of this project is to educate patients about the dangers of using benzodiazepines and encourage consideration of safe alternative therapies for anxiety and insomnia. Results suggest that patient education in the form of a handout may effectively discourage new benzodiazepine users from continuing or starting benzodiazepine treatment. However, this is not be the case for long-term users of benzodiazepines who have become dependent and require more aggressive intervention. Preventing initiation of benzodiazepine therapy for people who have never used them before may be an effective way to address the growing benzodiazepine epidemic.
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.