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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Advance Directive Initiative- St. Johnsbury, VT

Arjun Janardhan
Short-term Project
Valuable time is frequently lost during end of life care or in the unforeseen circumstance of severe injury or illness when a patient does not have appropriate advance care planning. While end of life care costs continue to increase in an aging U.S. population, only 26% of U.S. healthcare consumers have completed Advance Directives (ADs). One of the key barriers to increased participation and awareness continues to be lack of patient education. Due to the complicated terminology often used in these legal documents, one essential component of the AD initiative at St. Johnsbury Community Health Center is creating a simple and effective handout to improve patient education.
Cervical Cancer Screening at Community Health Centers of Burlington

Adrienne Jarvis
Short-term Project
Most invasive cervical cancers are found in women who have never been screened or who have not been screened in the last five years. In order to improve the cervical cancer screening rate at the Community Health Centers of Burlington, a chart review was conducted of female patients who did not have records of Pap tests within current guidelines. It was found that the 28% of these patients had pap tests by outside providers, indicating local care coordination is a major barrier to cervical cancer screening tracking. Another major barrier to screening was patients seen for acute visits only or for management of multiple chronic conditions but not for preventive visits.
MAT for Opioid Use Disorder in Maine

Eliot S. Jia
Short-term Project
Opioid Use Disorder (OUD) is a major problem in the state of Maine with one person dying from overdose every day. Medication Assisted Treatment (MAT) using Suboxone has been shown to be helpful in the treatment of OUD, but there is currently a great need for providers to prescribe Suboxone in this region. We looked at barriers that providers saw for obtaining a waiver to prescribe Suboxone and created a handout to educate providers on MAT and the process for getting the waiver.
Driving Under the Influence of Marijuana: Education of Vergennes Union High School Students

Margaret S. Johnston
Short-term Project
The leading cause of death for high school students is motor vehicle accidents and the risk of involvement in a motor vehicle accident increases 10-fold after marijuana smoking. There are many misconceptions surrounding driving under the influence of marijuana in adolescents and few high schools are spending adequate time addressing this issue directly. The 2015 Vermont Youth Risk Behavior Survey found that 18% of students in Addison County rode in a car or other vehicle in the past 30 days with someone who was using marijuana. This project was designed to present information about driving under the influence of marijuana to Vergennes Union High School students in small group settings. Topics discussed include the effects of smoking marijuana on clinical judgement and reaction time, consequences of driving under the influence, and how to talk to peers about this issue.
Media Screen Time for Young Children, a Culturally Competent Approach

Jenna Conway Jorgensen
Short-term Project
Young children are being exposed to excessive screen time. There are many health and developmental risks of excessive or inappropriate media exposure, including sleep disturbances, developmental delays, and obesity. New American families are likely unaware of the consequences of too much screen time in young children.
Acrylate Allergy to Fake Nails: Unique Presentations of Onchodystrophy and Subungual Hyperkeratosis

Marie Kenney
Short-term Project
Artificial nails are commonly used worldwide for cosmetic nail enhancement. Chittenden County, Vermont has 20 operating salons that offer acrylic nail procedures. Common procedures for the administration of acrylic nails include self-curing sculptured nails and light-cured nail lacquer, also known as “gel” nails. Both methods employ binding agents that utilize acrylic monomers or polymers. These acrylates are a frequent cause of allergic contact dermatitis in both manicurists and clients. A distinct presentation of allergic contact dermatitis to nail lacquer has been recently recognized in the community. It involves the sudden onset of painful nails and lack of associated eczematous changes. There are currently two reported cases in the literature which also describe onycholysis and subungual hyperkeratosis without surrounding dermatitis, and two reported cases recognized by dermatologists in Chittenden County. This project aims to identify offending acrylic chemicals in the community and educate primary care providers about this specific allergic presentation that can masquerade as onychomycosis or nail psoriasis.
Having a Conversation About Health Care Wishes and Goals in Vermont

Eric C. King
Short-term Project
Research has shown that people think talking with family and friends about end-of-life care is important, but they do not actually have this conversation. The majority of adults do not have any form of advance care planning in place. In the state of Vermont if you are 18 years of age or older there is no default person to make decisions for you (such as a spouse or next of kin) in the event that you would be unable to do so, which can result in a complicated ethical dilemma. The goal of this project is to improve conversation rates between patients and their friends and families about their health care wishes and goals.
My First Cookbook! Healthy Recipes that Kids Can Make

Emily KINN
Short-term Project
The obesity epidemic in the United States continues to negatively impact health outcomes in every age group. Interventions aimed at the pediatric population is an especially attractive public health strategy to help kids early on develop important skills for healthy eating to carry with them into adulthood. Childhood obesity prevalence remains alarmingly high at about 17% and has a huge impact on children’s health including higher likelihood of developing risk factors for heart disease, high blood pressure, asthma, sleep apnea, psychiatric problems and problems with self-esteem. This project aims to help elementary school aged children become more involved in making their own healthy food choices by creating a cookbook with recipes that children in this age bracket can make themselves. Its recipes are guided by the recommendations of the Mediterranean diet.
Promoting Skin Cancer Awareness

Sree Sahithi Kolli
Short-term Project
Skin cancer is the most common cancer in the nation and the cost to treat it is around 8 billion dollars a year. Sun exposure is linked to all three types of skin cancer and incidence of melanoma is highest in Caucasians compared to other races. In Brookfield, CT which is comprised of a predominantly Caucasian population, there is a lack of awareness of skin cancer detection and prevention. One of the best ways to promote skin cancer awareness is through education about the different types of skin cancers and sun safety behaviors. The idea is to start the conversation about skin cancer by capturing people’s attention with a visual poster. A poster is multifaceted in that patients can spend time reading it while in the waiting or exam room, can be used as instructional aide by the physician and can be transformed into a miniature handout made available for patients to take home with them. The goal is to promote skin cancer awareness so skin cancer can be detected and treated in a timely manner and patients are equipped with tips on how to minimize sun exposure.
Making Diagnostic Testing for Lyme Disease More Approachable

Jacob A. Korzun
Short-term Project
The CDC’s recommended testing and treatment guidelines can be confusing for patients and healthcare providers alike. There is often a knowledge gap in understanding what is being analyzed in serologic tests as well as why two step testing is employed. With the increasing incidence of Lyme in the northeast it is as important as ever to ensure that there is an approachable resource for patients to learn from. Better patient care can be provided while also reducing unnecessary testing and resource overutilization by empowering patients with a better understanding of the process of diagnosis of Lyme disease
Primary Care Treatment of HCV in Medicaid Patients

Stephanie S. Kulaga
Short-term Project
New, safer HCV treatment regimens make it more feasible than ever for primary care providers to manage Hepatitis C patients in their own practices, rather than leaving management solely to specialists. With the current prevalence of HCV and increasing number of new cases linked to the opiate epidemic, it makes sense to expand the number of providers who manage this illness. However, the landscape of new treatments and changing Medicaid requirements present administrative barriers to primary care treatment of HCV. This project aimed to clarify what those barriers were and create a treatment algorithm to simplify decision-making around which patients should be referred to management solely by specialists, and around how to manage those patients appropriate for primary care.
Provider Education: Managing Depression in Cancer Patients

Nicole Leonard
Short-term Project
Depression is more prevalent and less often treated in cancer patients compared to the general population. Cancer can increase the risk of depression in multiple different ways, but depression can also increase the risk of cancer. Untreated depression in cancer patients can increase the risk of metastasis and worsen prognosis. The purpose of this project is to educate providers on the connection between mental health and cancer as well as provide them resources on how to approach and manage patients with cancer and depression.
Provider Education & Requirements for Opioid Prescriptions

Lawrence J. Leung
Short-term Project
Nationally, there has been a surge in the opioid prescription crisis with associated overdose deaths. Vermont is no exception, with increasing opioid overdose related deaths within the last 10 years. A sample (n=111) of opioid addiction patients at the Community Health Centers of Burlington (CHCB) have demonstrated that 25% have their initial use due to provider prescription. New Vermont regulations to decrease opioid prescriptions are inefficient. The goal of this project is to implement a streamlined intervention to improve provider education and comfort regarding new Vermont state opioid prescribing regulations.
Community Awareness of Burgeoning Prostate Cancer Screenings

Rose Kristine Leu
Short-term Project
Prostate cancer screening is an ever-changing field because the benefits of using PSA as a screening tool is not clear-cut, subsequently causing a lack of standardization of screening protocols among various providers. In 2012, the USPSTF published their recommendation of grade D to prostate cancer screening, which caused a decrease in its use. However, the USPSTF recently changed their recommendation from grade D to C, conceding that screening can be beneficial to a certain group of people. Patients are understandably confused about what is appropriate for them; now is the perfect time to raise awareness about the importance of prostate cancer screening and to motivate patients to start a shared-decision making conversation with their provider.
Evaluation of a cancer risk assessment questionnaire to guide cancer screening decision-making in primary care

Anita Li
Short-term Project
Improving our response to positive food insecurity screening at Colchester Family Practice

Callie Linehan
Short-term Project
My project is to raise awareness of food insecurity among providers, and identify resources and next steps providers can take to help patients who screen positive for food insecurity using the AAP-recommended Hunger Vital Sign.
Patient-Oriented Smartphone Apps to Improve Health & Wellbeing

Geordie C. Lonza
Short-term Project
Patients have the ability to improve their health outcomes, but their capacity to do so is sometimes underutilized due to misunderstandings or ineffective engagement in their healthcare. Nearly everyone owns a smartphone today, and there are innumerable patient-oriented smartphone apps in both the Apple and Android app stores. However, the clinical utility of these apps has not been widely studied. It is possible that we can incorporate the use of technology such as smartphone apps into our recommendations to patients in order to improve their management of their chronic diseases and their abilities to make lifestyle modifications.
Lyme Disease Education: Prevention and Response to Tick Bites

Nicholas S. LoSchiavo
Short-term Project
Lyme disease is a major public health concern in Vermont, and is only becoming more prevalent. There were nearly 800 probable cases of Lyme disease in 2016, compared to 100 cases in 2006. Untreated Lyme disease has significant effects on overall health including cardiac disease. Lyme disease also has severe impacts on public health costs, and is responsible for roughly $1 billion annually. A Lyme disease handout for patients at a primary care outpatient center in Vermont was designed to help educate the public on disease prevention and progression.
Combating Diabetes in Chittenden County: A Healthcare Provider Referral Campaign to Increase Patient Participation in the Vermont Diabetes Prevention Program

Samantha Magier
Short-term Project
As of 2016, diabetes affects more than 29 million people in the United States and is the 7th leading cause of death nationwide. In Vermont, 1/10 people are diagnosed with either diabetes or prediabetes, with 6% of Vermonters affected by prediabetes and 5% of Chittenden Country affected by prediabetes. The public health burden of this chronic disease is immense: diabetes costs Vermont an estimated $543 million each year and is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness. Prediabetes occurs when blood sugar is higher than normal but not at the diagnostic threshold of diabetes. Prediabetes does not definitely progress to type 2 diabetes if interventions are made, including healthier eating and physical activity to promote modest weight loss. The CDC has developed evidence-based curricula for lifestyle intervention in prediabetics with intensive individual counseling and motivational support on effective diet, exercise, and behavior modification. One of these curricula is currently run through the CDC-led National YMCA Diabetes Prevention Program (YDPP). Participation in this program reduces the risk of developing type 2 diabetes by 58% across all ethnic groups and sexes overall and by 71% in individuals over age 60. The Vermont YDPP had 325 participants in 2016, with only 21% (n=70) of those referrals to the program coming from healthcare providers. Healthcare providers have a unique role in the community of being the voices of health promotion. With the correct provider awareness of the YDPP and patient identification, awareness, and education, an increase in the percentage of YDPP-referring healthcare providers can increase the overall YDPP participation in Chittenden county. As of 2016, 60,038 people in Chittenden county have prediabetes, but only 8,026 are diagnosed, and an additional 52,012 people could be diagnosed with prediabetes by their healthcare professional and referred to the YDPP. This campaign intends to serve as a pilot project to create provider and patient awareness of the YDPP, identify patients with prediabetes, and ensure providers screen and refer prediabetic patients to the YDPP. Through exam room posters, panel query management, electronic medical record reprogramming, and targeted patient intervention, this study aims to increase YDPP patient participation via healthcare provider referral and refine the model for adaptation and implementation in other healthcare centers throughout Chittenden County.
A Multimodal Approach to Hypertension: Behavioral Modifications on a Budget

Jayne Manigrasso
Short-term Project
Hypertension is one of the most common diagnoses in the adult population in the United States. Hypertension also has various sequelae that are preventable with adequate treatment, including medication and lifestyle modification.
Rutland City Public School At Risk Youth Mentorship

Michael J. Marallo
Short-term Project
This after school program’s purpose is to address the unique challenges of Rutland, VT Middle/High School students with multiple psychosocial risk factors (as determined by comparison to the ACE questionnaire) through mentorship, health and life skills education, and by guiding the development of positive coping skills. Activities will allow for self-expression outside of the classroom in a safe environment. Focus will be placed on assisting paraeducators and teachers with meeting goals that are appropriate for each individual student.
Teaching Value-based Care: A Framework for a Family Medicine Resident Clinic

Alexander W. Marchese
Short-term Project
Milton Family Practice is home to the University of Vermont’s Family Medicine residency program. As efforts to improve the value of health care increase, graduate medical education accreditation organizations may begin to reward and penalize residency programs based on their commitment to teaching and providing value-based care. Residency programs currently lack a clear strategy to prepare residents to assess and deliver value-based care. In this presentation, I present the VALUE Framework (Patel, Davis, & Lypson 2012) for the University of Vermont Family Medicine residency program to teach residents to assess and deliver value-based care for their patients during preceptor sessions.
Breast Density Notification: A Primary Care Summary

Nicole Lin Mendelson
Short-term Project
On January 15^th, 2017 Vermont Senate Bill 157 took effect requiring healthcare facilities that perform mammography to provide patients information that identifies their individual breast tissue classification. 40-50% of women fall into the category of having increased breast density. Increased breast density reduces the sensitivity of mammography and increases the chance that cancer will not be detected. Additionally, women who have dense breasts are at an increased risk for developing breast cancer. Supplemental screening provides an opportunity to increase detection of breast cancer, but comes with an increased rate of false positives. With this new law in place, there is a need to educate primary care physicians on the risks and benefits of available supplemental screening technologies so that they may appropriately counsel patient that wish to proceed. This project resulted in an educational document and presentation to primary care physicians at Berlin Family Practice with the aim of raising awareness about the topic, providing education on the screening options/counseling patients, and providing a forum to discuss how patients will be affected.
Addiction Recovery Support: Connecting Primary Care Providers and Community Resources

Amber J. Meservey
Short-term Project
Addiction to drugs and alcohol is a pervasive problem throughout Vermont and the U.S., and only a fraction of those needing help receive it. The vast majority of admissions to substance abuse treatment programs do not come from healthcare providers, who report a lack of preparedness in managing addiction screening and referrals. Recognizing that Family Medicine Providers are likely to be caring for many patients struggling with substance abuse, this project aims to improve provider familiarity with local resources. In particular, this project focuses on promoting long-term retention in self-help group programs, as these have been demonstrated to be the most approachable form of help for many presenting in the primary care setting.
Talking To Your Teens About Pregnancy

Sergio Andres Munoz
Short-term Project
Teen parents are at risk for a variety of adverse life outcomes. The rate of low birth weight and premature delivery is higher among teen mothers than the average population. Teen pregnancy and birth are major contributors to lower educational achievement and income as they are less likely to graduate High school and college, leading to increased rates of poverty among teen mothers. This project aims to educate parents of at risk teens on how to approach the topic with their kids and to provide them with a list of online sources to aid in the process.