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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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.
Nutrition, Diabetes and Misconceptions

Kristen M. Dalton
Short-term Project
One of the most effective ways to assist patients with diabetes is to empower them to manage their diabetes through lifestyle change. However, figuring out what to eat when you have diabetes can be very confusing. This project attempted to provide simple lifestyle changes patients could make.
SAD Management in Lewiston, ME

Ashley L. Deeb
Short-term Project
Seasonal affective disorder may be a significant issue in Lewiston, ME due to it's latitude. In addition, lack of transportation and poverty are also issues in this community. This project attempts to address treatment and increase awareness of SAD in Lewiston.
Mindfulness as an Effective Strategy for Anxiety Relief in Adolescent Patients

Desiree N. DiBella
Short-term Project
Anxiety disorders affect 6.8 million adults over the age of 18 in the United States, and anxiety disorders are the most common mental health illness in children.

Risk Factors for anxiety disorders in young adults include the following: -Shyness, or behavioral inhibition, in childhood -Being of the female sex -Having few economic resources -Exposure to stressful life events in childhood -Anxiety disorders in close biological relatives -Parental history of mental disorders -Elevated afternoon cortisol levels in the saliva Teens and young adults increasingly suffer from anxiety disorders with the CDC reporting the rate of anxiety disorders among 3 to 17 year olds in the range of 3% with current symptoms to 4.7% having ever reported having anxiety. Mindfulness or the ability to be fully present, aware of where we are and what we’re doing, and not overwhelmed by what’s going on around us, can be effective means to manage stress and anxiety symptoms. Primary care physicians can introduce and practice mindfulness strategies within patient visits in addition to or replacement for management with medications.
Education on Tick Bites, Tick Borne Disease, and Prevention in Middlebury, VT

Florence DiBiase
Short-term Project
Tick borne disease and tick encounters are continuing to increase significantly in Vermont, and represent a significant portion of primary and urgent care visits. In order to spread awareness and educate both providers and patients as to the incidence, symptoms, treatment, and prevention of tick borne diseases, an informational guide was made. This guide includes information for providers including up to date statistics, a tick identification and life cycle guide, and a chart explaining symptoms, lab findings, diagnosis, and treatment of the diseases found in Vermont. It also includes a patient education handout with a cut out identification card. This information was distributed to Middlebury Family Health doctors, nurses, and patients for their benefit.
Improving Access to Resources for the Medically Uninsured and Underinsured

Katelyn Donaldson
Short-term Project
Many patients are uninsured or underinsured and are burdened by paying for appointments, labs/imaging, and prescription medications. There are a number of resources available to help with financing healthcare; however, they are under often under utilized. The aim is to create a singular tool for patients to identify resources applicable to their specific healthcare needs to better empower the underserved community members.
Increasing Advance Directive Knowledge among Healthcare Professionals

Laura K. Donnelly
Short-term Project
Advance Directives (ADs) have been shown to be associated with increased patient satisfaction with end-of-life care, decreased in-hospital deaths, and decreased end-of-life costs in high-cost regions. Nationally, prevalence of ADs has increased over the last 20 years, but the majority of patients still have not completed an AD. A significant obstacle to completion is lack of awareness. A presentation to increase knowledge regarding ADs among primary care staff was created to address this.
Debate as a tool for rehabilitation: a 8 week debate and public speaking course at Woodside Juvenile Rehabilitation Center

Liam Donnelly
Short-term Project
Sanction based prison approaches help to prevent crimes, but newer studies have shown that they do not prevent recidivism. Conversely, rehabilitation based programs have been shown to reduce recidivism rates, sparking a resurgence in these types of programs. Further, sanction based practices cost significantly more than rehabilitation programs that use parole. While rehabilitation programs are more effective and cheaper, more studies need to be performed to determine which type of rehabilitation program is the easiest and most effective. Preliminary studies show that education and CBT based programs are among the most effective. In order to add to the knowledge about education based approaches, we conducted an 8 week debate and public speaking intervention developed and organized by Jessica Bullock and SPEAK Inc. We hope to show that debate programs can provide valuable rehabilitation skills to students in prisons and help to reduce recidivism rates.
Assessing Patient Perspective of Current Suboxone Treatment

Midori Eckenstein
Short-term Project
The number of people seeking treatment for opioid abuse and heroin use. While this number is increasing the number of heroin fatalities is also on the rise. Methadone clinics are reporting better retention rates than suboxone treatment. This project explores the patient perspectives of suboxone therapy and what can be improved to help establish better practices.
Hidden Adolescent Risks: Provider Education on Non-Suicidal Self-Injury

Bailey Fay
Short-term Project
Non-suicidal self-injury (NSSI) has been shown to be a strong risk factor for suicidal ideation and suicide attempt. One study has shown over 50% of people engaging in NSSI have at least one suicide attempt in their lifetime. The 2015 Vermont Youth Risk Behavior Survey found 17% of high school students reported non-suicidal self-injury at least once in the past year. This reflects roughly one in four females and one in ten males. Furthermore, these numbers have increased significantly since 2013. In an effort to promote awareness of NSSI in the primary care setting, a handout was created for providers at UVMMC Family Medicine on this topic. The goal of this handout was to increase early detection and intervention for adolescents engaging in non-suicidal self-injury. Information covered in the handout includes the prevalence of NSSI, who is at risk and why, signs of self-injury, how to assess the severity of NSSI and if emergency intervention is needed, how to discuss this topic with teens, available treatments, and local resources for adolescents.
Counseling Pregnant Women on Marijuana Use

Theresa B. Flanagan
Short-term Project
Marijuana is the most commonly used illicit substance for pregnant women nationwide, with rates of use trending upward. Marijuana use in Penobscot County is elevated well above the national average, and is likely to continue to rise with the legalization of recreational marijuana in the state of Maine. Though the American Congress of Obstetricians and Gynecologists (ACOG) discourages marijuana use during pregnancy and breastfeeding, studies have shown that providers do not emphasize counseling pregnant patients on marijuana use. This project looked at provider practices and perceptions regarding marijuana use during pregnancy at the Center for Family Medicine at Eastern Maine Medical Center in Bangor, ME. Addtionally, an information sheet for providers regarding marijuana use during pregnancy was created based on current research and survey results.
Sleep Hygiene In Danbury CT: Providing a Resource to Prompt and Initiate Behavior Change

Sebastian A. Franco
Short-term Project
Sleeplessness is a problem encountered frequently in the primary care setting, and often is inappropriately addressed by prescribing pharmacological intervention for indefinite periods of time. This project sought to promote behavioral intervention strategies modeled after CBT-I to address sleep hygiene in patients struggling with their sleep.
Immunization Safety: Addressing Parental Safety Concerns

Andrew Gallagher
Short-term Project
Since 1998, when a fraudulent research paper alleged a connection between the MMR vaccine and autism, increasing numbers of parents are refusing routine childhood vaccinations. Recent research has shown parents’ top vaccine-related concerns included the number of vaccines during the first 2 years of life, administration of too many vaccines in a single doctor visit, and a possible link between vaccines and autism. More than 10% of parents of young children refuse or delay vaccinations, with most believing that delaying vaccine doses is safer than providing them in accordance with the Centers for Disease Control and Prevention’s recommended vaccination.
Backpack Safety Awareness to Prevent Back Pain in School-Aged Children

Aaron M. Gelinne
Short-term Project
According to the Consumer Product Safety Commission, more than 6,300 children between the ages of 5 and 18 were treated in emergency rooms for backpack injuries in 2016. Swanton Elementary School services over 500 children and frequently cites back pain as a reason for nurse visits, but does not provide any education on proper backpack safety. September 20, 2017 was National School Backpack Awareness Day which provided a unique opportunity to educate school parents and children about backpack safety.
Improving Diabetes with an Exercise Log

Ramya Ghantasala
Short-term Project
Diabetes is a prevalent and costly disease. Everyone benefits from physical activity, but it is particularly beneficial for people with diabetes. One method to improve motivation and adherence to physical activity may be the use of monitoring with an exercise log.
Domestic Health Assessment for Syrian Refugees in Rutland, VT

Ian Grant
Short-term Project
The Vermont Dept. of Health/Agency of Human Services “Refugee Domestic Health Assessment Form” was reviewed, edited, and reformatted to improve provider work-flow, ensure accuracy, and ease the process of data collection. This form was redesigned specifically to be used by providers in Rutland, VT when assessing the health of newly-arrived Syrian refugees.
Improving Adolescent Nutrition: Using Smartphone Applications to Guide Healthy Eating

Allison Greene
Short-term Project
Rates of adolescent obesity remain high throughout the United States. While Vermont fares better than other states, 12.4% of high school students in the state are obese. This project sought to harness teens' frequent use of smartphones to communicate important nutrition information and promote healthy eating patterns. A search was conducted for nutrition-related iPhone and Android applications to create a list for distribution to adolescent patients at South Burlington Family Practice.
The Facts - Your Choice: STD Risk Information for the Adolescent Patient

J C. Gwilliam
Short-term Project
Sexual health education is one of the factors that has led to a dramatic drop in adolescent pregnancy since the 1990s. Paradoxically, though, rates of sexually transmitted-infections (STI) in the adolescent population during that period soared. The educational deficit appears to be a lack of understanding of both short- and long-term health risks that STIs pose, and conflation of contraceptive effectiveness with STI prevention. This project sought to develop an inexpensive, office-based education product that would aid practitioner-adolescent patient discussion and facilitate follow-up in the family medicine setting.
Concussions: A general approach to management for coaches

Morgan Hadley
Short-term Project
Youth sports (including Central Vermont Little League) are mostly coached by parents and while concussion training is suggested, it often does not occur. This leaves coaches much less likely to recognize concussion symptoms which can be dangerous. Additionally if coaches do not understand the impact of concussions they will be unable to provide any information to the youth athletes they are working with. Concussions symptoms have been shown to last longer in younger athletes and returning to play too soon puts the athlete at increased risk of an additional concussion. Therefore, education was provided to Little League coaches with the goal of ensuring that concussions can be recognized and proper management will be initiated with athletes.
Chronic Pain: Improving Patient Awareness of Management Options

Lauren E. Haggerty
Short-term Project
Chronic pain affects 100 million Americans and places a significant burden on patients and their families. Opioids are frequently used to manage chronic pain, and their potential for misuse, addiction, and adverse effects are of growing concern in Vermont. Increasing patient awareness of different pain management options could decrease patient suffering and mitigate the opioid epidemic. This project aimed to educate patients on chronic pain management and resources available in Franklin County.
Use of Opioids for Pain Management: Educating Patients and Providers on Upcoming Changes to Vermont State Law

Ashley C. Hodges
Short-term Project
Vermont is suffering from an opioid epidemic. With 112 opioid-related deaths in 2016, nearly every community has been touched by this crisis. In an attempt to combat this problem, new legislation (effective July 1, 2017) will change how opioids are prescribed for both acute and chronic pain management in Vermont. Changes include dose limitations for acute pain, stricter monitoring requirements, and mandated prescribing of naloxone (an overdose reversal agent) for patients on high doses of opioids or on both opioids and benzodiazepines. This project aims to educate patients about upcoming changes.