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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Assessing Access to Smoking Cessation Resources in Rural Populations

Tristan McKnight
Short-term Project
Smoking is a modifiable risk factor for cardiovascular disease. Upstate New York has a high adult smoking rate of 20.9%, compared to a New York state rate of 16.2% and a national rate of 18.1%. The Affordable Care Act has increased resources available that can help smokers quit, including tobacco use screenings, cessation interventions and stop smoking counseling; however, several patients that smoke are unaware of the resources available to them when they are ready to stop smoking. Multiple Cochrane Reviews on the effectiveness of smoking cessation programs demonstrate that some cessation interventions are more effective than others; however, some cessation resources remain unavailable to upstate New Yorkers.
Reducing Falls: Merging Research and Community Resources

Alison Mercier
Short-term Project
1/3 of older adults over the age of 65 fall, 10% of these falls can lead to serious injuries like hip fractures. The average length of life for someone who fractures their hip is 6 months. The risk and reasons for falling are multifactorial and often take a long time to assess. There are a few evidence based recommendations for reducing fall risk, yet a lack of awareness of these recommendations, and community resources to address this need. This project aimed to create a standardized assessment tool based on literature research and available community resources to facilitate fall risk assessment targeted at the most vulnerable population, and risks that have proven interventions.
Evaluation of Screen Time in Children

Mohammad Mertaban
Short-term Project
An evaluation of screen time and media use in children. This project looks to education healthcare practitioners about the effects of current media practices in the United States on children. A presentation was given to healthcare practitioners at a family medicine practice and a brochure was created to distribute to families in the waiting room. Practitioners reported an increase in knowledge regarding the subject of screen time in children, an increase in their comfort level in in discussing these effects with patients, and increase in their ability to effectively communicate the media guidelines of the American Academy of Pediatrics.
Patient Education: Assessing the Barriers to Utilize & Create Effective Educational Resources for Type 2 Diabetes Mellitus (T2DM)

Alexandra K. Miller
Short-term Project
Despite a myriad of diabetic information, group classes and diabetic patient educators, patient’s with poorly controlled diabetes persist. Educating patient's on diet and lifestyle modifications are particularly challenging for the patient and provider and making the changes are even harder. The use of printed patient education material in a primary care setting and referral practices to diabetic educators was evaluated by distributing a brief survey to staff in a primary care office. The convenience sampling showed that some staff did not offer printed materials at all and patient's seldom requested these resources. The referral practices and preference of counseling patient's on diet and exercise was provider specific. Practice guidelines may benefit patient's and increase participation in group classes and prevention programs that focus on behavioral changes, diet and lifestyle modifications.
Evaluating patient literacy to improve health outcomes in Milton, VT

Lindsay R. Miller
Short-term Project
Health literacy is one aspect of overall literacy that has an enormous impact on patient health outcomes, including knowledge of disease, health markers, general health status, and number of hospitalizations, among others. More than 1/3 of the US population has basic or below basic health literacy status. In Chittenden County, diabetes and heart disease deaths are higher than the state average; these diseases require complex personal care and management. Health care providers working at Milton Family Practice in Milton, VT, often noted that patients were often unwilling to disclose literacy issues and there were often problems communicating instructions to patients when providers were unaware of their literacy status/abilities. Residents working at Milton Family Practice were given three simple screening questions that were validated to assess patients' health literacy status with good sensitivity and specificity. These questions are quick and easy to use and avoid many issues with embarrassment or stigma. Residents were also provided local community resources to refer patients to who may benefit from additional help, including the Milton Public Library and the Milton Family Community Center.
Child Obesity Education: Sugar in Common Snacks

David M. Nguyen
Short-term Project
Causes of childhood and adolescent obesity are multi-factorial: sugary beverages, snack foods, portion size, activity level, environmental factors, socio-cultural factors, family factors and psychological factors to name a few. There are both immediate and long-term health effects for childhood obesity. Ultimately, it plays an economic burden with an estimated national medical cost of obesity-related illnesses in adults to be 209.7 billion. This pamphlet is an easy to read resource with the purpose of educating parents and adolescents about the hidden sugar in everyday snacks.
Facilitating HIV Pre-Exposure Prophylaxis (PrEP) Familiarity Among Vermont Primary Care Providers

Michael Ohkura
Short-term Project
Please see the updated version of this presentation: Ohkura, Michael; Bonefant, Nicholas; and Upton, Michael D., "A Sex-Positive Approach to Healthcare, and Truvada as HIV Pre-Exposure Prophylaxis (PrEP)" (2018). College of Medicine Faculty Publications. 3. https://scholarworks.uvm.edu/comfac/3

Nationally, incidence of new HIV infections has hovered around over 50,000 per year and men who have sex with men (MSM) carry the largest burden. In Vermont, 56% of individuals newly diagnosed are MSM, with 25% of diagnoses among youth ages 13-24 years old. Despite the proven efficacy and approval of daily Truvada (emtricitabine + tenofovir) as Pre-Exposure Prophylaxis (PrEP) against HIV infection, provider understanding and awareness of its use has remained extremely limited in Vermont with last estimates at just over 9 providers familiar with PrEP (excluding UVM Student Health, Planned Parenthood, and UVM Medical Center infectious disease department). Based on a UVM College of Medicine student public health project which identified provider training and education as the largest barrier to prescribing PrEP, this ongoing project aims to familiarize Vermont primary care providers with language and sexual history taking in MSM, emphasize accurate identification of higher risk times for HIV infection in an individual's lifetime, and encourage consideration for PrEP as a powerful element of a comprehensive sexual health program.
Screening for Domestic Violence Against Women: A Public Health Crisis in Maine

Clare Park
Short-term Project
The role of healthcare providers in stopping domestic violence against women, a public health crisis, through promoting a culture of universal screening and community education.
Resource Guide to Empower Walkers in the Newbury Community

Kishan Patel
Short-term Project
The project identified the need and barriers to healthy and accessible forms of exercise in the Newbury community of VT. Surrounding areas of Groton, Ryegate, Wells River, and Haverhill in New Hampshire are also covered. Walking trails were identified as the most accessible form of exercise in the region for patients with metabolic syndrome visiting doctors at Little River Health Care in Wells River, VT,
Improving Community Health with Affordable Internet Access

Joshua Jeremy Pothen
Short-term Project
Internet access is associated with increases in health information seeking and benefits in health statuses. However, many individuals of low socioeconomic status (SES) lack Internet access, thereby creating significant disadvantages from a health perspective. In this project, we describe a potential project for providing affordable Internet access to a neighborhood of Newport, VT containing many SES individuals. This network includes a splash page that provides regular health event promotion and health information dissemination to everyone connecting the network. We then discuss how to determine the impacts of the Internet on multiple aspects of health within the community.
Identifying Depression in the Elderly

Gayathri Prabhakar
Short-term Project
Depression among the elderly is significantly under-diagnosed and inadequately treated. With Vermont's rapidly aging population, particularly in Addison County, increased diagnosis and treatment, whether behavioral or pharmacological, will lead to increased quality of life for aging individuals and their caretakers. This study aimed to increase patient education about the signs of depression as well as available community resources available to help this patient population.
Tdap Vaccination in Pregnancy

Melissa N. Rafferty
Short-term Project
Since Maine's incidence of pertussis is higher than the national average, primary prevention through vaccination is important to protect vulnerable populations such as newborns in the state. Maternal Tdap vaccination between 27 to 36 weeks of pregnancy is recommended by ACIP to boost placental IgG transmission to the fetus and prevent newborn morbidity and mortality. For quality improvement, maternal Tdap vaccination rates were examined at Eastern Maine Medical Center Family Medicine Center and Residency and an educational handout was developed.
Creating a Welcoming Clinical Environment for LGBT Patients

Samy S. Ramadan
Short-term Project
The aim of this project was to develop a welcoming clinical environment for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients at Northern Counties Health Care (NCHC) and to serve as a model for community health centers across the nation that want to provide their LGBT communities with patient centered care that is affordable, compassionate and accessible. This was achieved by revising non-discrimination policies and new patient forms to be more inclusive of sexual orientations and gender identities, incorporating LGBT health learning modules into yearly provider and staff mandatories, and adding LGBT inclusive material into all waiting and exam rooms. The effectiveness of these interventions was evaluated using the Healthcare Equality Index (HEI) scoring criteria developed by the Human Rights Campaign. Future interventions include registering competent and sensitivity trained providers to the GLMA (Health Professionals Advancing LGBT Equality) provider directory, including data fields for sexual orientation and gender identity as part of the electronic health record (EHR) for all patients, conducting a community needs assessment with local LGBT groups such as Outright Vermont and NEK LGBTQ Advocacy Committee, developing a partnership with the DHMC Transgender Clinic for additional training in the management of hormone therapies, and measuring LGBT patient satisfaction through phone interviews.
Increasing Male Patient Awareness of Contraception Options

Saraga Pannala Reddy
Short-term Project
There are many effective contraceptive methods available, yet 46% of pregnancies in Vermont are unintended. The majority of educational initiatives to increase high-efficacy contraceptive use are directed only towards women, and not their male partners. This intervention aims to help primary care providers educate young male patients on contraception, using an engaging pamphlet. Improving male patient awareness and understanding of contraception options may help partners have open and informed discussions that lead to more consistent contraceptive use.
Abortion Resources Patient Handout SmartPhrase

Andre A. Robinson
Short-term Project
Many patients in Vermont need to seek abortion care outside of their regular doctors office. When a patient discovers that she is pregnant there should be a non-biased conversation about options as part of The Patient Centered Medical Home. This resource includes: where to go for an abortion, how to pay for it, who to call for support, and advice on how to avoid biased institutions.
HPV Vaccination: Educating and Empowering the Next Generation

Sruthi Sakamuri
Short-term Project
Vaccination against Human Papillomavirus (HPV) is able to protect against 70% of strains causing cervical cancer and and 90% of strains causing genital warts, yet vaccination rates for boys and girls are still well below average vaccination against many other preventable diseases. Experts agree that patient education and strong physician recommendation of HPV vaccination of pre-teens and teenagers is essential in improving vaccination rates in CT. The objective of this project was to assess and improve understanding of HPV, its implications, and vaccination in a high school population in Danbury, CT. The education session significantly improved students' understanding of HPV vaccination and subjectively improved their confidence in becoming health advocates for HPV vaccination.
Home Blood Pressure Monitoring Pamphlet

Isobel Ycasas Santos
Short-term Project
- Home blood pressure monitoring aids in the proper diagnosis of an elevated blood pressure in the office.
- Written instructions on proper BP measurement at home is currently lacking at the UVMMC Family Medicine South Burlington site in addition to other affiliated sites. A home blood pressure monitoring handout can serve as another opportunity for hypertension control.
- Its utility as a diagnostic tool is dependent on proper BP measurement techniques. The HBPM will hopefully encourage the proper utility of the device.
- HBPM encourages patients to take control of their own health, and at the same time it facilitates discussion with their physicians
Resources for Moms: Opiate Use in Pregnancy

Amy Schumer
Short-term Project
Substance use in pregnancy is not uncommon and the use of substances increases the risk of complications during pregnancy. In Vermont, opiate use in pregnancy is increasing as well as the number of people seeking treatment for opiate misuse. This project was designed to give pregnant mothers using opiates an idea of what to expect during their pregnancy as well as the resources that are available to them in the Springfield, VT area.
Promoting Physical Activity Using Walking Poles in Senior Citizens of Southern Vermont's Deerfield Valley Region

Siyeon A. Seong
Short-term Project
Walking poles have been shown to be beneficial in increasing physical activity and improving functional outcomes. Walking poles have been recommended during patient encounters using an informational pamphlet at Deerfield Valley Health Center in Wilmington, VT.
Evaluation of Geo-Social Networking Application Use Among Young Adults

Caleb Seufert
Short-term Project
Background: Since 2009 geosocial networking applications (GNAs) have rapidly emerged as a new technological platform for users to communicate, date, and meet for sex. Popular GNAs include Tinder, Grindr, Bumble, Plenty of Fish, and many more. GNA’s are unique to traditional dating websites in that they allow users to connect with each other based on geographic proximity of their mobile phones. Given the pervasiveness of technology usage among young adults, it is important to understand the potential risks and benefits that GNA-facilitated communication poses on sexual health, emotional well-being, and safety. Popular GNA’s, like Tinder, estimate the majority of users are 16 to 34 years-old. Coincidentally the CDC reports half of the 20 million new sexually transmitted infections each year are among 15 to 24 year-olds. Examination of GNA use and its association with high-risk behaviors and sexual health outcomes among heterosexual young adults is warranted.

Methods: A focus-group was held with Western Connecticut State University’s (WCSU) Collegiate Health Service Corps Club (CHSCC) in an effort to create a survey for undergraduate and graduate students on campus. WCSU Institutional review board granted an exempt review status for the project. Through a collaborative effort, a 26-question survey was developed and administered to WCSU students ranging from 18 to 25 years-old. The number of surveys distributed was stratified based on three age groupings: 18-20 years-old (n = 19), 21-23 years-old (n = 20), and 24-25 years-old (n = 20). The survey contained questions regarding GNA’s usage and practice, student sexual health and practice, and overall safety and wellness.

Results: A total of 26/60 (43.3%) young adults surveyed reported using geo-social dating applications. The distribution of GNA use among the three age groupings did not differ significantly. The most popular applications used: Tinder (58%), Plenty of Fish (15%), OkCupid (12%), and Bumble (6%). The vast majority of students report using the apps for 11 months or less. A total of 80% of students stated they were sexually active, however over half reported either inconsistent or none-existent barrier method contraceptive use. The primary reasons for using GNAs was “curiosity/fun” and “companionship,” however a smaller minority reported seeking either romantic relationship, casual hook-ups, or sexual intercourse. Of the GNA users, a total of 48% reported they meet-up with other users either “sometimes” (29%), “somewhat often” (15%), or “often” (4%). The nature of these encounters included mostly conversation, texting, social activity, and a smaller minority reported dating, ‘hooking-up,’ oral sex, and sexual intercourse. Interestingly, over half the GNA users have worried about their safety at some point.

Conclusion: Survey results cannot directly equate GNAs with STD risk or prevalence, however they do encourage app-users to think about whether their own app-use places them at a sexual, emotional, and/or safety risk. Given the demonstrated prevalence of GNA use among young adults, it is important for the general public, health care providers, and app-users to understand the potential risks and benefits of this type of social networking platform.
A Confidential SMS Texting Service for LGBTQ Youth Sexual and Reproductive Health

Matthew A. Shear
Short-term Project
Compared to heterosexual youth, lesbian, gay, bisexual, and transgender youth are at higher risk for depression, tobacco, alcohol and other drug use, suicide, and unhealthy sexual behaviors. The #1 priority set by Vermont's LGBTQ youth was access to queer-inclusive sex education during middle and high school. In collaboration with OutrightVT, an LGBTQ youth service organization based in Burlington, we worked to expand access to a 24 hour text-messaging based reproductive health hotline 724-888-7277 (SASS).

The number and frequency of text messages submitted to the hotline pre- and post-intervention were used measure the increase in access/awareness.
Barriers to Healthy Eating Among the Senior Populations in Brookfield, CT

Yueyue Shen
Short-term Project
In the U.S, the cost of diseases associated with unhealthy eating reaches $157 billion a year. In the Western Connecticut area, hypertension and diabetes are the top two reasons for admitting seniors to the hospital. Both of them can be managed by healthy diet and exercise. This project aims to identify the barriers to eating healthy among elderly in Brookfield, CT, and to discuss potential interventions that can be implanted to address the identified barriers.
Intimate Partner Violence: Providing Resources to Patients and Facilitating Understanding

Andrew R. Sheridan
Short-term Project
Intimate Partner Violence is defined as physical violence, emotional violence, sexual violence, psychological aggression and stalking against a current or former partner. High volume primary care offices like UVMHN Berlin Family Medicine address primarily medical concerns of patients. While this includes mental health, IPV is infrequently a part of doctor-patient interactions. This project assesses available data on IPV nationally and in Vermont. It aims to understand how IPV is currently addressed, recommendations regarding addressing it and provides resources to patients.
Diabetes and Your Eyes: The Importance of Annual Eye Exams

I-hsiang Shu
Short-term Project
Diabetes is the leading cause of blindness in the United States. With diabetes, one has a 25 times higher risk of blindness than the average American and each year in the US, there are more than 12,000 new cases resulting from diabetes. This significant risk of developing blindness is because diabetic eye changes often occur silently, without symptoms, until it is too late and permanent damage to your eye has already occurred. The two most important things a diabetic can do for eye health is to properly manage blood sugars and receive an annual dilated eye exam from an eye health professional. This will prevent development and progression of any new disease in the eye as well as detect any existing condition of the eye early enough such that it can be managed without complications. This project aims to improve the level of compliance for annual eye exams by diabetics at Milton Family Practice through an educational handout on how diabetes affects the eyes, the changes that can occur, and how their eyes should be examined annually.
Provider Resources for Managing Complex Patients and Physician Self-Care

Elena Romana Siani
Short-term Project
Physician burnout has increased over the past decade and continues to increase each year. Patients with high levels of medical and social complexity can be difficult to manage and when standard treatments fail it is often difficult to know what to do next. This project aimed to address the presence of both physician burnout and the effect it can have on the care of patients and particularly the most complex ones. A list of resources for complex patient management and physician self care was compiled and presented for physicians at Berlin Family Practice.