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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Caring for Caregivers: Addressing Caregiver Burden in Newtown, Connecticut

Zachary Wunrow
Short-term Project
In 2015, thirty-four million Americans provided unpaid care to an adult 50 years or older. Due to an aging population and an increased number of individuals living with chronic disease, the niche that caregivers occupy in healthcare administration will only become more invaluable in the coming years. However, studies demonstrate that one-third of caregivers report a high burden of care, and these stresses are accompanied by documented health risks including higher rates of depression, insomnia, and all-cause mortality. This project aims to increase awareness about caregiver burden via a pamphlet for caregivers listing local resources that may alleviate burden, and a presentation to healthcare providers at Newtown Primary Care.
Screening Youth for Suicide Risk in Middle School Setting

Nina Xue
Short-term Project
Depression and suicide ideation is a concern among the middle school population in Rutland County, VT. Youths who experience suicidal ideation are more likely to plan and/or attempt suicide later on in life. Standardized suicide screening and educational pamphlets would aid school counselors working with at risk students.
E-Cigarettes: What Primary Care Providers Need to Know

Jennifer S. Albert
Short-term Project
E-cigarettes are gaining in popularity, yet our understanding of their health effects remains uncertain. Many people believe that they can aid in smoking cessation, however the evidence is inconclusive. The conflicting information in the public media has led some providers in Central Vermont to recommend e-cigarettes to their patients. This intervention aims to educate primary care providers about e-cigarettes by creating and distributing a fact sheet that can guide patient-provider interactions.
Hematuria Awareness for Patients

David Arsanious
Short-term Project
In the United States, cancer of the urinary bladder is the most common malignancy of the urinary system, and in the state of Vermont, the prevalence of bladder cancer exceeds that of the nation. The marked discrepancies in outcomes between different stages in bladder cancer represents an exceptional opportunity for improving cure rates by way of strenthening patients' motivation to present to their PCP for evaluation. The most common presentation of patients with bladder cancer is painless hematuria. As such, this project has produced a public service awareness poster that could be adapted for presentation in a variety of print, electronic, and public space media. Furthermore, translation of the text of the poster into Arabic, French, Nepali, Somali, and Spanish is expected to be of significant benefit to those communities which make up visible minorities in the greater Burlington, VT area.
Vermont Concerns and Trends in the SBFP Sub-populations

Paul C. Baresel IV
Short-term Project
Analysis of specific vaccination trends over a 1 month period at South Burlington Family Practice.
Energy, Nutrition, and Exercise: An Effort to Prevent Childhood Obesity in Vermont

Eric Franklin Bennett
Short-term Project
Childhood obesity is an epidemic in the United States affecting 17% of all children. In Vermont 12.5% of children are obese. This carries increased risk for many health problems and an increased cost of medical care averaging $19,000 per obese child over a lifetime. This project aims to teach children about healthy food choices and exercise.
Patient Education: Airway Viral Infections in Danbury CT

Aniruddha Bhattacharyya
Short-term Project
Viruses are the most common cause of respiratory infections, and the most common illness encountered by patients. Antibiotics are frequently requested by the patient to treat viral infections, and efforts by physicians to educate patients on the inefficacy of this treatment plan is often unsuccessful.
Caught Between the Lines

Moshe Bitterman
Short-term Project
The Patient-Centered Medical Home (PCMH) is a model of primary care that combines teamwork and information technology to improve care, improve patient care experiences, and reduce health care cost.This project, conducted at the Hardwick Area Health Center, focused on quality improvement by exploring the patient experience in communicating with the health center by telephone.
Access to Diet and Exercise Resources

Andrea Blood
Short-term Project
In Vermont, about 22% of adults are obese, which has led to many medical co-morbidities and costs the state an estimate of $141 million annually. It is well known that diet and exercise can help tackle this problem yet the vast majority of obese adults do not meet CDC guidelines for physical activity level. This project aims to evaluate barriers and access to diet and exercise resources in a subset of obese patients in Waterbury, VT.
Wellness Resources for Colchester Vermont's Senior Population

Shannon R. Brady
Short-term Project
Vermont's elderly population (>65 years old) is growing rapidly- by 2032, almost 25% of the VT population will be >65. 90% of seniors in VT wish to age in place in their homes. Healthcare providers in VT could play an integral role in connecting seniors who are looking to remain active and involved in their community to resources. Older adults who are connected have a higher level of functional health and increased life satisfaction. Goal was to create a pamphlet highlighting services and activities that can fulfill three meaningful areas of VT senior's lives to help them to continue leading healthy, independent lives. Three areas including: wellness, social enrichment and volunteering.
Increasing Patient Understanding & Provider Awareness of Pap Smears

Stephanie Alexis Brooks
Short-term Project
Pap smear rates are lower than perceived by many primary care providers, and women refuse or miss pap smears for a variety of reasons. This project investigated both reasons for which women miss or refuse pap smears and ways in which physicians can increase pap smear rates, create a more positive environment during the pap smear experience, and more effectively communicate with patients about pap smears. Intervention consisted of an informational flyer about pap smears for female patients.
Vitamin D Screening and Supplementation

Christina Cahill
Short-term Project
Vitamin D helps protect against osteoporosis (by promoting calcium absorption), moderates cell growth, aids in neuromuscular and immune function and reduces inflammation. However, there is insufficient data to access the benefits and harms for screening for Vitamin D deficiency. This study looks at current recommendations for Vitamin D screening and aims to provide information to providers and patients about Vitamin D.
Understanding Opioid Addiction and Relpase Risks for Patients in an Office Based Buprenorphine Treatment Program

Rachel E. Carlson
Short-term Project
Opioid abuse is a serious problem in Maine with a societal cost of 1.4 billion dollars. Buprenorphine has been used as an office based treatment for addiction management. In Maine there is a provider shortage for substance abuse and a large need in the community for treatment. In fact there were 272 deaths in 2015 attributed to overdose. It is important that once patients begin treatment they remain in treatment without relapse. At EMMC Center for Family Medicine we explored risks for relapse from the provider perspective, patient perspective, and retrospective chart analysis in order to guide future interventions at this treatment program.
Introducing Opiate Addicts to the Hub and Spoke Treatment System in Vermont

Richard T. Carrick
Short-term Project
Opiate abuse and addiction is an epidemic in the state of Vermont. Brandon Medical Center has recently become involved in Vermont's "Hub and Spoke" system of medically assisted opiate addiction treatment. This project involved the development of a pamphlet for safe, low-threshold transmission of information regarding opiate addiction and entrance into this system for patient's who may be suffering from this disease.
Exercise for Osteoarthritis of the Knees

Elizabeth Carson
Short-term Project
Osteoarthritis of the knees is considered by many patients to be a barrier to exercise. It is common in primary care to hear patients express the fear that exercise will make their arthritis pain worse. Not only has exercise been shown to reduce joint pain and stiffness, as well as improve quality of life for arthritis sufferers, but it is a key component of weight loss. Weight loss is a major risk factor for developing arthritis, and no arthritis treatment is complete without addressing weight loss for overweight patients. This educational article is designed to provide patients with simple answers to frequently asked questions about arthritis and exercise.
Integrating Care: The Primary Care Provider’s Role in Age-Related Macular Degeneration in Eastern Maine

Homer Chiang and Steven Coffin
Short-term Project
Objectives: To assess general patient knowledge of age-related macular degeneration (AMD), including risk factors, early signs, treatment options, and low-vision resources. We also aimed to assess primary care provider practice patterns including early detection, timely referral to ophthalmology, and management after diagnosis of AMD.

Methods: A 20-point patient questionnaire was distributed to all adult patients at check-in by front office staff at the Center for Family Medicine office in Bangor, ME. Additionally, a looping waiting room slideshow and informational exam room flyer were created for patient education. A 10-point online questionnaire was distributed to residents and faculty at the Center for Family Medicine and three other local primary care offices. A care management summary document was distributed to residents and faculty at each practice.

Results: Our sample included 46 adult patients and 23 primary care providers. 18% of patients reported adequate or expert knowledge of early signs and symptoms; 50% reported poor to no knowledge. Similarly, 18% of patients reported adequate knowledge of risk factors; 50% reported poor to no knowledge. 64% of patients did not know what AMD was, but 74% wish they knew more about the disease. Patients with AMD in one or both eyes, or who have family members with AMD, were more likely to be knowledgeable of signs, symptoms and risk factors.

70% of providers routinely ask about vision at Well-visits. However, 43% of providers somewhat or completely disagree that they can comfortably perform a fundus exam. 52% of providers somewhat or completely disagree that they can comfortably perform and interpret the Amsler grid test. 39% of providers wish they knew more about the risk factors for AMD, while 34% considered themselves to have adequate or expert knowledge of the risk factors. 43% of providers wish they knew more of early signs and symptoms of AMD, while 53% considered themselves adequate or expert.

Conclusions and Recommendations: Our study suggests that knowledge of AMD risk factors, signs and symptoms are lacking in the general adult population. However, the vast majority of patients desire to know more about the disease. While the majority of primary care providers inquire about vision at well-visits, the majority of providers felt that their ability to perform funduscopic exams and Amsler grid testing were inadequate. Additionally, the majority of providers expressed inadequate knowledge of risk factors, early signs, and referral guidelines; subsequently, an even higher percentage or providers expressed a desire to know more. Furthermore, most providers lacked knowledge of low-vision behavioral modifications and community resources to support patients with existing AMD. This demonstrates the value and need for additional AMD education for primary care providers and the general patient population.
Bullying From A Medical Perspective

Mustafa Chopan
Short-term Project
Within the past decade bullying has captured the attention and interest of the media, researchers and policymakers. State laws have since enforced schools to implement anti-bullying programs. Ideally, the approach requires a multi-disciplinary effort directed at multiple levels of organization, but with limited resources schools often make do with what they can. This study looked at the effectiveness of community outreach, particularly from the medical field, in helping schools combat bullying.
Encouraging the use of asthma control questionnaires ATAQ and TRACK to improve asthma management and outcomes

Michael Chung
Short-term Project
Many asthma patients suffer from poor control, are not frequently evaluated by spirometry, and historically have underestimated the severity of their symptoms when reporting them to providers. Asthma questionnaires can be used regularly to establish asthma severity, which can serve as a basis for appropriate management of asthma. This project aimed to motivate and/or educate staff at Hinesburg Family Practice to disseminate the ATAQ and TRACK asthma control questionnaires to youth with asthma.
Fighting the flu - Devising a novel approach to address patient concerns with the seasonal influenza vaccine - South Burlington, VT

Theodore Cisu
Short-term Project
In Vermont, it is estimated that influenza-like illness is responsible for $8.9 million annually in direct medical costs. The flu vaccination rate ranges from 33% to 56% across the nation, and Vermonters are vaccinated at a rate of approximately 49% each year. This program aims to provide a novel educational material to patients, specifically addressing concerns with the safety of the seasonal influenza vaccine.
Providing Medication Assisted Treatment for Opioid Use Disorder in Family Medicine Clinics in Vermont

Kelley W. Collier
Short-term Project
Opioid use disorder is a nationwide issue and a serious problem in the state of Vermont. Medication assisted treatment (MAT) is currently being used to treat individuals with opioid use disorder. In an effort to address the opioid epidemic, more and more family medicine physicians in Vermont are becoming trained medication assisted treatment providers. This project aims to recognize some of the challenges faced by physicians who are currently prescribing MAT in family medicine clinics, as well as to identify the concerns of family medicine physicians who are not currently prescribing MAT. By determining barriers to providing MAT to patients with opioid use disorder in family medicine clinics, additional support and resources can be identified and implemented.
Improving Awareness of Low Health Literacy and Strategies to Overcome It

Sherilyn DeStefano
Short-term Project
This project outlines an intervention delivered at a family medicine residency program in Bangor, ME to increase residents' knowledge of the impact of low health literacy and supply them with communication techniques to help improve patient understanding. Over 36% of U.S. adults have basic or below basic health literacy skills and low health literacy has been shown to lead to poorer health outcomes, increased health disparities, and increased cost. Our presentation focused on communication techniques like Teach-Back, an evidence-based strategy that assesses patient understanding by asking patients to repeat back healthcare instructions in their own words, that has been shown to improve health outcomes.
Pertussis Vaccination in Pregnant Women at the EMMC Family Medicine Center

Elizabeth S. Doughty
Short-term Project
Pertussis, also known as whooping cough, primarily affects infants less than 12 months of age and frequently requires lengthy hospital stays. Maine has the 3rd highest rate of documented pertussis cases in the nation. Guidelines for prenatal vaccination recommend women receive pertussis vaccination during the third trimester of every pregnancy in order to protect the neonate. A small community project was designed to investigate adherence to prenatal vaccination guidelines. Rates of vaccination and electronic medical record (EMR) documentation for patient refusal were investigated for Jan. 1, 2016 - Aug. 1, 2016. Implementation of interventions focused on improving the rate of pertussis coverage in this population will require further follow up investigation to assess efficacy.
Patient Awareness and Understanding of Intrauterine Devices

Lindsey Marie Eastman
Short-term Project
Unintended pregnancy rates in the United States are near 50%, but use of safe and effective long-acting reversible contraception methods, such as intrauterine devices, remain low compared to worldwide rates. Common misconceptions about intrauterine devices likely contribute to this stark contrast in use prevalence. This project aimed to assess patient understanding, awareness, and perception of intrauterine devices at a Family Medicine office in Connecticut. A pamphlet that includes a summary of contraception methods was produced and distributed with the goal of increasing knowledge of intrauterine devices as well as other contraception methods for patients in the primary care setting.
Lyme Disease in Brattleboro, VT: Office Triage and Community Education

Peter Evans
Short-term Project
The rates of Lyme disease are rising Vermont, with 710 reported cases in 2015. While preventable, the disease has significant sequelae and primary care offices in Brattleboro, VT are reporting high volume of calls from patients asking for more information about Lyme disease. Formal surveys of Brattleboro Family Physicians and their clinical support staff identify the need for a uniform triage protocol to answer patient calls, as well as further patient education materials, particularly regarding prophylactic antibiotic use following tick exposure.
Psychotherapy: Skills and Resilience Through Self-Knowledge

Gilana Finogenov
Short-term Project
At least 20% of all primary care visits are related to mental health. A limited number of patients are being referred to therapy, even though therapy is shown to be as effective as medication for disorders like depression and anxiety. A pamphlet was designed to explain what psychotherapy is to patients and to describe several common therapy modalities.