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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HPV Vaccination in Vermont: Identifying Educational Resources for Adolescents

Shane Greene
Short-term Project
HPV vaccine is unique in that (1) it's not a required vaccine to enter school and (2) it's given at an age where patients have more agency over their medical care, so an adolescent who doesn't want to get the shot is often able to avoid it. In Vermont, there's a lack of educational material aimed at young adults about the benefits of the HPV vaccine.
Increasing Access to Community Support Groups for Patients with Mental Health Needs: A Guide for Primary Care Physicians

Daniel Haddad
Short-term Project
A large percentage of patients seen by primary care physicians suffer from mental health afflictions that are requiring increasingly more time and resources to treat. There is a lack of mental health providers to meet the needs of the community which result in 3-6 month waiting periods for patients to get an appointment with mental health providers. More mental health resources are needed to help family practitioners address this problem.
Improving Vascular Health of Patients with Diabetes Mellitus

Pishoy Haroun
Short-term Project
Some diabetic patients are reluctant to take the extra step in their long-term health care, which is particularly problematic as it relates to cardiovascular disease. In addition to difficulty controlling blood glucose levels, patients struggle maintaining an appropriate blood pressure. This is often due to a reluctance to maintain a proper diet, exercise regularly, and take certain medications. Studies have shown that compliance with exercise regimens falls from 80% at 6 weeks to 20% at one year. Many patients are reluctant to start on a statin, and some physicians are even hesitant to adhere to the new recommendations proposed by the AHA.
Marijuana Use Among Pregnant Women in Buprenorphine Treatment for Opioid Dependence

Tara Higgins
Short-term Project
New program, "Closer to Home," will allow pregnant women in buprenorphine treatment for opioid dependence to get treatment closer to home and deliver at Copley Hospital instead of being required to go to Burlington. This requires local physicians to prescribe buprenorphine to pregnant women. In creating the program, prescribing physicians have to decide policies around non-opioid substance use.
Low T? Late Onset Hypogonadism

Cheng-Wei Huang
Short-term Project
Recently, there has been an increase in commercials and ads by pharmaceuticals pushing for testosterone supplementation by capitalizing on the sensitive subject of "low T" or decreased manhood and vague non-specific symptoms of low T. The idea that testosterone is something that occurs within our natural body and that we are only supplementing what’s originally there can be misleading. Many may interpret this as there is no harm but good, but the latest studies have shown otherwise. It is clear that there is a lack of proper understanding regarding testosterone treatment in the public, from when treatment would be suitable to what the risks and benefits are.
Dietary Supplement Education in a Primary Care Setting

Suleiman Ismael and Mikaela Rodriguez
Short-term Project
More than 50% of American adults use at least one dietary supplement. Despite their popularity, patients and physicians are often unaware of the limited regulation of these products as well as their potential risks and benefits. During our rotation at the Center for Family Medicine in Bangor, Maine, we observed several patients asking about the efficacy and safety of various supplements. Also, many patients wanted to avoid taking pharmacological drugs and inquired about any "natural" treatments to their illnesses. The residents we worked with expressed a lack of confidence in their ability to discuss dietary supplements with their patients. In the overwhelming majority of cases, if a patient did not bring up supplement use on their own, the providers never inquired about it.
Caregiver Burden: Finding Resources, Offering Support

Sarah Johnson
Short-term Project
- Definition: Informal caregivers are unpaid individuals (often a spouse, partner, family member, friend or neighbor) involved in supporting others in activities of daily living.
- Caregiver burden is an emerging public health issue largely attributed to longer life expectancy that not only increases the number of elderly individuals, but also the level of dependency in these individuals.
- Despite many formal support services, informal support continues to be the primary source of care for the elderly, dependent and disabled.
- Unpaid family caregivers will likely continue to be the primary source of long-term care in the United States as the aging population will more than double between the years 2000 and 2030 from 35.1 million to 71.5 million.
- In 2009, three in ten U.S. households reported at least one person providing unpaid care as a family caregiver.
- Caregivers report performing housekeeping and personal tasks, running errands, managing medical needs and more.
- Caregivers spend on average 20.4 hours per week providing care. Those who live with their care recipient spend 39.3 hours per week caring for that person.
Health and Community Resources For Older Adults in Chittenden County, Vermont

Matthew Jordan
Short-term Project
The vast number of resources available to older adults are widely unknown to both health care providers and the older adult population itself.
HPV Infection Prevention in Males by Gardasil Vaccination

Russell Landry
Short-term Project
About 1% of sexually active males in the U.S. have genital warts. Each year 400 males get HPV related cancer of the penis, and 1,500 get HPV related cancer of the anus. 2-3 cases of Genital warts have been reported at Harwood High School (Moretown and Waitsfield), where the school nurse reports 1-3 males students each year seeking information about STIs (including HPV).
Alternative Medicine Resources for Primary Care Physicians

Laura Lazzarini and Angelina Palombo
Short-term Project
Despite the prevalence of patients that would benefit from Complimentary and Alternative Medicine (CAM) at EMMC Center for Family Medicine (CFM), practicing physicians lack sufficient education on CAM and knowledge of community resources to refer their patients to.
Concussion Management in Primary Care

James Levins
Short-term Project
Concussion awareness is a hot topic in youth sports, resulting in increased health care visits. There has been much change in concussion management over the past decade. VT passed a law (Act 68) implementing a concussion management program in schools. Not all primary care physicians are aware of how this law may affect their practice, nor are they all aware of some of the recent changes in concussion management. Improper concussion management can lead to prolonged symptoms, recurrent injuries and long-term sequelae.
School Based Yoga Intervention for Childhood Stress Management

Erica Marden
Short-term Project
Childhood stress can have immediate and long-term negative impacts on physical health, mental health, school performance, self-esteem, and relationships. For children in rural communities there are fewer resources available as recreational and therapeutic outlets for healthy stress reduction. Extracurricular activity involvement also puts significant financial and time burdens on families. There is a particular need to provide children in rural areas with tools to manage stress that can be incorporated into the school day and require few resources. Yoga is an excellent school-based activity that has proven benefits on physical and emotional health for both students and teachers. It has been shown to be effective at improving children's sense of wellbeing and reducing self-perceived levels of stress, and can practiced individually at home without requiring any special equipment.
Community Resources for Elevated BMI in Downeast, ME

Nicolas Monte
Short-term Project
The US is currently mired in a decades-long battle against an epidemic of obesity. According to the CDC 69.2% of the US population over the age of 20 is either overweight or obese. As primary care clinics move towards becoming “Patient-Centered Medical Homes” the need exists to provide adequate and specific educational materials.While a great wealth of educational resources exist to inform patients about the nature and pathogenesis of individual diseases, access to specific local treatment tools is lacking. Although nearly all clinicians screen patients for elevated BMI and provide general information about general healthy habits, this is often the limit of the discussion.Time restrictions on appointment length hinders the ability of the clinician to adequately provide recommendations about how/where patients may work to reduce their BMI.
Managing and Treating Allergic Rhinitis in the Primary Care Setting

Leah Novinger
Short-term Project
Screening and appropriate treatment of allergic rhinitis in the primary care setting is a challenge for providers due to time constraints. Providers in the practice desired more information about where in the community to refer patients with persistent allergic rhinitis and what information or test results they should send those specialists.
Fluoride supplementation: recommendations in the primary care office

Dwight Parker
Short-term Project
Physicians in a Vermont family practice setting tend not to be very familiar with CDC/AAP/AAD recommendations regarding fluoride, especially when it came to rural areas in Vermont not on town or public water. Questions include: What are the pros and cons of fluoride supplementation? What are the indications for supplementation? How does one go about testing their well water? Which towns have fluoridated water, and what are their levels? What doses are recommended, and what options are there for treatment?
Common Naturopathic Therapies for Chronic Conditions

Jordan E. Perlman
Short-term Project
Complementary and Alternative Medicine has started to achieve greater public prominence – many patients report satisfaction and believe these therapies are cost effective. Allopathic physicians are largely unfamiliar with the supplements prescribed by naturopathic doctors, and have trouble integrating these therapies into traditional treatment plans. Patients are not trained to evaluate the safety or efficacy of their medication regimens, and rely on their primary care physicians to provide that service -– even if the majority of their "medications" are supplements recommended by an "alternative" provider.
Creating a Guide for Patient Self-Management of Weight Loss (For Management of Diabetes)

Kelsey Preston
Short-term Project
In my first week working with Dr. Flynn, I saw more patients coming in with a diagnosis of diabetes than those without; this is likely untrue, but it certainly felt like that. I realized how big of an issue diabetes really is, and hoped to work on a project targeted towards diabetes. While I noticed medical and medicinal management of patients with diabetes was adequate, there was a large gap in patient self-management of their diabetes – they followed their prescriptions, but did not seem to have changed other aspects of their lives, most importantly, their diets.
Improving Vaccination Rates in Bangor, ME

Noah Quinlan and Whitney Thomas
Short-term Project
Providers believe vaccination rates at EMMC Center for Family Medicine can be higher. A resurgence in some preventable diseases is likely due to decreased immunization rates. While other preventable diseases have not seen a resurgence, the potential for outbreak exists if immunization rates remain low. Factors contributing to low immunization rates are misinformation, lack of awareness, cost, inconvenience, and infrequent office visits by adolescents.
Addiction Burden and Resources for Patients in Connecticut

Jacob Reynolds
Short-term Project
Nationally, the US has 60 million smokers, 14 million dependent on alcohol, and 14 million illicit drug users. One quarter of Americans over 15 have physiologic dependence on at least one addictive substance. A quarter of all deaths in the US are caused by addictive substances: alcohol, tobacco, drugs. There are an additional 40 million injuries and illnesses per year. Locally, one Connecticut therapist reports sending 30 of her patients under age 22 to in-patient treatment for opiate abuse.
Providers’ Views on Transition of Healthcare for Youth with Developmental Disabilities

Cordelia Y. Ross
Short-term Project
Problem: Youth with DD have conditions that may limit their ability to function, with resulting social, emotional, or behavioral sequelae, and experience difficulty transitioning from child to adult health care. Also, adult providers may lack training and comfort level in working with patients with DD. For example, youth with ASD need an adult provider who understands autism but doesn’t see every health or behavior problem as a result of autism.

National Need: 1 in 6 children in the U.S. has a DD. Each year, almost half a million of these children transition into adulthood. As for ASD, 1 in 68 children (1 in 42 boys) meets ASD diagnostic criteria.

State Need: In Vermont in 2006, 540 children and adults with ASD (with 126 in Chittenden County alone) were being served by the Vermont Community Mental Health and Developmental Services programs. Since then, the number of children with ASD has grown approx. 20% per year.

Community Need: Hinesburg Family Practice currently sees 11 patients with a Code 299 diagnosis (pervasive developmental disorders) per year. These patients accounted for 25 visits during FY 2014. The patients range in age from 5 to 53 years (median age: 17 years).
Identifying and Coping with Adolescent Anxiety

Merima Ruhotina
Short-term Project
Anxiety disorders, which include panic disorder, generalized anxiety disorder, post-traumatic stress disorder, phobias, and separation anxiety disorder, are the most common class of mental disorders present in the general population. These disorders have a negative impact on the quality of life in a number of areas of functioning, including academic performance, social interactions, self confidence, and ability to enjoy daily life experiences and may impact future emotional health. Approximately 20% of youth ages 13 to 18 experience severe mental disorders in a given year. Almost one-half of youth ages 8 to 15 with a mental illness received no mental health services in the previous year. At Colchester family practice, all practicing physicians have a multitude of adolescent patients with a wide spectrum of anxiety disorders.
Creating Patient Instructions for Community Health Resources

Kevin Saiki
Short-term Project
In the US, more than a third of adults are obese as well as 17% of children. A recent report estimates the annual cost of obesity in Maine amounts to approximately 452 million dollars. Additional reports estimate the cost of obesity to the entire country lies somewhere between 10-30 billion annually.

Encouraging patients to have healthy diet rich with whole grains, fruits, and vegetables, and to maintain regular exercise (150 minutes a week) are effective ways to combat higher BMIs and to stave off associated hypertension, coronary artery disease, type II diabetes, and dyslipidemia.
Medicare Part D: Avoiding the “Donut Hole” and Cost-related Medication Nonadherence

Daryl Selen
Short-term Project
Problem: Studies have shown that only ~50% of patients with chronic conditions take their medications as prescribed. Patient nonadherence can be due to forgetfulness, desire to avoid adverse side effects, and high costs of medications, particularly in patients with low incomes, multiple chronic health problems, and no prescription coverage. Attempting to reduce medication costs by taking less than prescribed dose does not allow for full therapeutic benefits, and may put patients at increased risk for declining health. Consequences of cost-related nonadherence (CRN) and underuse: increased ED visits, psychiatric admissions, nursing home admissions, and decreased health status. In patients with asthma, medication nonadherence has led to increased hospitalization rates and other adverse outcomes. Up to 88% of patients with asthma do not properly follow their inhaled medication regimen. CRN behaviors are influenced by financial pressures and polypharmacy. However, physicians and other members of the health system may prevent these behaviors by fostering trust, prescribing cheaper medications, and providing access to prescription assistance programs.
Health Insurance Coverage and Young Adults

Cameron Sikavi
Short-term Project
- Young adults have the largest percentage of uninsured citizens of any age group in the United States. According to the CDC, 38.4% of the uninsured population in 2013 was between the ages of 19 – 34. This equates to 27.2% of 19 – 34 year-olds in 2013 not having health insurance.
- In Connecticut, 18-34 year-olds represent by far the largest demographic of those uninsured, at 43.3% , more than double the rate of the second highest uninsured demographic (45 – 54 year olds, with an uninsured rate of 19.2%). Unfortunately, this remains significantly higher than the national average.
- Danbury in particular has a total uninsured population of 34.0%, which represents the fourth highest percentage of uninsured citizens of all cities in the state.
Improvement in Diabetic Care

Richard Smith
Short-term Project
Over the years, steps have been taken to 'streamline' the process when it comes to diabetic management in the Village Primary Care (VPC) practice. As more and more outcomes are monitored, it is important to both identify the shortcomings of the practice as far as diabetic management, and attempt to implement processes to ensure better outcomes. VPC is doing well in many areas (LDL/BP/BMI), but is lacking in monitoring and implementing certain areas of diabetic management: Recommending and tracking eye exams, HbA1c, Micro albumin, Foot exams.