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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Harm Reduction in the Emergency Department

Alexa J. Golden
Short-term Project
The number of overdose deaths in Vermont has been trending up over the past several years. A majority of these fatalities involved synthetic opioid fentanyl. The Emergency Department (ED) at Central Vermont Medical Center delivers medication assisted treatment (MAT) through the Rapid Access to MAT (RAM) program. This program has connected many people in the region to treatment for opiate use disorder. However it was identified that we lacked connection to harm reduction services for those not interested in MAT. Harm reduction education was provided for recovery coaches and ED nursing staff. Harm reduction kits containing life-saving supplies such as naloxone and fentanyl test strips, safer use information, and local harm reduction services were developed for distribution through the ED.
Assessing the Need and Desire for Nutritional Education

Marc Robert Hammond
Short-term Project
Many people suffer from health conditions that may be affected directly by diet and nutrition including diabetes, hypertension, hyperlipidemia, iron deficiency anemia, obesity, coronary artery disease, and cerebrovascular disease. Education of providers and patients alike may help decrease the prevalence of these health issues and their sequalae. The St. Albans Community has slightly poorer health and nutrition when compared to the entire state of Vermont. Patients in an outpatient primary care clinic in St. Albans, VT were provided with a survey that would assess:

The patient’s confidence in their nutritional skills and knowledge

Their willingness to go to a nutrition appointment Their preference in who would provide the nutritional education to them Results from the survey were used to attempt to understand some of the driving forces for poor nutrition.
Integrating Oral Health in Primary Care to Reduce Early Childhood Caries (ECC): Evidence-Based Guidelines and Recommendations

Alyssa Heiser
Short-term Project
Early childhood caries (ECC) is the most common chronic disease affecting children, despite being almost 100% preventable. ECC has become associated with a multi-factorial etiology including poor feeding practices, enamel hypoplasia, oral colonization by cariogenic bacteria, and demineralized tooth structure due to metabolism of sugars by tooth-adherent bacteria. ECC can lead to school absences, poor school performance, difficulty sleeping, attention problems, slower social development, and poor overall health. According to U.S. Preventative Services Task Force (USPSTF) guidelines, all children are at potential risk for developing ECC beginning at the time of first tooth eruption. While there are no validated multivariate screening tools to determine which children are at higher risk for ECC, there are a number of individual factors that elevate risk, including lack of preventative oral health care and screening before the age of 3 years old. The American Academy of Pediatrics (AAP) recommends fluoride varnish in the primary care setting every 3-6 months starting at tooth emergence. Thus, primary care providers can play a major role in screening for and preventing ECC by initiating fluoride varnish and providing parents and/or caregivers with information on proper oral hygiene for their children at routine well-child visits.
Identifying Barriers to Sunscreen Use and Sun Safety Education

Seneca Hutson
Short-term Project
Using your phone as a weight-loss tool

Sidika Kajtezovic
Short-term Project
Over one-third of the population in the United States is obese. Obesity is a risk factor for many chronic diseases, such as type 2 diabetes, cancer, hypertension, asthma, myocardial infarction, stroke, osteoarthritis and other psychological disturbances. Patient often find it challenging to make dietary changes in order to lose weight. This project focused on the use of a smart phone application to track daily caloric and nutritional intake, as well as exercise, to help patients lose weight.
Type 2 Diabetes Medication Breakdown

Kristen Keene
Short-term Project
There are many new medications for treatment of type 2 diabetes and these medications have many positive effects that go beyond lowering blood glucose. However, many of these medications are expensive and some insurance plans don’t cover them. Many patients struggle to pay for their diabetes medications and providers often are unsure of which medications will be covered by insurance. This project was designed to enhance patient education regarding diabetes medications and potential costs associated.
Type 2 Diabetes Medication Breakdown

Kristen Keene
Short-term Project
There are many new medications for treatment of type 2 diabetes and these medications have many positive effects that go beyond lowering blood glucose. However, many of these medications are expensive and some insurance plans don’t cover them. Many patients struggle to pay for their diabetes medications and providers often are unsure of which medications will be covered by insurance. This project was designed to enhance patient education regarding diabetes medications and potential costs associated.
Utilization of Student Community Health Projects in an Outpatient Primary Care Office

Diane Kim
Short-term Project
Clinical sites for family medicine clerkship have accumulated several years of student community health projects, many of which are written patient education materials. Anonymous surveys elicited the perspectives of medical professionals and faculty on the utilization of these projects in their medical practice. Medical professionals thought the community health projects were valuable educational experiences but cited lack of time as a barrier to utilization in patient care.
A Health Resource List for transgender patients in Vermont

Kathryn Kurchena
Short-term Project
Transgender folks encounter barriers to accessing healthcare for a multitude of reasons. Recent surveys have found that 28% of the transgender people delayed care due to past discrimination within healthcare. In an effort to improve upon this issue in the Burlington area, a list of affirming and effective healthcare resources, services, and providers was created to be distributed at the Community Health Centers of Burlington.
Attitudes Towards Telehealth at the South Burlington Family Practice

Alexandra Elizabeth Kuzma
Short-term Project
In this project, we explore the attitudes of the patient population of South Burlington Family Practice concerning telehealth. To assess the attitudes towards telehealth in the South Burlington Family Medicine Practice patient population, we distributed a brief anonymous survey following telehealth appointments to patients. I focused my intervention on what patients mentioned the most for concerns about a telehealth visit- lack of a physical exam. I made an infographic addressing how to do a thorough physical exam over telehealth to educate providers and ultimately improve patient satisfaction.
Telemedicine in Rural NY: What Comes After COVID-19

Sylvia Lane
Short-term Project
Despite ever increasing access to technology, prior to the COVID-19 2020 pandemic, telehealth has had a slow uptake. This pandemic has shown that telehealth can break boundaries and provide access to healthcare in non-traditional ways. In the rural community of Clinton County, NY, there are higher than average rates of ED visits, obesity, and chronic preventable illnesses. Despite greater than average insurance coverage, this population is not accessing preventative healthcare. Though telehealth appears to be a cure to these issues, the ever-evolving system has found many barriers that were not previously considered. 1 in 5 of these patients does not have access to broadband internet and a large majority cannot afford smart devices. This project aimed to collect telemedicine initiatives that creatively address these barriers and allow for use of technology to improve healthcare for all patients of this community. A comparison of different initiatives in the fields of transitional care, pediatrics, mental health services, and high risk chronic care was created for the health care administrators of the CVPH Family Medicine Clinic.
Genitourinary Effects of Smoking in Men: An Alternative Approach to Smoking Cessation Through Patient Education

Michael J. Lawrence
Short-term Project
Smoking remains a prominent problem in Vermont, especially outside Chittenden County. The genitourinary effects of smoking tend to be poorly appreciated among patients. This presents an opportunity for further patient education and incentivization to quit. This project focused on the genitourinary effects of smoking in men, specifically highlighting how smoking increases risk of bladder cancer, poorer outcomes in prostate cancer, and a higher risk of erectile dysfunction. The project culminated in creation of an educational poster intended for display in patient bathrooms in a medical setting.
Vaping: What Are the Risks?

Matthew Eric Lebow
Short-term Project
In recent years there has been a precipitous rise in the number of individuals using e-cigarettes or vaping devices. According to the Vermont Department of Health, in 2016, there were 22,000 adults who used e-cigarettes. However, even more, concerning was that there were approximately 3,000 high school Vermonters who used electronic vaping products. The dangers around vaping products are multifactorial, including the lack of perception of harm by youth, the risk of nicotine addiction, ease of access, and the potential harms including chemicals, contaminants, and metals.

Even more concerning has been the rise of E-Cigarette and Vaping Produce Use- Associated Lung Injury Outbreak (EVALI). To date, there have been nearly 2,700 hospitalized cases of EVALI, including 34 in Vermont. While there are several hypotheses for what causes EVALI, what is known is that most cases involved vaping products with THC, particularly from informal sources.

The goal of this project was to set the foundation for information dissemination regarding vaping in Vermont and the risk factors for EVALI.
Addressing Pandemic-Related Barriers to Fitness

Kyle Leonard
Short-term Project
Obesity is a persistent concern in Clinton County, New York. Over one-third of children and over two-thirds of adults in the county are classified as either overweight or obese. Obesity is associated with many adverse health outcomes, including all-cause mortality, cardiovascular disease, osteoarthritis, diabetes, and various cancers. Moreover, increased prevalence of obesity leads to increased healthcare costs for those affected, amounting to tens of billions of excess dollars spent annually. As a result of the pandemic, several fitness centers in the Plattsburgh area had closed for good, leaving many residents without access to fitness. Many of those residents had been drawn to these centers due to affordable access or public funding. Now, only a few centers have reopened, all of which may pose financial barriers for Plattsburgh residents to access them. Further, many residents are unaware that some facilities have reopened in the first place. This project aims to provide patients at the Plattsburgh Family Medicine clinic with information on accessing fitness in the era of the Covid-19 pandemic, either through home fitness programs or with operating fitness centers. Additionally, this project aims to inform patients of various incentives from health insurance providers to encourage physical activity in the community.
Assessing Provider Perspectives of Transportation Difficulties for Patients at Hinesburg Family Medicine

Evan Thor Lowry
Short-term Project
This project aimed to assess provider perspectives on transportation difficulties at the UVMMC Hinesburg Family Medicine Clinic. Vermont has an aging population, which is above the national average. Many older patients, lower socioeconomic patients, and patients with disabilities have a hard time making their appointments due to transportation challenges. This study surveyed the experiences of providers with this issue and found that patients routinely mention issues with getting transportation to the facility. To help with this, the author created a list of transportation resources that providers and staff can use for patients at Hinesburg Family Medicine.
Identifying Food Insecurity in a Rural Vermont Primary Care Setting

Jessica Lyon
Short-term Project
Recent years have shown an emergence of interest in social determinants of health by healthcare providers, community leaders, and social service organizations alike. Among the social determinants of health, food insecurity has been associated with higher incidences of chronic disease and poor health outcomes as compared to rates among individuals not screening positive for food insecurity. This project aims to compare the effectiveness of screening patients for food insecurity via formal paper questionnaires versus the traditional approach of an open patient-provider dialog guided by provider intuition in identifying food insecure individuals in a primary care setting.
Maintaining Oral Health in the Era of COVID-19

Kelly MacPherson and Sameer Alidina
Short-term Project
Access to oral healthcare can be challenging for many patients and limited accessibility has been further amplified during the COVID-19 pandemic. Poor oral health is linked to several health complications and insurance coverage for dental care can be restrictive or nonexistent. Recent surveys show that many Vermonters of low-income status feel that their oral health is in poor condition. This project aims to review current barriers to maintaining oral health and propose potential solutions for patients during the COVID-19 pandemic at Milton Family Practice. Two handouts for patients were created, as well as one handout and a smartphrase within the electronic medical record for primary care providers to further assist with oral health maintenance.
Accessing Healthcare in the Era of COVID-19 for Youth Experiencing Homelessness

Ray Mak
Short-term Project
Youth experiencing homelessness face multifactorial challenges in obtaining adequate health literacy. The COVID-19 pandemic has increased the need for healthcare as well as heightened confusion with the spread of health misinformation. This project aims to provide a step-by-step guide for when youth should seek medical treatment for COVID-19 to avoid unnecessary medical costs.
Healthcare Gaps in Migrant Farmer Populations

Elena P. Martel
Short-term Project
Various healthcare gaps have been identified in migrant farmer population, including preventative care, continuity of care for chronic conditions, occupational hazards and work related injury, and mental health services. Barriers to accessing care include lack of transportation, non-English speaking populations, and lack of education regarding US healthcare systems. For this project, flu vaccines were provided to migrant farmers at their homes throughout Vermont. Over 250 vaccines were provided by the Vermont Department of Health. Future directions include annual mobile flu clinics, continuing this model for Covid vaccines, and implementing a global health course for fourth year medical students aimed at addressing migrant farmer healthcare needs.
Conversations about safe firearm storage with patients: why and how

Rose Martin
Short-term Project
This project outlines the need for firearm safe storage counseling in the medical encounter and provides some evidence-based suggestions regarding how to approach conversations about safe firearm storage with patients.
Increasing Influenza Vaccination Access among Migrant Farmworkers on Dairy Farms in Northern Vermont

Allyson R. Miller
Short-term Project
An immediate need exists to provide influenza vaccination to migrant workers on dairy farms in Northern Vermont as vaccination is not accessible to the farmworker population within the current framework that exists. The importance of widespread distribution of the influenza vaccine, especially during the COVID-19 pandemic, has been established but significant barriers to access prevent the migrant farmworker population from receiving the vaccine.
Lifestyle Changes During the COVID-19 Pandemic and Their Impacts on Cardiovascular Disease Risk Factors

Francis T. Mtuke
Short-term Project
The COVID-19 Pandemic has been particularly stressful for a wide array of patients, which has manifested in a number of ways. At the Brookfield Primary Care Clinic in Brookfield, CT, one of the ways that this was most prominent was through the change in the way patients exercised and ate. The impact this will have down the line is unknown, but this study aimed to assess the degree to which these changes have permeated the lives of patients.
Emphasizing Year-Round Physical Activity of Seniors in Vergennes, Vermont

Carley R. Mulligan
Short-term Project
Many senior citizens in the Vergennes community are active in the spring, summer, and fall with various activities, community groups, and walking. However, in the winter with colder temperatures and less sunlight, these activities are difficult to maintain, even more exacerbated by the current Covid-19 pandemic. Encouraging maintenance of physical activity throughout the winter months in Vermont is difficult, but can provide many benefits to these individuals both physically and mentally.
Medication-Assisted Treatment in the Hudson Headwaters Health Network

Jordan Munger
Short-term Project
Background: Opioid use results in over 45,000 overdose deaths annually in the US, with rural areas disproportionately affected. While medication-assisted treatment (MAT) for opioid use disorder (OUD) is an effective intervention available through outpatient primary care, less than 25% of patients with OUD are currently in treatment. This study explored factors associated with patient retention in an MAT program offered by Hudson Headwaters, a Federally Qualified Health Center that serves a vast and mostly rural region of Northeastern New York.

Methods: We included a total of 354 patients diagnosed with OUD who had at least two appointments for MAT between December 2016 and November 2019 in this analysis. We ran univariate and multivariate regression analyses to examine factors associated with overall retention.

Results: The median age at the first MAT visit was 35.2 years (IQR=12.0), and 50% of patients self-identified as female. Overall, the one-year retention rate was 74.7% (95%CI=68.6-81.4). Increased risk for lower retention was seen among men (HR=1.7, 95%CI=1.0-2.8) and those not commercially insured (HR=3.2, 95%CI=1.1-8.7). Receiving MAT directly from a primary care provider greatly reduced the risk of lower retention (HR=0.4 ,95% CI=0.2-1.0). Roundtrip, median travel time to access care was 27.2 minutes (IQR=33.1). Although 12% of patients drove over 60 minutes to get to their MAT clinic, travel time and distance was not associated with retention.

Conclusions: While some surveys have suggested that patient access to MAT clinics is a significant barrier to treatment, for this chiefly rural population, ease of access as measured by travel time and distance was less influential on outcomes than other patient- and provider-level factors. Potential recommendations to improve retention include engaging primary care providers in MAT provision and the use of case management services to address other socioeconomic barriers to treatment.
HHHN Clinicians' Beliefs, Barriers, and Motivations Surrounding MAT

Casandra Nowicki
Short-term Project
Medication-assisted treatment (MAT) consists of using medications that act on the same receptors as opioids to treat opioid use disorder (OUD). MAT providers require formal training and a DEA waiver in order to prescribe certain medications. Providers were asked to complete a survey about the beliefs, barriers, and motivations surrounding MAT to provide valuable insight into what the future of MAT might look like at a specific nonprofit network of community health centers in upstate New York.