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Capstone Scholarship & Discovery-PURCH (CSD-P)

CSD-PURCH is a mentored, student-driven, four-year-long scholarly experience on a topic you are passionate about in medicine. Core CSD

In your first year, you work with your mentor in the Brightwood Learning Community to brainstorm ideas, scale the project, and connect you to potential advisors and resources to begin your capstone.

By the fall of your second year you must select a Capstone Advisor who will provide the expertise and additional support you need to complete your capstone. You have the option of collaborating with faculty and colleagues at either the Springfield or Worcester campus.

How is Capstone Different for PURCH Students?

Because your CSD project is driven by you and based on your personal passions (as long as it's related to medicine and meets at least one of the core competencies) it provides an opportunity to make a more direct connection with the purpose of PURCH.

Throughout your four years in the PURCH track, you will gain a deeper understanding of the complex local and regional issues that impact the health of rural and urban populations in western Massachusetts. This valuable longitudinal perspective will help you develop a capstone project that addresses the health needs of our community.

Focusing your capstone in Baystate Health's communities gives you access to the creative and innovative work being done by our community partners and the change-makers in a diversity of fields who are working to transform the health, health care, and the overall well-being of community members in western Massachusetts.

2021 PURCH Capstone Presentations

Colton Conrad

Program Evaluation of the Hampden County Medical Reserve Corps Hands-Only CPR Training

Project Advisor | Goshea, Christopher
Learning Community Mentor | Churchill, Eric

Juliana Dixon

Implementing Universal Screening for Social Determinants of Health in Adult Well Visits

Project Advisor | Gnazzo, Melanie MD
Learning Community Mentor | Wu, Jacqueline

ABSTRACT

Individual and population health outcomes are heavily influenced by the social determinants of health (SDOH). In recent years, healthcare has turned increasing awareness to identifying and addressing these factors. Many health centers have begun universal SDOH screening as an unbiased way to identify patient needs. The goal of this project was to design and implement an approach to universal SDOH screening at an urban Federally Qualified Health Center. The project consisted of multiple phases including analysis of current processes, planning and design, pilot study, and expansion. The scope included the screening process as well as intervention process. Outcome metrics included subjective feedback from health center staff, screening rates, and referral rates. Social needs were also quantified. Results showed that 34-37% of patients screened positive for one or more social need. Of those screened positive, 30-45% desired assistance, these patients were referred to a patient advocate or care manager. Those with urgent needs were given warm hand-off. This project standardized identification of SDOH, initiated standardized, multidisciplinary care for SDOH at an FQHC, and provided population level data on social needs.

Kirstin Lee

Development of culturally competent visual educational materials to enhance women's health literacy in rural areas of Honduras

Project Advisor | Cavalari, Jennifer
Learning Community Mentor | Borden, Samuel

ABSTRACT

Compared to more developed countries, Honduras has a disproportionately high morbidity and mortality rate from cervical cancer. Because of the progressive nature of cervical neoplasia prior to invasive disease, it is a good candidate for screening and should be prioritized as a life-saving service in both urban and rural settings. I partnered with an organization in rural Honduras called SELF, which has multidisciplinary community empowerment projects including a women’s health initiative “Soy Yo”. I hoped to augment their women’s health curriculum through culturally competent visual educational materials. To accomplish this, I would need to investigate the state of cervical cancer screening and treatment in Honduras. The primary goal would be to seek understanding of attitudes and barriers towards preventative cervical screening in rural Honduran communities by immersing myself in conversations with people living there. The secondary goal would be to produce an educational resource to be used during “Soy Yo” programs. In July 2019, I traveled to Honduras with SELF to participate in community seminars and site visits to medical facilities. Questions and conversations with providers revealed several women’s health topics as areas for improvement in education and understanding. Barriers to seeking cervical cancer screening included availability to nearby services, lack of urgency, facilities lacking privacy, costs associated with obtaining care, fear of embarrassment and vulnerability, lack of follow-up, fear of results, and partner disapproval. Upon reflection, it was decided that we would highlight HPV and cervical cancer in the initial set of educational materials due to generalized low health literacy on the topic. Much input was gained from local providers and community members to produce a concise pamphlet to be handed out at future educational forums. Due to COVID-19 and natural disasters affecting the region, community gatherings and educational outreach have been paused. The future of women’s health in rural regions of Honduras must be prioritized through education, empowerment, and improved infrastructure to support patient participation in care.

Wendy Ma

Award for Outstanding Performance in Capstone Scholarship & Discovery

MLKFS Food Pantry Health Fair: Analysis of a Potential New Legacy Project

Project Advisor | Robinson, Frank PhD
Learning Community Mentor | Churchill, Eric

ABSTRACT

In order to address healthcare disparities and increase access to healthcare information, many community programs and academic health centers have worked together to develop sustainable and culturally competent health education and outreach interventions. Students at the University of Massachusetts School of Medicine’s Population Urban and Rural Health Program (UMMS PURCH) program partnered with Martin Luther King Junior Family Services (MLKFS) analyzed the health and social needs of families who visit the food pantry. The needs assessment showed food, health, transportation, and safety needs were not being met. To address these unmet needs, UMMS PURCH students created a community health fair. The primary goal of this paper is to focus on the sustainability of this health fair and the possibility of creating a PURCH legacy project. Results showed overwhelming support from consumers of the food pantry and student volunteers for the health fair to be a continuous event. This study emphasizes the importance of community and medical system collaboration in creating a sustainable health care intervention to address health disparities.

Poornima Manikantan and Prithwijit Roychowdury

Exploring Physical Education Teachers Perceptions About Facilitators and Barriers to Student Engagement; Before and After a Global Pandemic

Project Advisor | Senn-McNally, Molly MD
Learning Community Mentor | Eagleson, Elizabeth

ABSTRACT

Engagement in physical activity during primary education is a significant element of healthy lifestyle promotion in young adults. Barriers to participation have been identified in a variety of settings. As a result, we sought to understand the problem in a local urban high school setting. Amidst our study period, the COVID-19 pandemic dramatically shifted our way of life including in physical education (PE). Our goals herein are twofold: (1) present our initial findings about factors that drive student engagement and (2) relay the impact of the COVID-19 pandemic on a local PE program. We identified an urban high school with a high pass rate and adopted a positive-deviance strategy. We conducted surveys with PE teachers to understand the strengths and barriers faced by this group to successfully engage students. Teachers identified sufficient support from peers, high levels of student engagement and opportunities for physical activity as the strengths of their PE program. Perceived drivers of high-level student engagement included creating personal connections with students, knowing the class is a graduation requirement and overall enjoying PE. The main cited barrier to student engagement was that students are excluded from class due to disciplinary reasons or injuries. Following COVID-19, creativity in virtual PE activities was the most commonly cited strength. Limitations due to lack of space at home and connectivity issues were cited as major concerns in a remote learning setup. Further qualitative work should focus on interviewing students to develop a more holistic understanding of PE at Putnam.

Elisabeth McGovern

Award for Outstanding Performance in Capstone Scholarship & Discovery

Caregiver Experience with Trauma Educator Pilot: A Qualitative Analysis of Participant Feedback

Project Advisor | Forkey, Heather MD
Learning Community Mentor | Eagleson, Elizabeth

ABSTRACT

A trauma educator (TE), modeled from the “diabetes educator” role, was integrated into a child abuse clinic to provide immediate and ongoing support to families impacted by child sexual abuse. 55 child-caregiver dyads with children ages 3-16 were enrolled and referred to the TE. The TE provided referrals to evidence-based therapy services, educational materials about trauma and its impact, mental health resources for the caregiver, and telephone coaching of parents to respond to trauma symptoms. At six-months after initial screening, caregivers were contacted over the phone to answer open-ended questions about their experience in the TE program. Feedback on the TE program was collected from 45 caregivers and analyzed using an online qualitative data analysis program. Codes were assigned to excerpts of feedback and organized into a hierarchy to identify salient themes. Themes were organized under three overarching categories: content of trauma education, experience with TE, and services accessed. Caregivers in this study expressed a predominantly positive experience working with the TE, reporting that the TE was knowledgeable, empathetic and accessible. Caregivers accessed similar services with and without referral from the TE, and identified counseling and support groups as most helpful. Frustration with waiting lists was a recurrent theme and speaks to the need for more trauma-focused services and providers.

Caleb Noone

Foot Care Clinic for the Homeless

Project Advisor | Bossie, Jessica MD
Learning Community Mentor | Borden, Samuel

ABSTRACT

Foot care issues in the homeless population are common, often go unaddressed for long periods of time and are caused by multiple factors including chronic diseases like diabetes, improper footwear and a lack of access to adequate hygiene. Currently, there is no dedicated foot care clinic for the homeless population of Northampton, MA. The goal of this project was to fill that gap by determining the feasibility and utility of a foot care clinic for this community. The author designed the structure of the pilot clinic to determine its feasibility through collaboration with his advisor, who hosts a foot care clinic in Springfield, MA. A pre/post-session survey was designed to assess the clinic participant’s attitudes and needs towards a regular clinic. Due to the Covid-19 pandemic, the author was not able to run the pilot clinic. However, the design of the pilot foot care clinic including the location, materials and volunteers was deemed to be feasible after social distancing restrictions were discontinued.

Kathryn Norman

Assessing the American College of Gastroenterology Screening Guidelines for Barrett Esophagus: How Effective Are They?

Project Advisor | Nason, Katie MD MPH
Learning Community Mentor | Churchill, Eric

ABSTRACT

Objective: Screening for Barrett’s esophagus (BE) promotes early detection and treatment of esophageal adenocarcinoma (EAC). Our study aimed to determine if current screening guidelines accurately identified individuals with EAC versus controls.
Methods: Patients diagnosed with EAC (n=158 cases) and healthy age-, race- and sex-matched population controls (n=158) were interviewed using a structured questionnaire about health status and risk factors. Responses were analyzed according to the American College of Gastroenterology (ACG) screening guidelines using conditional logistic regression.
Results: Responses to screening criteria were available in 304 individuals (150 cases, 154 controls). 75% of cases and 64% of controls qualified for screening under the 2016 ACG guidelines (OR 1.77; p=0.032). Cases were more likely to have frequent gastroesophageal reflux disease (GERD) symptoms (p<0.001), a history of smoking (p<0.001), and positive family history of related conditions (p=0.017). Adjusting for the effect of other risk factors, smoking history (p<0.001) and family history (p=0.040) showed increased odds of cancer while GERD symptoms did not (p=0.416). Calculating the relative odds of cancer in Caucasian men over 50 with all combinations of additional risk factors (frequent and/or chronic GERD, smoking history, family history, and obesity) showed that smoking history was the single greatest risk factor (OR 5.51, p<0.001) and increased cancer risk more than every combination of risk factors that excluded smoking history.
Conclusions: The 2016 ACG BE screening guidelines show an improvement over past guidelines but they fail to acknowledge the varying effect of risk factors. Future editions should consider the effect of each risk factor.

Afua Nti

The Role of Initial Public Health Responses on the Infection and Case Fatality Rates during the initial waves of the COVID-19 Pandemic – A longitudinal Comparative Study of Germany, Ghana, and the United States

Project Advisor | Korboe, Akosua MD
Learning Community Mentor | Borden, Samuel

ABSTRACT

The SARS CoV-2 Virus has changed the world in ways few could ever have imagined. The initial responses to the pandemic in terms of preparation and public health measures to detect, contain and minimize person-to-person transmission have varied widely from country to country. This project compared the initial public health responses in three countries – The United States, Germany, and the west African nation of Ghana – against their respective pandemic outcomes thus far. Pandemic outcomes were measured by COVID-19 case rates and case fatality. Statistical tests were used to investigate differences in outcomes and infection and case fatality rates in these countries in the initial waves of the pandemic. Successes and failures in initial responses were identified and their impacts on the course of the pandemic in each country were highlighted. An outline of principles to inform a uniform and coordinated global public health response for ongoing mitigation of this and future pandemics was made. Options for future extension of this work include multivariate regression analyses using each of the principles for mitigation steps proposed to explore and quantify their effects on pandemic case burdens in these or other countries.

Tatiana Petrovick

Peripartum Depression and Delayed Child Development Outcomes within a Home Visiting Program in Springfield, MA

Project Advisor | Peacock-Chambers, Elizabeth MD MSc
Learning Community Mentor | Churchill, Eric

The Healthy Families Springfield program is a home visiting program for high-risk first-time mothers administered by the Square One organization in Springfield, MA. Over the course of the program, participants receive home visits from a qualified professional and receive regular screenings to assess child development milestones and peripartum depression symptoms. This report aims to: 1.) Describe the demographics of the population the Healthy Families program serves. 2.) Identify the prevalence of peripartum depression and delayed child development within this population and 3.) To determine the relationship between established risk factors for peripartum depression and child developmental delay. Reports containing de-identified data were obtained from Square One. The data was cleaned and compiled into a single database organized by participant ID number. A descriptive study was performed to analyze the demographic characteristics of all participants. Subsequently, participants were separated into groups based on presence or absence of peripartum depression and presence or absence of delayed childhood development and the characteristics of these groups were analyzed using Microsoft Excel. A descriptive study of the participants in the Healthy Families Springfield program revealed a population largely composed of young, low-income, unmarried mothers with a high school education. A large proportion of the participants (52%) experienced depressive symptoms at some point during their enrollment in the program. Presence of peripartum depression was associated with intimate partner violence in the household. Depression appeared to be time-limited with most participants experiencing resolution of symptoms by the 36 month mark. Overall, 27% of participants screened positive for delayed childhood development. Fine motor skills was the domain most likely to experience delays, with 39% experiencing a delay in fine motor skills. There is a statistically significant relationship between peripartum depression and delayed childhood development within this population. This information could offer the Healthy Families Springfield program the opportunity to offer services to these high-risk families and intervene at a critical point in child development with mental health services and point in child development with mental health services and resources.

Laura Schwartz

QMass West: Bringing the UMass LGBT Student Group to PURCH Students at Baystate Medical Center

Project Advisor | Meade, Lauren MD
Learning Community Mentor | Wu, Jacqueline

The new campus of the University of Massachusetts Medical School at Baystate Medical Center, when first founded for the Population-Based Urban and Rural Community Health (PURCH) track, was limited in its LGBTQ+ community-specific programming aimed at medical students. Most of the programming on this topic on the main Worcester campus comes from the student group QMass. In order to fill the gap on the new campus, this student group was brought to Baystate in the form of a new chapter, QMass West. To guide QMass West programming, PURCH track students were surveyed regarding their participation in past QMass events and interest in future QMass West events. Based on student responses, QMass West was rolled out at Baystate in the form of a successful kick-off mentoring event, several new educational sessions, and a new site for an existing QMass longitudinal initiative, the Push for Pronouns. This student group will be continued in the future by rising 4th year medical students in classes to come, and aims to be a significant, consistent resource for LGBTQ+ PURCH students, as well as allies from the student body and faculty.

Alay Shah

Improving outcomes in patients with diabetes through integrated care management

Project Advisor | Nakrani, Preeti MPH
Learning Community Mentor | Churchill, Eric

ABSTRACT

Social determinants of health are the financial and social conditions that influence the health outcomes of an individual or community. They have been identified as important factors to consider when treating populations where chronic comorbidities are widespread, such as in communities that are medically underserved. Community health worker may fulfill an important role in addressing the social determinants that impact their community’s health. The goal of this study was to determine the impact on Hemoglobin A1C levels of patients with diabetes by addressing social determinants of health insecurities. This study was done in collaboration with the BeHealthy Partnership Medicaid ACO, which consists of 4 Baystate Health Centers, Caring Health Center, and Health New England as the Managed Care entity. In this study, A1C levels of patients with diabetes were monitored before and after engaging in care with a community health worker. Any insecurity in food, housing, and transportation were identified through patients’ responses to a Care Needs Screening. The mode of communication from community health workers to engage patients in care was also recorded. The study window was from 2018 to 2020. Overall, this study found that community health workers addressing any of the three insecurities correlated with a decrease in A1C levels. However, addressing housing insecurity correlated with the greatest impact on decreasing A1C levels in patients with diabetes, as compared to addressing food or transportation insecurity. It also found that engaging patients through a home visit correlated with a greater impact in decreasing A1C levels.

Daniel Wenzel

A Retrospective Chart Review of Spindle Cell Tumors Diagnosed and Treated at an Academic Multidisciplinary Institution for the Past 20 Years

Project Advisor | Mclean, Riley MD
Learning Community Mentor | Eagleson, Elizabeth

ABSTRACT

AFX tumors are histologically well circumscribed, non-encapsulated dermal tumors that are separated from the epidermis by a narrow zone of collagen. AFX tumors are characterized by a spindle cell proliferation with prominent nuclei, multinucleated giant cells, and epithelioid cells. The differentiating features of UPS/PDS tumors are their characteristic aggressive growth patterns and presence in the deep dermis/ hypodermis, tumor necrosis, lymphovascular invasion and perineural invasion. UPS tumors demonstrate a more aggressive clinical course. Although they are thought to originate from the skin, they are grouped, staged and treated in similar fashion to other often more aggressive soft-tissue sarcomas. Another challenge in treating UPS tumors in addition to surgical margins, is how to differentiate a UPS from an AFX both clinically and histologically. The diagnosis of MFH, now called UPS, is typically reserved for tumors which extend beyond the dermis into the subcutaneous fat. As both of these tumors present on sun damaged skin, extension to the fat is common. The purpose of this retrospective study is to analyze the number of Atypical Fibroxanthoma (AFX), Pleomorphic dermal sarcoma, and Undifferentiated pleomorphic sarcoma tumors- collectively called “spindle cell tumors”- and assess how these varied tumors have been diagnosed and treated in the UMass Memorial healthcare system over twenty years.

Kevin White

Public Health Education and Social Capital’s Role in Making an Impact for Change

Project Advisor | Szegda, Kathleen PhD MPH MS
Learning Community Mentor | Borden, Samuel

Amanda Whitehouse

Qualitative Study of Strategies and Barriers to Accessing a Career in Academic Medicine

Project Advisor | Philbin, Mary EDM
Learning Community Mentor | Borden, Samuel

ABSTRACT

This was a qualitative study of UMMS faculty to discuss strategies and barriers to accessing a career in academic medicine. There were 16 participants who completed the phone or Redcap survey. Themes from the survey were collated and will be used to inform curriculum for medical students on accessing a career in academic medicine.