How is PURCH different?
PURCH is both a Track and a Pathway??? PURCH integrates both a Track and a Pathway?? PURCH combines a Track and a Pathway??? Will there still be tracks??
This track-specific pathway model aims to prepare future physicians with the knowledge, skills, and attitudes required to deliver equitable healthcare in both direct patient care and within a system.
Students will participate in a community-centered, community-engaged longitudinal curriculum in health equity practice with a focus on the care of underserved populations in urban and rural communities of Western Massachusetts which are disproportionately impacted by persistent social and health inequities.
The pathway provides students with a community of practice and experiential learning opportunities to establish Community-Doctor relationships and enhance students’ understanding of how structural racism, power and privilege develop and propagate local SDOH, health disparities and health inequities that adversely impact quality patient care and population health outcomes.
PURCH Scholarly Project (formerly Capstone Scholarship and Discovery)
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.
Following the PURCH Principle of being team oriented, we encourage and support collaborative scholarship through group capstone projects.
2022 PURCH Capstone Presentations
Emily Adler
Beyond Mentoring: Integrating Patient Care, Education and Research into a program for Homeless Teen Mothers in Worcester
Project Advisor | Judy Savageau
Learning Community Mentor | Samuel Borden
ABSTRACT
Objectives Our goals were twofold: to support adolescent mothers and educate future physicians.
Methods Medical students were trained by a professional parenting coach to deliver an evidence-based, parenting, and mental health curriculum for 18 adolescent mothers experiencing homelessness. Data were collected from surveys, focus groups, individual interviews, and hair cortisol samples [Adler, cont.] from an intervention and comparison shelter for these mothers to assess stress levels, parenting attitudes, and lessons learned before and after the programming.
Results Findings from participant surveys, focus groups, and interviews showed that adolescents in the intervention group felt more prepared to be supportive caregivers than the adolescents in the control group. Hair cortisol levels did not significantly change over time in either the control or intervention group; further studies are warranted with larger samples. A focus group with medical students revealed newfound sparked passions and confidence in advocating for young mothers.
Conclusions This pilot study can be used to inform future interventions and medical school curricula. Furthermore, we hope that by training and inspiring the next generation of physicians, our cohort will continue to advocate for this diverse population, a group often overlooked in medical education.
Deirdre Buckley
Capstone Merit Award
Rescreening Following Sexually Transmitted Infections in the Department of Pediatrics
Project Advisor | Zoon Wangu, MD
Learning Community Mentor | Eric Churchill
ABSTRACT
Background Given increasing case numbers of STIs at the national, state, and local levels, this quality improvement project was developed to assess whether UMass patients ages 15-24 years who test positive for a sexually transmitted infection (including gonorrhea, chlamydia, or trichomoniasis) are being rescreened at 3 months post-treatment according to guidelines from the United States Centers for Disease Control & Prevention (CDC).
Methods Chart abstraction and data analysis were completed to evaluate rates of rescreening and an anonymous online survey was administered to evaluate clinician knowledge of CDC rescreening guidelines to inform an intervention aimed at improving appropriate rescreening. 100 patients who met inclusion criteria and who tested positive for chlamydia, gonorrhea, or trichomoniasis in 2018 were included. Each was then evaluated for tests of reinfection and/or STI diagnoses within a year of the positive test.
Results Of 100 patients, 88% tested positive for chlamydia, 6% for gonorrhea, 6% were positive for both, and none were positive for trichomoniasis. 51% of patients did not receive any subsequent testing after their positive test. Of those who were ever retested, 47% tested positive for an STI when rescreened. The clinician survey yielded a 7% response rate with only 38% reporting that they rescreen their patients for STIs 3 months after an initial positive test. 67% did not know if guidelines differed between cisgender and transgender patients and 67% did not know if they differed between women who have sex with women and heterosexual women.
Conclusion A large percentage of patients who test positive for an STI are not being rescreened in the UMass Department of Pediatrics. While no one clear pattern emerges for a setting or follow-up approach leading to low rates of rescreening, inconsistency in follow-up is an area for future intervention. Additionally, there is variable clinician comfort and knowledge about rescreening guidelines particularly as they vary by gender identity and sexual behavior.
Colby Cayton
RECOVERS: Reproductive Education and Contraception Options Via Existing Recovery Systems
Project Advisor | Katherine Callaghan, MD
Learning Community Mentor | Eric Churchill
ABSTRACT
Substance use has been associated with numerous negative outcomes on a woman’s health.Unplanned pregnancies in women with opioid and other substance use disorders are due, in part, to alarmingly low rates of effective contraception use.The establishment of a contraceptive clinic on-site at an opioid treatment facility is a novel model of delivering reproductive health care to women with behavioral health needs, as well as to women supporting friends and family with behavioral health needs.The goal of this study is to provide robust contraceptive and reproductive health counseling services embedded within an Opioid Treatment Program (OTP) to increase LARC uptake in women with opioid use disorder (OUD). Ultimately, we hope this reduces the number of unintended pregnancies for women with OUD or at risk for OUD, as well as reduces the number of infants treated for Neonatal Abstinence Syndrome (NAS). A survey was created and administered to garner baseline data on knowledge of contraception before a contraception was established on site at an OTP. 31 respondents completed the survey. The majority did not desire pregnancy, though only 35% reported using contraception. Most had heard of LARCs. From the data gathered, the majority of respondents were women of reproductive age who were not using contraception regularly. Though participants were not using contraception regularly, most reported that they did not desire to become pregnant. The most commonly used contraception reported was condoms. Due to COVID and loss of funding, this project was not able to be continued.
Lauren Cralle
Visually Diversifying the UMMS Medical Education
Project Advisor | Jules Trobaugh
Learning Community Mentor | Elizabeth Eagleson
ABSTRACT
For decades, researchers and physicians alike have acknowledged the implications of bias in medicine particularly as it relates to race, gender, sexual orientation. The discussion of bias in healthcare has become a critical component of medical education from the studies of undergraduate pre-meds at university to medical students beginning clinical training to resident physicians at major institutions. Even attending physicians are privy to the lessons of bias training and challenging their own implicit biases through in-house educational conferences and online training modules. Through various studies we have seen how implicit bias can affect patient care, disproportionately affecting black, Hispanic, gender nonconforming, queer, and other minority patients. Medical education initiatives, such as the D.R.I.V.E. initiative at the University of Massachusetts Chan Medical School, are aimed at building future physicians that are culturally competent and able to combat the biases they find in themselves and others, including colleagues. As medical students transition from pre-clinical to clinical training, they are thrust from the shelter of the classroom to the challenges of hospitals where often times the bias that they were shielded from as closely supervised students is more apparent. They may be bystanders to microaggressions from attending physicians or victims of patient biases. With this in mind, we aimed to provide a manner for students to cope with this difficult transition by creating an open forum of discussion and providing resources to combat these biases. We hoped that by allowing students to debrief and process their experiences, they would be better able to handle bias moving forward.
Christine Donohue
Capstone Merit Award
Culinary Medicine CME
Project Advisor | Barbara Olendzki
Learning Community Mentor | Elizabeth Eagleson
ABSTRACT
Proposal for a culinary medicine CME course. This course is designed to increase dietary counseling provided to ethnic minority and underinsured patients. Combines hands on experiential learning with didactic and dedicated practice of motivational interviewing and SMART goal creation.
Christine Grech
Death and Dying: Perceptional Change of Healthcare Workers During the COVID19 Pandemic
Project Advisor | Vandana Nagpal
Learning Community Mentor | Jacqueline Wu
ABSTRACT
Meghan Harrington
Capstone Merit Award
Addressing Foster Care in Western MA: Expanding the Provision of Care Packages to Children at UMass Medical School's Regional Campus
Project Advisor | Ian Goodman
Learning Community Mentor | Elizabeth Eagleson
ABSTRACT
The foster care system is widely utilized in the United States, with Massachusetts being one of the first states to adopt its practice. Entering the foster care system may represent a difficult transition time for children, particularly for those who are newly placed in a foster home after hospitalization. At UMass Medical School, a student interest group called Kelley Backpacks aims to ease this transition time by providing backpacks filled with comfort items to children being discharged from the hospital into foster care. With UMass gaining a satellite campus at Baystate Medical Center in 2017, there existed an opportunity to expand this student group to Springfield to serve another geographically distinct population. This capstone project assessed the need for such a program at Baystate, garnered student interest and funding, and launched a pilot program, called Baystate Backpacks.
Molly Ingemi
Exploring Community Health Through Viticulture: An Immersive Education Experience for Third-year Medical Students
Project Advisor | Rebecca Blanchard PhD
Learning Community Mentor | Eric Churchill
ABSTRACT
Medical education has come a long way in teaching students about the social determinants of health. However, solutions to social issues are not easily taught in the classroom as social dynamics affecting the health of the community can be complex and multifaceted. Instead of the traditional didactic method, medical students may benefit from explicit training in creative thinking in order to build a skill set that is useful in addressing complex problems faced by patients. Here we propose a novel approach to teaching medical students to be innovative problem solvers through an immersive experience at a local vineyard. Concepts from viticulture, or the study of cultivating grapes into wine, will be used to analogize common community health topics. Through this experience, medical students will have the opportunity to learn about a subject outside of medicine and practice thinking creatively about community health.
Alexander Kaplan
Improving the Sexual and Gender Minority Advocacy Curriculum
Project Advisor | Carol Bova
Learning Community Mentor | Elizabeth Eagleson
ABSTRACT
Sexual and gender minorities (which include lesbian, gay, bisexual, asexual, transgender, gender non-binary, two-spirit, queer, and intersex individuals) experience significant health disparities that prevent them from receiving quality medical care. Although these health inequities exist, studies have indicated deficits in medical and nursing education in regards to LGBTQIA+ care and communication. Upon extensive literature review, there were no outlines, plans, or syllabi for medical and nursing students to address SGM advocacy in rural and urban settings. Creating curricula addressing advocacy for queer and gender diverse patients is essential as having awareness of public policies, resources, and support services allow medical professionals to promote health services and foster improved therapeutic relationships with LGTBQIA+ patients. The overall aim of this capstone was to improve the SGM advocacy curriculum by (1) evaluating the existing curriculum in the LGBTQIA+ Population Health Clerkship (PHC, a two-week curriculum where second-year medical and nursing students integrate into the community and learn about disparities faced by a marginalized group and their health needs) through survey administration to a group of students that took the PHC and a separate group of students that did not take the PHC (PHC-naïve group) and (2) making modifications to the curriculum based on themes distilled from both surveys.
Iha Kaul
Implementing the “Enhanced Recovery After Surgery” (ERAS) Program for Caesarian Sections at Baystate Medical Center
Project Advisor | Jennifer Fantasia
Learning Community Mentor | Eric Churchill
ABSTRACT
There continue to be gaps in medical student comfort and knowledge with the male genitourinary system. With no required rotations in urology, medical students often must elect to find information that reflects up to date physical exam techniques and evidence-based practice for the male GU exam. At UMass Medical School, students are provided a single standardized patient session in which they are guided through the male genitourinary exam, including a digital rectal exam. Outside of this, exposure is variable. Almost 50% of medical students at UMass will pursue a primary care specialty requiring them to be adept at the male physical exam. Circumcision is another topic in the GU system in which the evidence is limited and controversial. Personal attitudes may influence medical student attitude towards future counseling for patients regarding neonatal circumcision. This project seeks to survey the literature and develop a survey that assesses personal attitudes that influence knowledge and clinical comfort in male genitourinary care and circumcision counseling for UMass Medical Students.
Leo Kuwama
Capstone Merit Award
Advocacy Curriculum Integration into the PURCH Population Health Clerkship Experience
Project Advisor | Rebecca Blanchard PhD
Learning Community Mentor | Samuel Borden
ABSTRACT
Purpose Healthcare professionals hold a unique position that allows them to have exposure to social, economic, and political factors that ultimately impact health outcomes. This position makes healthcare professionals an excellent population to engage in health advocacy. However, current literate notes that healthcare professionals lack preparation to engage in these health advocacy initiatives despite widespread interest.
Implications The students enrolled in the University of Massachusetts Chan School of Medicine’s (UMMS) Population-based, Urban and Rural Community Health (PURCH) Track partake in a two-week Population Health Clerkship (PHC) to address the lack of preparation to engage in health advocacy. This study aims to evaluate the PHC in terms of how they incorporate the six health advocacy competencies: communication, self-reflection, facilitation, decision-making, trustworthiness, and humility.
Methods A survey was distributed to all UMMS PURCH students and community organization faculty who participated in the 2021 PHC to assess the current state of the PHC with respect to exposure to opportunities to practice each of the health advocacy competencies. Results: The study demonstrated that the PURCH PHC experience currently provides students opportunities to practice all six health advocacy competencies.
Conclusion The current state of the PHC gives students the opportunity to practice and demonstrate all six HACs; however, [Kuwama, cont.] there is still room for improvement to expand these opportunities. Successful implementation of any changes to the PHC will require ample communication between the faculty and students about any positives or unforeseen consequences to the changes. Given the value of this PHC for students and community members, this effort will only continue to improve.
Jessica Ma
Examining the Impact of Rurality on 1-year Outcomes Following COPD-related Hospitalizations
Project Advisor | Peter Lindenauer MD
Learning Community Mentor | Jacqueline Wu
ABSTRACT
Chronic obstructive pulmonary disease (COPD) refers to a group of chronic progressive diseases, including emphysema and chronic bronchitis, that cause airflow limitation and shortness of breath. COPD is a serious public health problem in the U.S., both in imposing a significant resource burden on our strained healthcare system, as well as a high mortality and morbidity burden on patients. In this study, we utilized a cohort of over 240,000 Medicare beneficiaries hospitalized for COPD, and examined the association between patient residence (rural vs. urban) and post-COPD hospitalization outcomes, specifically 1-year and 30-day mortality and re-hospitalization. We also utilized patient residence to understand the social determinants of health factors within their communities. We found that residence in rural counties adjacent to metropolitan areas was associated with a modestly higher risk of both death (30-days and 1 year) and of all-cause re-hospitalization within 30 days. Though we found patients with rural residence had clinical and community factors that would suggest more severe COPD and therefore increased mortality and re-hospitalizations, our study found minimal differences. The challenges rural patients face may translate into greater disease burden and lower quality of life, and this may not be adequately captured in the outcomes we measured in the claims data. The reduced access to pulmonologists, lower likelihood of post-discharge services, increased patient-reported disability, and greater number of days of patient-reported poor physical health, support this notion that COPD patients living in rural areas do experience increased disease burden.
Eleanor McClements
Development of Decision Aid for Initiation of Suboxone in the Emergency Department
Project Advisor | Elizabeth Schoenfeld
Learning Community Mentor | Eric Churchill
ABSTRACT
Opioid use disorder (OUD) is a significant cause of mortality and healthcare cost in the United States. Emergency Departments (ED) are an integral site for addressing OUD on both an individual and a population level. EDs serve as the first point of contact for many people who use opioids and can offer life-saving harm-reduction interventions including medications for opioid use disorder (MOUD). However, the stress on ED providers limits the time and tact available for productive conversations around initiating MOUD. Shared decision-making and decision aids are used in the ED to help streamline challenging conversations and to empower patients to be involved in their recovery and care. This literature review seeks to evaluate if shared decision-making improves access to MOUD in emergency departments for patients with OUD. Fifteen scholarly papers met inclusion criteria. Through evaluation of these papers three themes arose: 1) while emergency medicine providers are crucial in the initiation of MOUD, they face many barriers to initiating care in the emergency department; 2) shared decision-making offers a viable option to address provider-based barriers to care; 3) decision aids may further streamline initiation of MOUD. Ultimately, this review supports shared decision-making for initiation of MOUD as a strategy to address barriers and improve patient engagement and outcomes.
Theodore Medling
Patient Opinion of Alcohol Use on Cardiac Health: Does It Impact Patient Alcohol Intake?
Project Advisor | Quinn Pack
Learning Community Mentor | Eric Churchill
ABSTRACT
Background Media reports frequently cite observational studies and meta-analyses to promote the reputed cardiovascular benefits of moderate alcohol consumption, however it is unclear whether public opinion or drinking behavior align with these reports. [cont on next page]
Methods We administered an anonymous, single-center, 35-question, cross-sectional survey among patients hospitalized for acute cardiac illnesses from June to September 2019 who were eligible for cardiac rehabilitation. We assessed patient opinions toward alcohol use, perceptions of alcohol’s health impact, and role of media in forming these beliefs. We hypothesized that drinking habits are associated with beliefs about the health benefits of alcohol consumption.
Results Of 300 patients approached, 290 (97%) completed the survey. Most (69%) reported having heard moderate alcohol use is heart healthy from one or more sources including: TV (61%), family/friends (33%), newspapers (21%) and internet (10%) although only 19% reported believing these reports. In total, 12 (4%) patients reported intentionally increasing alcohol intake due to the reported beneficial health effects. There was a strong association between binge drinking and increasing alcohol use to improve cardiac health [OR 8.8 (95% CI 2.7, 29)].
Conclusion Among patients hospitalized with heart disease, a majority report having heard that moderate alcohol use is heart healthy, particularly from media, although many fewer believed it to be true. Binge drinkers often reported increasing their alcohol use for heart health benefits. Given the known cardiotoxic effects of alcohol, particularly in large doses, strategies aimed at population-based education regarding the unhealthy cardiovascular impact of alcohol use is needed, especially among binge drinkers.
Kimberly Reimold
The Case for Medical Respite for the Homeless in Springfield, Massachusetts
Project Advisor | Jackie Spain
Learning Community Mentor | Samuel Borden
ABSTRACT
Introduction Medical respite care is defined as acute or post-acute care for patients experiencing houselessness who are too ill or frail to recover on the streets but who are not ill enough to be treated in a hospital. This project explores the need for and feasibility of medical respite in Springfield, Massachusetts.
Methods The National Institute for Medical Respite Care’s online toolkit was reviewed and summarized, including a separate literature review for other systematic review articles. Data on medical respite programs in the National Institute for Medical Respite Care Directory were described using summary statistics. Interviews were performed with community stakeholders.
Results There were 41 toolkit resources, including 1 systematic review and 1 white paper. 135 medical respite programs were listed in the online directory, with 33% of the programs established in the last 5 years. The majority of programs are operated by nonprofit operating agencies, located either in a homeless shelter or stand-alone building. Funding was typically from multiple sources, with 13% of programs funded solely by hospitals. Interviews with Baystate Health and Community Support Options highlighted the financial barriers to opening medical respite in Springfield.
Discussion Community Support Options and their Friends of the Homeless shelter is the frontrunner to operate and serve as home to a medical respite in Springfield. Despite positive findings in the literature surrounding medical respite, difficulties predicting financial impact of a respite make rallying funders challenging.
Bronwyn Wada-Gill
Behavioral Health Integration into Primary Care Practices within Western MA
Project Advisor | Phoebe Walker
Learning Community Mentor | Samuel Borden
ABSTRACT
Franklin County is the most rural county in Massachusetts and has a high rate of behavioral health needs. Behavioral health is a crucial component to maintaining good physical health. Therefore, mental health disorders, substance use disorders, and lack of access to psychosocial resources are some of the most common causes of morbidity and disability. Mental illnesses, such as depression and anxiety can prevent people from participating in healthy behaviors such as physical activity, nutrient-rich dietary intake, and social engagement. In turn, physical health problems highly correlate with the development of mental health conditions. The connection between psychological and physical health is inextricably linked. The Franklin County and North Quabbin region have been experiencing the devastating effects of substance use disorder, with a higher fatal opioid overdose rate in 2018 than the principal city of Boston.2 For this reason, the Franklin Regional Council of Governments (FRCOG), Baystate Franklin Medical Center (BFMC), and other key community stakeholders have made it a top priority to improve behavioral health care access through integration efforts into local primary care practices.
This capstone project will review behavioral health integration efforts into regional primary care practices and suggest next steps for the future of this effort.
Simone Thibault and Anthony Foscolos
Capstone Merit Award
SGOI (Sexual Orientation and Gender Identity) Climate Survey: Impact of Intersecting Minority Identities on the Treatment of Learners at an Academic Health Science Center
Project Advisor | Jules Trobaugh
Learning Community Mentor | Jacqueline Wu
ABSTRACT
Background A more diverse healthcare workforce provides better care for a diverse patient population. However, LGBTQIA+ and BIPOC individuals face disproportionate barriers to enrolling and thriving in an academic healthcare setting due to individual and institutional biases. It is imperative to assess institutional attitudes toward diverse identities and create interventions to better support these individuals.
Materials and Methods A survey was created to assess institutional attitudes toward individuals based on their actual or presumed identities and was validated through cognitive interviews. The final survey was distributed electronically to all learners, faculty and staff at the institution. All responses were collected anonymously, and all data was deidentified.
Results Results were stratified by identification as LGBTQIA+ and/or Underrepresented in Medicine (URiM) and compared to a group of participants representing individuals of majority identity. 90% of survey respondents, regardless of identity, believed this is a place that values individuals of diverse identities. A significantly higher number of LGBTQIA+ and/or URiM identifying respondents reported awareness of derogatory language and discriminatory content and were more likely to report awareness of an individual’s grades/evaluations being affected by their identity. The confidence that the institution adequately addresses incidents of mistreatment related to identity was 63% overall, and 48% for LGBTQIA+ respondents.
Conclusion There is a need for increased institutional resources and support for LGBTQ+ and URiM individuals and the current reporting system must produce more direct interventions to effectively curtail mistreatment. The data reveals opportunities for intervention to reduce the impact of bias in grading and evaluations.
Mary Bassaly, Olivia Nuelle, and Heloise Dubois
Medical Interviewing in Spanish
Project Advisor | Lisa Morris
Learning Community Mentor | Elizabeth Eagleson, Jacqueline Wu
ABSTRACT
This capstone project details the creation and implementation of the Medical Spanish Pilot Elective that has been sustainable and growing since its creation in 2019. Through the review of Medical Spanish materials from various sources and outreach to different members of faculty and staff, we created the pilot elective that was successfully delivered in fall of 2019 with 7 sessions and 19 medical and nursing students enrolled. The curriculum mirrored the anatomy and DCS curriculum of first year medical curriculum with PowerPoints that included pertinent questions and vocabulary which was taught by Spanish-speaking faculty who volunteered to teach. Each session included a breakout session with Spanish speaking standardized patients, many of whom were volunteers from the Graduate School of Biomedical Sciences. We developed surveys to evaluate the students before and after the elective in the fall as well as an anonymous feedback link for ways to improve the elective. Overall, the results from our student designed elective show that self-perceived confidence intervals improved in all categories in the pre-survey compared to the post survey. Students reported improved confidence in their communicating with a Spanish speaking patient, interviewing a Spanish speaking patient, and in their medical Spanish vocabulary. We successfully gained OEE approval for the spring continuation of the elective, and passed on student leadership for the Spring 2020 elective.
Ryan Payne and Patrick Joslin
Physical Diagnoses: A Video Series
Project Advisor | Stephanie Clegg MD
Learning Community Mentor | Jacqueline Wu, James Broadhurst
ABSTRACT
Background Physical diagnoses (PD) begins in the first year at The University of Massachusetts Medical School (UMMS). The current UMMS PD exam videos are an amalgamation of examples from other institutions; they can be difficult to navigate and do not always correlate with the current expectations for the UMMS PD exam.
Objectives Identify areas for improvement in the current PD exam videos through surveying current UMMS students and create a single video that demonstrates the techniques of the first year UMMS physical diagnosis exam. The resulting video is intended for first year students to use as a resource to learn PD and study for the UMMS PD exam.
Methods The data for this project was collected via a Google Forms survey posted on the class Facebook pages of current second, third, and fourth year UMMS medical students (Classes ’22, ’23, ’24).
Results Fifty-three UMMS students completed our survey. Fifty-nine percent of the students surveyed, responded that they would find a UMMS specific PD exam video “very helpful.” Further, 98% of the students responded that a UMMS specific PD exam video would be helpful. Additionally, 73% responded saying they would use a UMMS specific PD video to study for the first-year PD exam. The student’s responses aided in the creation of an example PD exam video.
Conclusion Based on the results of the survey, it appears as though there is a need for a more robust UMMS specific PD exam video. A UMMS specific example PD exam video was created.
Dina Roche and Megan Hansen
Addressing Social Determinants of Health in St. Anne’s Free Medical Clinic Through Implementation of Case Management Services
Project Advisor | Jane Lochrie
Learning Community Mentor | Samuel Borden
ABSTRACT
St. Anne’s Free Medical Program in Shrewsbury, MA provides free medical care to uninsured and underinsured people in the Worcester area, and is a member of the Worcester Free Care Collaborative, a group of student-run free clinics that provide care throughout the city of Worcester (“St. Anne’s”). However, prior to 2019, patients had little access to case management services to help them with housing, food, insurance, and other concerns that intimately influence health. The goal of our project was to address the structural determinants of health in Worcester and Shrewsbury, MA by implementing medical student-run case management services and track the utilization of these services at St. Anne’s Clinic in order to address various barriers to health that the patients of that clinic face and to improve delivery of case management services at the clinic in the future. We worked with existing leadership at St. Anne’s Free Medical Clinic in order to establish case management services at the clinic in August 2019. Since its inception, we have trained and built a team of medical students trained in case management at St. Anne’s Free Medical Clinic. We have collected data in order to better understand the patient population and their needs, which allowed case management leadership to implement population-specific strategies to address structural determinants of health. Additionally, we surveyed medical students who completed training in case management at Worcester free clinics to understand their perceptions of the impact of training as a case management volunteer on their medical education.
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
ABSTRACT
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
ABSTRACT
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.