Application Process: Apply online » (Applications for 2019 are closed.)
Duration: Eight weeks: May 20 – July 12, 2019
The Department of Family Medicine and Community Health (DFMCH) has several faculty who are eager to have medical students come join them on people-oriented, clinically relevant, hands-on research projects. Students have ample opportunities to see patients in a variety of settings (office, hospital, others), learn some important concepts and skills about research, and participate in social events with other faculty and students.
Schedule: This is a tentative schedule:
- May 20-22 — Participate with faculty
- May 23/24 — Orientation at the DFMCH, Madison, Wisconsin
- May 28 – June 20 — Participate with faculty
- June 21 — Mid-point seminar in Madison
- June 21 – July 11 — Participate with faculty
- July 12 — Final presentations in Madison
Locations: Madison area, Milwaukee
Director: Jon Temte, MD, PhD
Stipends/Housing/Travel: We have funding available to support up to ten students at $3,200 each for the eight-week session.
Apply online » (Applications for 2019 are closed.) Thank you for your interest.
Please complete the online application, including your cover letter described at the bottom. As soon as your application is received, copies of your application will be circulated to the faculty with whom you are interested in collaborating with. The faculty members will contact you to set up interviews either in person or by phone. These interviews will allow faculty and students to determine whether there is mutual interest. Faculty and student matches will be consummated by signing an agreement, which shall be considered binding on both parties unless dire, unforeseen circumstances occur. Since agreements between faculty and students may be made at any time, students who submit their applications early are more likely to have their choice of projects. For additional information, please contact Joyce Jeardeau at:
Phone: (608) 263-1334
2019 Research Projects
Mentors: Sarina Schrager, MD, MS
Location: Madison, WI
Background Information: The risk of developing breast cancer increases with age. However, it is not clear when women should stop screening mammography. The USPSTF carries an I (insufficient evidence) recommendation for screening in women over 75 and the American Cancer Society recommends that women continue screening as long as they are “in good health and have a life expectancy” of over 10 years. Primary care clinicians are left with the difficult situation of navigating these disparate recommendations with older women who present asking questions about screening.
Summer Student Opportunity: This summer project will provide the student with a variety of research experiences. The student will participate in multidisciplinary team meetings focused on developing screening guidelines and shared decision making for women over 65 deciding whether or not to continue breast cancer screening. S/he will see patients with Dr. Schrager two half days per week and have the opportunity to use an online patient decision aid with clinic patients that uses shared decision making to help women make screening decisions. The student will also have the opportunity to pursue other clinical experiences relevant to the topic (breast radiology, breast cancer clinic, etc.) The outcomes of the summer will include a paper for primary care clinicians to guide screening decisions about breast cancer in older women and a presentation about shared decision making in breast cancer screening in older women.
Mentors: Jensena Carlson, MD and Jeffrey Berry, MD
Background Information: There have been significant efforts to decrease the amount of chronic opiate prescriptions, however they remain a tool to manage chronic pain in our clinical practice. In order to practice safe prescribing, it is important to assure patients and loved ones have access to and confidence in use of Narcan for use in accidental overdose. Currently there are no Epic hardstops or clinic workflows to assure that patients with prescribed opiates have a concurrent Narcan prescription.
Summer Student Opportunity: We would like to use chart review to identify these patients and use quality improvement tools (including an A3 document and PDSA cycle) increase our prescription rate from baseline to 90%.
Mentors: Bruce Barrett MD, PhD; Maggie Grabow, PhD; Cathy Middlecamp, Margaret Mooney
Background Information: Mindful Climate Action (MCA) is an 8-week mindfulness-based wellness program aimed at improving mental, physical, and ecological health. During the summer of 2019 we hope to engage a medical student in: 1) gathering pre-post qualitative/quantitative during an MA class with 14-16 participants, and 2) develop a literature review paper examining similar projects from around the world.
Significance: Climate change threatens human health and is driven to a large extent by behaviors related to transportation, diet, and energy use. We hypothesize that substituting active transport (biking and walking) for automobile transport, and eating more plant-based foods will support mental and physical health while also reducing carbon footprint. Mindfulness-based trainings have been successful in changing behaviors to enhance mental and physical health but have not been tested for impact on ecological health and sustainability.
Specific Aims: Pilot-testing of the revised MCA curricula will include collection and analysis of data regarding hypothesized:
- Increases in knowledge of climate change, carbon footprint, and energy use;
- Reductions in automobile and air miles traveled;
- Increases in physical activity and active transport;
- Reductions of high carbon footprint foods in diet;
- Reductions in household consumption of gas, electricity, and water;
- Increases in self-reported general mental and physical health, self-efficacy and happiness.
SSRCA Student Role: The medical student will assist with implementation and assessment of an MCA class, and will conduct a literature review of similar “eco-health” behavioral interventions.
Mentors: Brian Arndt, MD; Michelle Bryan, MD; Mark Micek MD; Matt Swedlund, MD; Wen-Jan Tuan, MS, MPH
Context: There is growing evidence that time spent on electronic health record (EHR) systems impacts quality of life and wellbeing for primary care physicians. However, it is unclear how much of the EHR burden is due to work associated with non-face-to-face patient care tasks associated with InBasket management versus the work associated with face-to-face office visits.
Objective: To assess the time and usage patterns of PCPs interacting with their EHR InBasket during conventional clinic hours Monday through Friday. The study provides insight into how PCP work in the EHR is handled and further develops a mechanism for using EHR system task analysis to study PCP workload. This has implications for physician satisfaction, reimbursement models, design of primary care teams, and policy.
Design: Time motion studies will be completed through direct observation of family physicians in both residency clinic- and community clinic-based settings. The WorkStudy+ application (Quetech Ltd) will be used on an iPad (Apple Inc) to track InBasket activities. These activities will be compared to EHR system access logs from an enterprise data warehouse to validate PCP time spent on various non-face-to-face patient care activities associated with InBasket management. After the period of direct observation and data analysis, clinicians will be stratified into three groups based on their total time spent (proficient / average / less proficient) in the InBasket. Qualitative analysis performed by the student and faculty will include structured interviews about clinician attitudes toward their work with representative clinicians from each of the three groups.
Mentors: Sean Duffy, MD; Jim Svenson, MD
Location: San Lucas Tolimán, Guatemala/Madison
Context: Residents of the rural communities of San Lucas Tolimán, Guatemala have identified poor access to women’s health care as a priority concern. Members of these communities have found access to prenatal care and cervical cancer screening to be particularly lacking. The maternal mortality rates of indigenous Guatemalan women are among the highest in Latin America. Cervical cancer is the leading cause of cancer in Guatemalan women and one of the leading causes of death for reproductive age women. Previous women’s health care initiatives, including a cervical cancer screening program, have led to short-term improvements in access to care, but these programs have not been sustained over time.
Role of student: We are seeking a highly-motivated student with strong Spanish language skills to conduct a women’s health-focused community needs assessment in the rural communities of San Lucas Tolimán. Such an assessment will help to further clarify the perceived needs of the community, identify current barriers and facilitators to women’s health care services, and generate recommendations for the implementation of evidence-based and cost-effective interventions to meet identified needs. Activities will literature review, interviews with women living in the communities of interest, meetings with stakeholders at the San Lucas Mission (UW’s local partner), and generation of an action plan. In addition to working on the diabetes project, the student will be able to participate in the UW Service Learning experience in San Lucas. While in Madison, the student will have the opportunity to work with Dr. Duffy at Wingra Clinic, a federally-qualified community health center with a diverse patient population, including many Spanish-speaking patients.
Mentors: David Rebedew, MD; Larry Hanrahan, PhD, MS
Location: Albany, WI /Madison
Background and Significance: The Amish are a significant patient population for health care providers in rural Wisconsin, but yet there is little understanding of their health care beliefs. Traditional Amish medicine includes chiropractic care, religious methods such as prayer, and perhaps most widely used: herbal medicine. The literature describing herbal medicine, especially Amish use of herbal medicine, is limited, and therefore the knowledge base of herbal medicine for western health care providers is also limited. This gap in cultural knowledge has led to a rooted skepticism among Amish people of western health care. Health care providers need to determine the roots of that skepticism and what we can do to improve the health care system so that Amish communities receive the best health care possible.
Specific Aims: The goals of this project are to identify the herbal medicine practices used by the Amish communities in Southwestern Wisconsin, describe what is known about the herbs from previous research, and identify ways western health care providers could integrate herbal medicine into their practices in order to better serve their Amish patients. The study aims to improve Amish patients’ experiences with western health care providers, and providers’ knowledge and cultural competency for this rural patient population.
SSRCA Student Role: The medical student will assist with questionnaire distribution, data entry and analysis, and manuscript preparation.
Mentors: Zorba Paster, MD, James Conway, MD
Location: Dharamshala, India
Background Information: The Tibetan refugee population in India has historically struggled with high rates of Tuberculosis. The incidence of tuberculosis (TB) in Tibetans in India in 2014 was 467 new cases per 100,000 people. This is more than twice the incidence of the rest of India (211 per 100,000) and 100 times higher than the incidence in the United States (3 per 100,000). The majority of cases of active TB were found among individuals living in congregate settings such as boarding schools, monasteries, and nunneries where the risk of TB transmission is high. The Tibetan Delek Hospital functions as a specialty treatment center for complex and drug-resistant cases, and currently serves as the coordinating center for the Zero TB campaign—an expansive TB control program aimed at identifying and treating active and latent TB infection in high risk populations living in congregate settings. UWSMPH has long supported Delek Hospital in its mission to provide general outpatient and inpatient medical services to the large Tibetan refugee community living in India.
Summer Student Opportunity: We are looking for a UWSMPH students to spend eight to ten weeks living and preforming research at the Tibetan Delek Hospital in Dharamshala, India. The students will have the opportunity to participate in daily rounds at the hospital and accompany the Zero TB staff on institutional TB screenings in local boarding schools and Buddhist monasteries and nunneries. In addition, the students will be expected to design and carry out quality improvement projects relevant to Delek Hospital or Zero TB activities. There will be some on-site guidance from Delek program staff. However, the students should expect to work primarily independently. This role requires experience in research or familiarity with public health work as well as a “self-starter” attitude as supervision and guidance is limited. That being said, it is an invaluable opportunity to gain experience in global health and to learn about the Tibetan people, tuberculosis, and the Indian healthcare system.
Mentors: David L. Hahn, MD, MS
Background: Macrolides (particularly the azalide macrolide azithromycin) have proven efficacy in the spectrum of chronic lung diseases including asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, bronchiectasis, and post-lung transplant bronchiolitis obliterans. Evidence for macrolide efficacy is least well developed for asthma; however, existing evidence supports the use of azithromycin for severe, refractory asthma (SOR B) and for new-onset asthma (SOR C). Importantly, it is unknown what proportions of community dwelling, primary care outpatients with severe refractory or new-onset asthma will experience clinical benefit from long-term (3-6 months) macrolide treatment.
Goals: The project goal is to estimate the prevalence of clinical response to macrolide treatment in a prospective cohort of ≥200 outpatients with severe, refractory asthma or new-onset asthma who have elected to be treated with macrolides by their physician for asthma.
Importance: Estimating the “number needed to treat” to achieve a clinical response is important information to be included in shared decision-making conversations with patients.
Activities: The student will help create an on-line registry into which clinicians can enter data prospectively for individual patients with asthma for whom they have prescribed long-term macrolides for severe refractory or new-onset asthma. The student will also: (1) learn the principles of practice-based research as applied to asthma, (2) observe the process of obtaining human subjects approval for the registry, and (3) assist with creating and disseminating information to prescribing clinicians regarding the evidence for macrolides in asthma, and instructions on registry use.
Mentors: David Kiefer, MD; Katie Schwartz
Location: Madison, WI
Background: Group Medical Visits (GMVs) are an approach to utilize inter-patient interactions, moderated by a physician and co-leader(s), to discuss common topics that would otherwise be laborious to discuss simply one-on-one. In the field of integrative medicine, there are many topics that may not be reviewed in a typical clinic visit, such as the healing effects of mind-body therapies, the safety and efficacy of dietary supplements, and optimal approaches to promote a resilient microbiome and overall gut function. GMVs were developed at The American Center (TAC) in the Wellness Department about Healthy Sleep and Healthy Gut in order to discuss these topics and other integrative health modalities. The hypothesis is that after a 4-series GMV, patients will report an improvement in their symptoms, either with respect to sleep or gastrointestinal function, as well as overall health/wellness metrics and patient satisfaction.
Role of Student: I envision that a student on this project will immerse themselves in the literature on group medical visits (GMVs) in order to learn about the variation in techniques used and the evidence for efficacy. Also, they may also be involved in the development of the pre- and post-surveys, learning the content for Healthy Sleep and/or Healthy Gut, and the administration of the class itself. It will depend a bit on timing (especially based on the number of classes that take place during the summer and the total number of participants), but ideally some data analysis of the survey metrics would take place.
Mentors: David Kiefer, MD
Location: Madison, WI
Background: The Integrative Health Consult Clinic (IHCC), under the umbrella of the Department of Family Medicine and Community Health but housed in the Research Park clinic site, was established in 2001. It was one of the first such integrative clinics associated with a university, and remains a model for programs through the United States. Numerous modalities are provided through IHCC, including acupuncture, massage therapy, mind-body treatments, Feldenkrais, and a physician consult clinic. Hundreds, if not thousands, of patients have been seen at IHCC over the last 17 years, but the details of who those patients are, and other nuances of the development of the clinic and its evolution over time, have not been explored. There is the general thought that the IHCC benefits patients and saves costs for the health care system as a whole, but for which diagnoses and demographics it remains to be specifically documented. In this project, we will attempt to prove/disprove this hypothesis, namely that people seek integrative therapies for some diagnoses more than others, and, based on pre-existing literature for similar clinics, tend to pay for these services out of pocket. It is through a thorough literature search and extraction of information from clinic databases and the electronic medical record, that we should be able to collect information relevant to this project.
Role of Student: I envision that a student on this project will immerse themselves in the literature on integrative consult clinics throughout the United States. I already have the beginnings of an annotated bibliography for this, but we will add to it, focusing on demographics of patients who engage with integrative health, and any information about diagnoses, and cost expenditure/savings. From there, we will use a pre-existing IRB approval to access anonymized electronic medical records, attempting to characterize, by CPT codes and ICD-10 diagnosis codes, the use of the integrative clinic over the past 17 years. A yearly patient tally, as well as descriptive information about those patients will be used to compare the UW clinic with other clinics throughout the country.
Mentors: Jennifer Edgoose, MD, Shelly Shaw, MPH and Alyssa Tilhou, MD, PhD
Location: Baraboo and Madison
Background: The DFMCH Office of Community Health is seeking a SSRCA to assist in the development of a comprehensive and searchable report profiling the Baraboo community. This work builds upon the 2017 SSRCA Project, “Evaluating Community-Clinical Partnerships.” The goal of this project is to provide residents and faculty with a foundational understanding of the communities they serve and to facilitate community engagement. To this end, the SSRCA would help compile data to describe the social determinants of health impacting the Baraboo community and define opportunities for future research and community-based initiatives.
This project would parallel similar work to be conducted by an intern in the OCH this spring on the Dane County residency clinic sites. Contributing data sources to this project include the HRSA Grant Clinic Portal, CARPC Area of Opportunity Report, Cuentame Mas, Meeting the Healthcare Needs of Transgender Patients, Race to Equity and others.
Role of Student: By the summer of 2019, we anticipate that a framework for this tool will have been established for the Dane County residency clinics. An SSRCA assigned to this project would then assist the OCH and Alyssa Tilhou (Baraboo) in creating a similar framework for the Baraboo site. In particular, a student interested in rural health might find this work especially rewarding. In addition to working on this report with the OCH Team and Dr. Tilhou, the SSRCA will have clinic observation hours both at the Northeast Clinic in Madison and Baraboo.
Mentors: Bethany Howlett, MD MHS
Background: During the summer of 2018, One WisCARES, with support from the DFMCH SSRCA Program, conducted a community health needs assessment and staff assets assessment at WisCARES with the goal of developing novel interdisciplinary community health programming. Results of the client survey demonstrated that, despite increasing access to insurance and primary care, individuals experiencing housing insecurity in Dane County still face significant health issues and barriers to care. Staff assessments revealed that future WisCARES programming could aim to leverage the human-animal bond in an effort to mitigate health disparities amongst housing insecure members of the Madison area community. Next steps for 2019 could include the following:
- Continue to explore the themes of One Health and the human-animal bond in ameliorating health conditions.
- Continue to serve as a resource for the community in order to mitigate the negative companion animal influences on human/community health; and the negative human influences on companion animal/community health.
- Advocate for and offer training to interprofessional teams to leverage the human-animal bond as a clinical tool.
Role of Student: For SSRCA 2019, students will gain experience with cultural and medical issues affecting a marginalized sector of the Madison community while fostering skills to promote health equity. The student will be expected to participate in regularly scheduled program activities, identify challenges, and explore the experience. Students will be encouraged to participate in the WisCARES program and/or attend clinic in a UW outpatient family medicine clinic.
Mentors: Jillian Landeck, MD; Julia Lubsen, MD; and Karyn Cecele, MD (PGY-2)
Background: UW Belleville clinic providers have identified a need to reduce opioid and benzodiazepine misuse amongst patients at their clinic and in the surrounding community. In July 2018, we began efforts to standardize the treatment of patients with controlled substances in order to reduce dependency and overdose risk. This includes ensuring patients have annual controlled substance agreements, urine drug screening, naloxone prescriptions (when appropriate) and taper plans for patients on high dose opioids or with concurrent benzodiazepine use. We also began offering medication assisted treatment for opioid use disorder through a partnership with Green County Human Services. The goal of this quality improvement project is to assess the progress we have made with these efforts including the following outcomes 1) reduction in total MMEs for patients of UW Belleville, 2) reduction in concurrent use of opioids and benzodiazepines, 3) treatment retention and outcomes of medication assisted treatment.