Burlington Standard

For many colleges students, summer break means taking time off from the rigors of academic life, spending time with friends and family, and not worrying about papers or projects until next semester. For medical students at the Larner College of Medicine (LCOM), scholarship takes place year-round.

Each summer, many rising second-year LCOM students engage in medical research projects, gaining hands-on experience with basic science or health policy under the guidance of medical faculty. This year, students explored the complexities of some hidden aspects of medical care. From determining the medical school loan default rate to battling unsafe patient behavior in hospitals, these students explored the unseen challenges facing the healthcare field today. 

Read on for a glimpse of what the LCOM Class of 2025 researched with their summer projects. These students will present their findings at a poster session on September 22.

The debt medical students face

Richard Vuong studied the complexities of medical student loan default rates with Mitchell H. Tsai, MD, MMM.

While average college graduates hold between $10,000 and $40,000 in student loan debt, medical students face a greater challenge, holding an average of nearly $200,000 in debt, according to the Association of American Medical Colleges. Richard Vuong wants to explore the many intricacies of medical student loan debt, specifically the ability of medical students to repay their loans. 

“My research project looks at how different time periods affect the ability of medical school graduates to repay their student loans across various demographics and schools,” Vuong said. “We are calculating 25 different medical schools representing approximately 100,000 students between 2009 and 2018. From what I and my research mentors know, this project of analyzing default rates for medical schools is the first of its kind.” 

By comparing medical school default rates for the past nine years, Vuong hopes to uncover discrepancies in default rates across ethnic and geographic differences. 

“[My research could] potentially show how increased interest rates on student loans deter marginalized and minority populations from entering medical school,” Vuong said, “and thus questions why medical students pay interest rates set above that of other student borrowers.” 

The average undergraduate loan is tied to an interest rate of 4.99%, whereas PLUS loans, typically used for graduate and medical school, sit at 7.49%. The average mortgage interest rate is 5.64%.  

Vuong hopes, if his project is successful, to facilitate the reconsideration of the current policy of higher interest rates for medical and graduate students, which could benefit millions of student borrowers.  

“Financing student loans hits home. My parents shared with me how they struggled to refinance their student loans from when they went to podiatry and pharmacy school. They always cautioned me from taking out more loans than I needed, and their advice has served me well to become financially literate as I pursue medical school,” Vuong said. “Now that I have the chance to help others understand medical school finances, especially those who did not have relatives who went to healthcare professional schools, it matters to me more that I can share what I have learned.”

Telemedicine's effectiveness during COVID-19

Charlotte Evans, under the mentorship of Andrew Wilcock, Ph.D., studied the effectiveness of telemedice in Vermont during the COVID-19 pandemic.

Even though COVID-19 restrictions have loosened — both here at UVM and across the country — research into the pandemic will continue for years to come. Charlotte Evans hopes to find out just how effective telemedicine was during the pandemic, and how disparities across the state may have led to poorer health outcomes. 

“Research on healthcare access disparities in general is important because access plays a huge part in determining health outcomes — think everything from insurance coverage to time off from work to whether there are even doctors where you live,” Evans said. “Adding telemedicine to healthcare delivery may remove some of these barriers, like travel, but adds others like poor internet service and discomfort with technology.” 

Ideally, telemedicine bridges the gaps left unfilled by traditional, in-person healthcare practices. But Evans wants to explore the disparities throughout Vermont.  

“Studies on specific healthcare systems or insurance holders have all found disparities in the use of telemedicine. Non-English speakers, for example, are commonly a group that has lagged in their uptake, as often are BIPOC patients,” Evans said. “There's less consensus on rurality and age as factors which are particularly important in Vermont.” 

Evans expects that older individuals’ rates of telemedicine use would be lower, assuming a lack of access to and comfort with technology. Conversely, rural residents, preferring not to travel, may experience increased rates. Studying these disparities can lead to better telemedicine outreach and outcomes. 

“During the pandemic, I worked in a federally qualified health center where telemedicine was a huge part of how we saw patients. I know it's here to stay and will be a part of my practice in the future, so ensuring that its delivery is equitable and is actually serving communities effectively is essential,” Evans said. “My hope is that this study will add a different perspective on healthcare access disparities to the literature that will be relevant to Vermont policymakers and beyond.” 

Helping children with mental disorders during COVID-19

Caitlin Early studied children with complex medical issues and mental disorders and the effects of the pandemic with Valerie Harder, Ph.D.

With some students studying telemedicine’s impacts on the COVID-19 pandemic, others, like Caitlin Early, explored the intersection and medical complexity of the pandemic and children receiving services within the Children’s Specialty Center at UVM Medical Center (UVMMC). 

“We are looking at the relationship between medical complexity and mental disorder diagnosis along with the impact of the COVID-19 pandemic on the prevalence of mental disorders among this population,” Early said.  

Multiple studies have shown that mental disorders are more common and sometimes more severe for children with chronic illness. According to the National Institute of Mental Health, depression is among those who suffer from chronic illnesses like diabetes, epilepsy, and autoimmune diseases.  

“This is an important relationship to understand to get the right access to care for our patients here in Vermont,” Early said. “Quality improvement teams at the Vermont Child Health Improvement Program (VCHIP) are working on improving services for children with special health care needs, and our research will help inform their quality improvement projects.” 

Early hopes to find connections between the pandemic, chronic illnesses, and mental disorders, but is eager just to explore the data.  

“We anticipate that mental disorders are highly prevalent among this population of children, and that they likely increased since the start of the COVID-19 pandemic,” Early said. “Regardless, I am just excited to explore these data and hopefully find some information that is able to better inform quality improvement projects. I really care about health care in Vermont and this research, along with all VCHIP’s amazing work, aims to do that. 

As a Vermonter, Early cares deeply about the state and the connections healthcare providers in the state share with their patients.  

“As a future physician I want to be able to provide thorough and comprehensive care to my patients and research is a huge part of that,” Early said. “Having a greater understanding of what is making patients sick, seeing connection between community and health, and ultimately being able to point my patients to the resources they need are major goals for my career.” 

Tackling the stigma of substance use disorder

Heather Kettlewell, with David Krag, MD, studied the biases against those who suffer from substance abuse

While those suffering from substance use disorders (SUD) face stigma throughout much of the social order, they may also face bias from those within the medical field, including students and residents.  

Heather Kettlewell’s research will explore how those students’ and residents’ attitudes change throughout their medical education. 

“Physicians across all specialties treat patients with SUD whether as their chief complaint or as a comorbid condition. Physician bias towards those with SUD influences the quality-of-care they receive as patients,” Kettlewell said. “When those struggling with SUD experience bias within the medical system, it reduces the likelihood that they will seek out medical care and follow through with treatment.” 

Though studying the biases themselves is important, Kettlewell also wants to study how those biases manifest. According to the CDC, over 100,000 people died of drug overdoses in the US last year, a 28.5% increase from the year before.  

“Without ubiquitous scientifically supported information about SUD, stigma has flourished, branding SUD as a character flaw defined by a lack self-control. This pervasive perspective has impeded SUD treatment,” Kettlewell said. “People with SUDs are often reluctant to seek care because they fear encountering biased practitioners and/or have had prior marginalizing healthcare experiences. Practitioner-held-bias can also prevent patients from receiving appropriate care.” 

Kettlewell also explains that while there are medication-based treatments for SUD, many physicians hesitate to prescribe them. This could be because they may now know about medication options, feel too inexperienced to prescribe them, or may fear  it would encourage further drug use. However, research shows medication-based treatments prevent relapse. According to the Substance Abuse and Mental Health Services Administration, a branch of the US Department of Health and Human Services, medication-based treatment has been shown to improve patient survival, increase retention in treatment, and increase patients’ ability to gain and maintain employment.  

“Improving treatment of SUD and decreasing stigma starts with medical education. Currently we receive limited training specific to those with SUDs. Beyond this, physicians are overworked, exhausted, and burnt out,” Kettlewell said. “This inhibits their ability to maintain patience and compassion in the face of difficult conditions. Without a strong basis in the biology behind SUDs and continuous reminders to check one's biases, it is easy for practitioners to fall into a more stigmatizing mindset.” 

Exploring and managing unsafe behavior in healthcare

Ana Homick explored the dangers of unsafe patient behavior with Timothy Lahey, MD, MMSC

It seems reserved for a medical drama television show plot, but violence in healthcare is a worldwide issue. The Bureau of Labor Statistics, in 2017, reported healthcare workers are five times more likely to experience violence on the job than the average worker in the US. UVMMC has instituted a pilot project — the Behavior Response Team (BRT) — to manage aggressive and violent patient behavior and students, like Ana Homick, are studying just how effective the BRT is.  

“[The BRT] team uses inquisitive assessment of interprofessional perspectives, patient interview, and staff instruction facilitated by a trained medical psychologist to develop a consensus approach to balance patient-centered care and workplace safety,” Homick said. “The interventions proposed by the BRT include de-escalation communications, therapeutic alliance, establishing boundaries and expectations, and post-hoc employee support.” 

Homick’s research project will ultimately describe the tensions raised by unsafe patient behavior, characterize the BRT pilot, and assess how effectively it helps that tension for employees.  

“As caretakers, we often know no bounds to how we can help others,” Homick said. “However, we also fundamentally understand that it in order to be the best caretakers we can be, we must first take care of ourselves. When patients respond to providers in a threatening, violent, or biased manner, determining what resources we have available and what boundaries we can set can be complex.” 

Homick — who is fascinated with medical ethics with an interest in psychiatry, mental health, self-care, and building relationships in healthcare — her findings will be implemented into the improvement of the BRT program and UVMMC policies. 

“I have a background in healthcare administration and program development, which I loved. I hope to grow into a career as a potential psychiatrist with a special focus on medical ethics, healthcare administration, and lifestyle medicine and wellness,” Homick said. “What I’ll learn from this project will help me as an individual learn how to mitigate burn-out and professional boundaries now and throughout my career.”

The future is bright for the LCOM class of 2025, thanks to the many students shining a light on the unseen healthcare issues. To read about more LCOM students' summer projects, visit the LCOM website.

Original source can be found here.