When do emergency first responders in Vermont decide to turn on lights and sirens? Can narrative medicine help physician burn-out? How do disadvantaged students fare during the admissions process for medical school? These are just some of the questions explored by fourth-year students at the University of Vermont College of Medicine through their scholarly projects, and on May 11, they had the chance to showcase their work during an afternoon event that featured oral and poster presentations.

Directed by Eileen CichoskiKelly, Ph.D., the Teaching/Scholarly Projects course entails either one month serving as a teaching assistant in one of the Vermont Integrated Curriculum Foundations courses, or completing a research project in the basic or clinical sciences. For scholarly projects, students work with a faculty mentor to identify a topic and carry out the research. The following are snapshots of some of the work presented on May 11.

Zoe Agoos ’15 came to the UVM College of Medicine with a love of writing and storytelling, which she translated into a scholarly project on narrative medicine. Narrative medicine has been defined by one of its founders, Columbia University Professor Rita Charon, M.D., as “medicine practiced with the narrative competence to recognize, absorb, interpret, and be moved by the stories of illness.” It’s a field that helps healthcare providers more fully integrate their patients’ stories into their clinical practice, as well as process their own emotions and reactions to illness, injury and death.

Thanks in part to Agoos’ past experience working in global health through the international non-profit organization Partners in Health, co-founded by Harvard Medical School Professor Paul Farmer, M.D., Ph.D., she was familiar with the benefits of writing as a tool for reflection. So she jumped on the opportunity to suggest readings and contribute ideas for a new fourth-year elective on narrative medicine, co-taught by Tania Bertsch, M.D., associate dean for clinical education, and Aaron Hurwitz, M.Ed., Foundations Level curriculum coordinator.

Agoos also took the course herself, and she parlayed that experience into her scholarly project on whether narrative medicine may help to prevent burnout, an acknowledged problem in the medical field. In addition to performing a literature review, she asked students in the course to fill out the Maslach Burnout Inventory – a well-established tool to measure burnout – at the beginning of the course, and again at the end. The goal was to compare the results to symptoms reported by students who didn’t take the narrative medicine course. For her scholarly project, she presented her quantitative data with a portfolio of poems and essays she wrote during the course.

Agoos’ personal experience in the longitudinal elective – taken by 11 students who met once every two weeks for the spring semester – speaks to the power of getting together with a group of like-minded students to discuss their experiences.

“Our conversations have been so good,” she says. “It magnifies and multiplies what I’ve been getting out of doing the writing.”

In terms of research, narrative medicine’s potential as a tool to prevent burnout is only beginning to be explored, Agoos says. Of particular interest is the value of practicing narrative medicine over time.

“There have been small, pilot studies in various places,” she says, “but most studies end with a call for more research.”

Tyler Lemay ’15, a Vermont native with extensive experience as an Emergency Medical Technician, focused his scholarly project on the use of lights and sirens during ambulance transport. Since there’s growing consensus about the dangers of using them when not necessary – and no established protocol in Vermont regarding their use – it’s an issue ripe for further study.

 Lemay partnered with Kalev Freeman, M.D., Ph.D., assistant professor of surgery and emergency medicine specialist, and a team of undergraduates enrolled in a surgery course Freeman teaches for the Institutional Review Board-approved study. The students, whose course participation includes staffing the UVM Medical Center Emergency Department in shifts 16 hours per day, asked emergency first responders to complete a survey related to when they turn on lights and sirens. Their responses have provided a nuanced look at how Emergency Medical Technicians in Vermont make decisions about transport.

“What we’re hoping is that it will identify targets to reduce the use of lights and sirens,” Lemay says. “Nobody has really looked at why they’re being used.”

Although the College of Medicine requires fourth-year students to choose either a scholarly project or a teaching month, Lemay was one of a few students who elected to do both. For his teaching month, he focused on wilderness medicine, serving as “trip doctor” for a group of students from his high school alma mater – Vermont Commons School in South Burlington– during a week-long trip in the Adirondacks. He also taught a wilderness first responder course at UVM. This builds on previous work he’s done as a medical student, including co-founding a Wilderness Medicine Student Interest Group and helping to create a wilderness medicine day for the College’s first-year orientation course.

Sarah Vossoughi ’15 studied medical school admissions as it relates to disadvantaged students. In 2013, the Association of American Medical Colleges created two categories of students, called E01 and E02, based on certain data points – including whether a student’s parents had obtained a bachelor’s degree or higher, and whether parents held a professional or hourly job – to help track the socioeconomic diversity of medical school applicants nationwide.

Vossoughi worked with the College’s Office of Admissions to explore how students in these categories, which have been shown to encompass socioeconomic as well as racial diversity information, scored during the application process as compared to students outside of these categories. The goal was to create a baseline assessment, and use this to suggest potential interventions. With the College’s recent move to a Multiple Mini Interview format, the study also provides some comparison data moving forward. Vossoughi found good news: for the Class of 2018, the College admitted about 22 percent of students in E01 and E02 categories, which compares favorably to medical schools nationwide. And although a statistically higher percentage of these students also ended up on the waitlist, they were also more likely to be taken off the waitlist, in part because E01 and E02 students tend to score higher in categories like service and achievement.

“It was nice to learn that my school is doing really well,” she says. “I’ve been impressed with how [the admissions team] looks at the whole person.”

The issue is important, Vossoughi notes, in part because of a responsibility to make access to a medical education equitable regardless of background, and in part because the future physician workforce depends on a diversity of practitioners.

“We have a duty to try to make it fair,” she says, “especially in a country with a shortage of primary care physicians.”

View photos from the event here.