Digital Commons Network^™

Artificial Intelligence In Medicine: Barriers, Solutions, And Strategies, Anil Harrison, Melissa Stradley Moreno, Caroline E. Williams, Munevver Mine Subasi, Ersoy Subasi

HCA Healthcare Journal of Medicine

The integration of artificial intelligence (AI) and machine learning (ML) into health care holds the potential to revolutionize patient care by enhancing clinical decision-making, improving diagnostic accuracy, and reducing costs. Despite this promise, adoption remains limited due to a range of technical, regulatory, educational, and cultural barriers. This paper examines these challenges and proposes strategies to support safe and effective implementation of AI in clinical practice.

Key barriers include the lack of model interpretability, often referred to as the "black box" problem, which undermines clinician trust and accountability in clinical settings, evolving regulatory frameworks and unresolved questions surrounding liability, and …

The Role Of Simulation In General Surgery Residency: Advancing Technical Proficiency And Clinical Confidence, Matthew A. Daniel, Alyssa Mcmandon, Rachel Daley, Andrew Gustetic, Alexis Howarth, Meghana Jacob, Holden Lewis, Kushali Patel, Taylor Locklear, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Surgical training has changed significantly over the past several decades, largely due to advances in technology. After the introduction of laparoscopic and robotic surgery into residency programs, simulation-based training (SBT) has become an important addition to surgical education. Simulation-based training offers a safe and structured environment to practice skills, receive feedback, and develop technical and non-technical abilities. While its benefits are well recognized, wider use of SBT continues to face challenges, including high costs, limited faculty availability, and time constraints within residency schedules. New technologies such as artificial intelligence, virtual and augmented reality, and standardized simulation frameworks may help address …

An Innovative Model For Graduate Medical Education Faculty Development Through Physician-In-Training Delivery, Daniel A. Nguyen, Dustin Wilkes, Marshall Hall, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Background

Faculty development is a core requirement for Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs. Successfully delivering content to faculty can be challenging. This pilot study aimed to assess expert-developed sessions delivered by resident physicians to faculty at the completion of their clinical rotations.

Methods

A prospective cohort project was conducted, involving precepting faculty and resident physicians in a dermatology residency program. Each resident, at the end of their rotation, delivered a faculty development program to their attending physician. Each resident participated in the program for 1-3 years. The faculty development programs were based on faculty development programs …

A Scalable Model For Resident And Faculty Well-Being: Applying Self-Determination Theory And The Job Demands-Resources Framework In Graduate Medical Education, Gregory Guldner, Adam Neufeld

HCA Healthcare Journal of Medicine

Despite growing attention to burnout in graduate medical education (GME), many institutional efforts remain fragmented and lack theoretical coherence. In response, HCA Healthcare developed a system-wide initiative grounded in Self-Determination Theory (SDT) and the Job Demands-Resources (JD-R) framework to guide leadership development, learning climate improvement, and resident and faculty well-being. What began as a single-program effort evolved into a multi-year, system-wide initiative involving more than 5800 residents across 366 programs at 85 hospitals. In collaboration with workplace psychologists from Claremont Graduate University and Immersyve Health, the initiative integrated theory-informed leadership workshops, validated assessment platforms, and continuous quality-improvement processes to help …

Fostering Leadership Competency And Professional Identity Formation Through Near Peer Educator Programs, Justin Choi, Gabriela Martin Gonzalez, Tahina Ahmed, Shirley Eisner

HCA Healthcare Journal of Medicine

Introduction

Leadership competency development is a pivotal component of physician professional identity formation (PIF), and its instruction across undergraduate medical education (UME) institutions is diverse. Near-Peer Educator Programs (NPEPs) foster experiential leadership development through teaching junior learners. We evaluated the impact of participation in a structured longitudinal NPEP on medical students’ self-reflections of their leadership growth.

Methods

Medical students serving as Near-Peer Educators (NPEs) were invited to complete a baseline survey prior to facilitating any sessions and a follow-up survey after facilitating more than 1 session. The surveys, measured using a 7-point Likert scale, were modeled on a validated clinical …

Resident Scholarly Activity Plan And Scorecard Implementation In Graduate Medical Education, Michele L. Mccarroll, Afsha Rais Kaisani, Joseph Kessler, Tasaduq H. Mir

HCA Healthcare Journal of Medicine

Background

Scholarly activity (SA) is a requirement of the Accreditation Council on Graduate Medical Education (ACGME); however, many programs struggle with interpreting ACGME trainee requirements and lack standardized tools to effectively communicate, document, and track individualized, resident-centered approaches to SA. This educational project aimed to develop a universal educational graduate medical education (GME) SA plan and scorecard tool to establish shared program expectations, provide formative and summative feedback on SA progression, track SA, and support individualized SA pathways aligned with residents’ professional goals.

Methods

In May 2022, faculty, associate program directors, and program directors within the North Texas Division of …

Icare Compassionately: An Innovative Approach To Improving Nursing Education, Lori M. Brodie

HCA Healthcare Journal of Medicine

Historically, compassionate care has been briefly introduced in nursing education, without a sustained focus throughout nursing programs. Compassionate care models define the essential qualities needed to deliver meaningful care. Many of the traditional compassionate care models rely on high-level concepts that can be difficult to operationalize in academia. Further, current compassionate care models are typically limited to specific settings and are taught separately from other parts of the nursing curriculum. To address these concerns, a single purpose nursing college created and implemented the iCare Compassionately Model, which emphasizes both measurable behaviors and concepts related to compassion. As a result of …

Owning Difficult Outcomes: Navigating Medical Error Disclosure For Trainees In Accordance With Acgme Standards, Sara Andrabi, Anita Rohra, Kelly Keene, Alison Haddock, Daniela Ortiz

HCA Healthcare Journal of Medicine

Background

The American College of Graduate Medical Education (ACGME) mandates that physicians promote patient safety and high-quality care, including training trainees in disclosing adverse events to patients and families. Despite its importance, many trainees lack formal preparation in error disclosure, leading to inconsistent practices. Structured training programs are essential to meet societal expectations and professional responsibilities.

Methods

A simulation-based curriculum was integrated into our annual "Difficult Communications" simulation day in response to feedback from residents. The curriculum employs standardized patients to create realistic error disclosure scenarios. Sessions include pre-briefing with faculty facilitators and standardized patients, simulated encounters, and structured debriefings. …

Building A Better Clinical Competency Committee: A Multi-Institutional Approach To Improving The Quality Of Resident Feedback Through Appreciative Inquiry, Nikita Khetan, Emma Omoruyi, Elizabeth Hanson

HCA Healthcare Journal of Medicine

Background

The Accreditation Council for Graduate Medical Education (ACGME) requires pediatric faculty to convene twice yearly as a Clinical Competency Committee (CCC) to review resident performance and provide feedback. Variability in review processes and limited feedback quality remain common challenges. Incorporating Appreciative Inquiry within a Deliberate Practice framework may enhance the quality of summative feedback provided to residents.

Methods

This project was conducted with pediatric residents and faculty during the 2019–20 academic year at The University of Texas Health Science Center at Health San Antonio (UTHSA) and during the 2021-22 academic year at The University of Texas Health Science Center …

Novel Strategies To Optimize Individual Performance On The In-Service Training Exam: A Case Series, Julie Zemaitis Decesare, Christina Deangelis, Ana I. Decesare, Elizabeth Teets

HCA Healthcare Journal of Medicine

Background

Obstetrics and gynecology residents in the United States take the Council on Residency Education in Obstetrics and Gynecology (CREOG) in-service training exam on an annual basis. Performance on the exam is essential to assess any deficits in a resident’s knowledge as well as to evaluate the probability of passing the American Board of Obstetrics and Gynecology (ABOG) qualifying board exam. Given the substantial number of residents who experience performance issues during the exam, residency programs and individual learners benefit from the development of personalized learning plans to ensure trainee success. Test-taking anxiety is a big part of these performance …

The Distinguished Humanitarian Society, Ashley Charales, Grace Desrochers, Lakshmi Tatineni, Shane Jenks, Rajeev Raghavan

HCA Healthcare Journal of Medicine

Background

The Gold Humanism Honor Society (GHHS) is a nationally recognized organization present at over 80% of medical schools in the United States to promote humanism, integrity, and volunteerism among students. There is no equivalent national honor society present at the majority of Graduate Medical Education (GME) training programs.

Methods

Our institution created the Distinguished Humanitarian Society (DHS) as a local honor society in 2022 to recognize trainees who exemplified the ideals espoused by GHHS. In January and February 2025, we conducted semi-structured interviews to extract themes regarding inductees’ experiences with the DHS. Both interviewers used the same list of …

Gamification To Improve Emergency Medical Service Personnel Knowledge Of Medical Capacity Determination, Ross Sinicrope, Nasim Motaghedi, Zackary Yates, Elliott Richardson, Stephanie Schiffert, Jacob Wright, Abigail Alorda, Jeffrey Katz, Linh Nguyen, Shayne Gue, Christine Van Dillen, Ayanna Walker

HCA Healthcare Journal of Medicine

Background

As medical education evolves, innovative techniques are being explored to enhance learning and engagement. While existing literature on gamification in medical education primarily focuses on graduate medical education, its application in other fields, such as nursing or emergency medical services (EMS), remains underexplored. This study evaluates the feasibility of using gamification to teach EMS personnel about patient capacity assessment and examines its impact on the frequency of pre-hospital transport.

Methods

A relay race with 3 stations was developed by emergency medicine residents, EMS fellows, and emergency medicine and emergency medical services teaching faculty to teach capacity assessment. Each station …

Optimizing Antibiotic Strategies With A Clinical Pathway Approach: Enhanced Initiation And De-Escalation In Community-Acquired Pneumonia, Ahmad Behzadpour

HCA Healthcare Journal of Medicine

Background

Community-acquired pneumonia (CAP) remains a leading cause of hospitalization, mortality, and health care expenditure worldwide. Inappropriate use of broad-spectrum antibiotics contributes to antimicrobial resistance, adverse drug events, and increased costs. Antibiotic stewardship and standardized clinical pathways are key strategies to improve prescribing practices.

Methods

This quality improvement (QI) initiative was conducted at a 240-bed tertiary care teaching hospital from January 2023 through January 2025. A CAP-specific digital clinical pathway was developed using Curbside Health® and integrated into the electronic health record (EHR), accessible through a structured order set to support real-time clinical decision-making. The intervention included provider education and …

Impact Of Innovative Interprofessional Practice And Education Intervention Led By Graduate Medical Education Resident Physicians With School-Based Nursing In 32 School Districts, Christoffer A. Amdahl, Hans Drawbert, Sadra Forati, Tyler Fields, James Mantil, Afsha Rais Kaisani, Marci Ayers, Michele L. Mccarroll Phd

HCA Healthcare Journal of Medicine

Background

School nurses play a critical role in student well-being, underscoring their growing importance in both education and health care systems. Research consistently demonstrates their contributions to individual student care and broader population health.

Methods

This resident-led project explored community-based partnerships to facilitate mutual learning between school nurses and graduate medical education (GME) physicians. Conducted during the 2023–2024 academic year, this quality initiative (QI) involved the Medical City Healthcare (HCA Healthcare) GME programs and North Texas school districts. Educational resources were delivered through in-person teaching sessions led by resident physicians and hands-on medical simulations. School nurses who attended the Continuing …

Establishing Nurse Innovator Competencies: A Collaborative Initiative, Lori M. Brodie, Susan B. Patton, Dara Lanman, Ismail Dilek, Noah R. Zanville, Tracy A. Ortelli

HCA Healthcare Journal of Medicine

Background

Rapid advancements in augmented and artificial intelligence (AI) are reshaping health care, necessitating a strategic approach to integrating innovation into nursing education and practice. This article details a collaborative initiative between academic and practice partners aimed at the initial steps towards establishing the required knowledge, skills, and abilities for nurses to lead change through the creation of Nurse Innovator Competencies.

Methods

After an extensive review of literature, the team identified the absence of established Nurse Innovator Competencies. Through a collaborative and iterative process involving subject matter experts (SMEs) in both innovation and academia, key domains for the competencies, including …

Improving Scholarly Activity Through A Bundled Intervention Of Resident-Faculty Connection And Research Ideas, Katie Suleta, Norman W. Gill

HCA Healthcare Journal of Medicine

Background

Residents report barriers to engaging in scholarly activity despite this being a common requirement across residency programs. Two commonly reported barriers are a lack of mentorship by faculty and a lack of ideas for projects that meet the criteria for scholarly activity. The study objective is to describe the effect of an intervention to address a lack of mentorship and a lack of ideas for scholarly activities.

Methods

A retrospective cohort design was utilized to investigate changes in scholarly activity between 2 academic years. An internal medicine residency program with 30 residents and 17 faculty members participated in an …

Enhancing Resident Preparedness For The American Board Of Surgery Certifying Exam Through Low-Stakes Mock Oral Sessions, Camila R. Guetter, Taylor Locklear, Omar Haque, P Nina Scalise, Saptarshi Biswas, R. Wesley Vosburg

HCA Healthcare Journal of Medicine

Background

The American Board of Surgery (ABS) requires trainees to pass both a written qualifying examination (ABSQE) and oral certifying examination (ABSCE) to achieve board certification. The high-stakes nature of the ABSCE, which assesses knowledge, clinical judgment, and decision-making, necessitates extensive preparation. To address the challenges of the ABSCE format and associated trainee stress, structured mock oral programs have been developed. Here we evaluate the impact of structured mock oral sessions on residents' comfort levels and familiarity with the ABSCE at a single institution.

Methods

A mixed-methods survey was given to 50 general surgery residents in different training years who …

Medical Education As Both Process And Environment For Innovation, Gerald Wickham

HCA Healthcare Journal of Medicine

The promise of better medicine, better health outcomes, and better lives depends on a culture of innovation and implementation in medical education. HCA Healthcare Graduate Medical Education continually strives to achieve this environment, to identify the health breakthroughs of tomorrow by fostering innovation in the daily work of the residents, scientists, and physicians of our enterprise. This special issue highlights some of this important work and shares actionable programs to elevate and inspire the next generation of physicians.

Beyond Tacit Consent: Rethinking Immigrant Membership In Locke’S Social Contract, Claire A. Orfield

Bates College Undergraduate Law Review

This thesis considers the tension in Locke’s writings between universal natural-rights obligations required of a state and the exclusion of foreigners from the potential to become express consenters, thereby becoming permanent members of a state and receiving more than just baseline legal protection. Although other scholars certainly acknowledge this tension, most of them utilize it to support the abandonment of Locke’s framework of tacit and express consent altogether. This thesis, on the other hand, conducts an immanent critique of John Locke’s theory of consent by demonstrating that his own conceptual framework contains the resources for a more expansive understanding of …

A Constitutional Black Box: Critically Assessing The Constitutional And Algorithmic Implications Of The Netchoice Cases, Sam Merkatz

Bates College Undergraduate Law Review

In 2024, the Supreme Court of the United States jointly heard Moody v. NetChoice, LLC and NetChoice, LLC v. Paxton, cases challenging Florida and Texas statutes that restricted the capacity of social media platforms to moderate content. While remanding the cases, the Court reaffirmed that content moderation and curation qualify as protected expression under the First Amendment. This paper critically assesses the Court's majority opinion and its nonbinding dicta regarding the expressive nature of algorithmic moderation.

Specifically, drawing on Justice Alito’s concurrence in judgement only, this paper argues that the Court fails to account for fundamental differences between traditional …

Public Opinion And State Abortion Policy, Gender, Age, And Ideology: Agreement With Dobbs Vs. Jackson Women’S Health Organization (2022), Jack Mcroberts

Bates College Undergraduate Law Review

No abstract provided.

Chicago, Arbitrary Detention And Torture: An Examination Of Human Rights Violations And Legal Responses Under The Second Trump Administration, Gianna Keuer

Bates College Undergraduate Law Review

This paper uses a human rights-based analysis to explore the legal implications of the second Trump administration’s deportation policies, using frameworks enacted by international legal organizations and state-level bodies. Drawing upon the Convention Against Torture, the International Covenant on Civil and Political Rights, and established state policies, the paper identifies important jus cogens norms against arbitrary detention and torture. With Chicago serving as a case study, the paper explores different avenues that have been employed to counter violations of prohibitions of arbitrary detention and torture, ultimately concluding that state-level policy responses and impact litigation cases serve as a more efficacious …

How Maine Beat Strict Scrutiny, Nicholas Glover Esq.

Bates College Undergraduate Law Review

No abstract provided.

Understanding Government Regulation On Food And The Constitutionality Of Banning High Fructose Corn Syrup For National Defense, Charlotte Bernhard

Bates College Undergraduate Law Review

The following work explores a hypothetical scenario in 2029 where President Gavin Newson  hopes to decrease obesity to increase the number of Americans eligible for the draft. As tensions rise in North Korea, the President considers sending around 200,000 troops to South Korea and Japan, yet with high levels of obesity in the United States, a low number of eligible Americans for deployment may put unnecessary strain on troops. Therefore, the President considers banning high fructose corn syrup-containing products to decrease obesity rates.

This work explores how the President and American government can constitutionally limit foods containing high fructose corn …

An Interdisciplinary, Case Study-Based Approach To Teaching The Un's Sustainable Development Goals, Allison Bellaire, Meghan Mcdonough, Becky Tugman, Julia Sherry, Claire Dancz, Jim Strickland

Land-Grant Press — Teaching Section

Collaborative learning across disciplines can be advantageous. A Creative Inquiry (CI) course paired Animal and Veterinary Sciences and Public Health Sciences students to compete in a Global Solution Competition. This CI challenged the student pairs to develop solutions toward the United Nations Sustainable Development Goals (SDGs) in a low-income nation. Course participants reported a deeper understanding of SDGs through collaborating with non-discipline peers, as reflected in survey and focus group findings.

Lost In The Fine Print: A Phenomenological Inquiry Of Adhd, Student Loans, And Scarcity, Gaurav R. Sinha, Lakshya Kadiyan, Leon Banks, Kannappa V. Shetty

Journal of Student Financial Aid

The primary objective of this phenomenological study was to explore the cognitive and affective challenges faced by individuals experiencing ADHD and their student loans, particularly through the lens of “scarcity theory”. We analyzed 250 posts (~86 pages/67,000 words) from an online community on Reddit, where individuals experiencing ADHD shared experiences related to student debt. Thematic analysis was employed to identify key themes in these posts. Four key themes emerged: (1) ADHD and baseline mental bandwidth, highlighting preexisting executive functioning challenges that limit cognitive and affective capacity; (2) demands of student loan debt, which intensify stress through complex repayment systems and …

Eating Trees To Save The World, Belle Breyanna Li

Pepperdine Journal of Communication Research

This essay posits that all climate solutions will require change, an important one being eating more trees. While our current crisis is the result of indifference and inaction, we must consider innovative solutions. Like all the other possibilities, investing in more trees will require the joint efforts of our communities. As we allocate effort, time, and resources to climate solutions, the benefits will return tenfold in numerous ways. By prioritizing trees as a food source, we can empower our communities and increase their resilience. At the same time, we will positively contribute to the global climate by sequestering carbon. This …

Interprofessional Palliative Care: Implementation Of What Matters Most, Nicole Moran, Madeleine A. Keppel, Madison E. Markey, Alicia Naccarato, Kristen Cumming, Lori Boright

Oncology Rehabilitation in Practice

Palliative care (PC) is defined as specialized care plans for people with serious, life-limiting illnesses, emphasizing comfort care and management of complex symptoms. Rehabilitation professionals such as physical and occupational therapists have unique skills and perspectives towards managing and contributing to this population though are often under-represented on interprofessional palliative care teams. The Guide to What Matters (The Guide) was created upon recognition of the need for an increased presence of rehabilitation services in PC.

Severe Chemotherapy-Induced Peripheral Neuropathy Presenting With Paraplegic Symptoms: A Rehabilitation Case Report, Cecilia Hammond, Elizabeth Campione

Oncology Rehabilitation in Practice

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is characterized by sensory and/or motor symptoms in distal extremities starting within 24 hours of receiving chemotherapy and can potentially last for years. Management of CIPN may include medication (i.e. Duloxetine) and physical therapy (PT). The purpose of this case report is to describe the rehabilitation process and adjustments to the plan of care for a patient with severe CIPN. This case underscores the importance of a proper diagnosis and the need for research to develop evidence-based guidelines for PT interventions for non-ambulatory patients with severe CIPN.

Case description: The patient was a 53-year-old female …

Clinical Management Of A Patient With Lipo-Lymphedema Using Adjustable Compression Wraps: A Case Report, Candace Alexander, Claire Davies, Martha Monroe

Oncology Rehabilitation in Practice

Background: Lipo-lymphedema indicates the presence of lipedema and lymphedema. Compression is used to achieve volume reduction and assist with long-term management. Adjustable compression wraps (ACWs) have been used in lymphedema care to replace traditional compression bandaging and facilitate patient self-care.

Case Description: This patient reported issues with bilateral leg edema for more than 35 years. She reported poor experiences with compression garments and had tried self-management with a compression pump only. She was referred for lymphedema care when her malfunctioning compression pump enabled her edema to worsen.

Assessment and Treatment: Lipedema may have been present for many years …