Medicine and Health Sciences Commons^™

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 …

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.

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 …

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 …

Recurring Axillary Web Syndrome (Aws) Following A Strenuous Increase In Upper Extremity Strengthening Exercise: A Case Report, David Locke, Linda Koehler

Oncology Rehabilitation in Practice

Background: Axillary web syndrome (AWS) refers to cords presenting in the axilla, upper extremity, and lateral chest wall after breast cancer surgery with axillary lymph node dissection. This unique case demonstrates the onset of AWS 2 weeks post-operatively with recurrence at 4 and 21 months, following rapid progression in upper extremity strengthening exercise.

Case Description: A 33-year-old athletic woman with invasive ductal carcinoma underwent a left mastectomy with sentinel node biopsy (6 nodes removed). Cord development occurred at 2 weeks after surgery. She sought physiotherapy consisting of AWS education, myofascial pin-and-stretch techniques applied to the cord in end-range abduction, a …

Physical Therapy Management Of An Adult Patient Diagnosed With Spindle Cell Rhabdomyosarcoma: A Case Report, Jennifer Carrano

Oncology Rehabilitation in Practice

Background: Rhabdomyosarcoma (RMS) is a rare soft tissue sarcoma that primarily affects children and adolescents. Adult RMS is uncommon and associated with poorer prognosis and limited evidence to guide rehabilitation.

Case Description: A 29-year-old male presented with right facial pain, hearing loss, tinnitus, and right facial and tongue paresthesia. Imaging and biopsy revealed spindle cell RMS of the right masticator space. He had no cancer-related family history, did not smoke, and used alcohol occasionally. Treatment included neoadjuvant chemotherapy, major oncologic resection with scapular free flap reconstruction, and adjuvant radiation. He was referred to outpatient physical therapy with trismus, restricted …

Navigating Care In Cancer: Aligning Rehabilitation And Exercise To Support Patients, Christopher M. Wilson

Oncology Rehabilitation in Practice

The growing evidence base supporting both exercise oncology and cancer rehabilitation highlights their complementary roles across the cancer continuum. Research consistently demonstrates that physical activity improves physical function, fatigue, quality of life, and survival, while rehabilitation addresses impairments and restores participation in meaningful activities. Despite these advances, current care models often lack coordination, resulting in fragmented services, inappropriate referrals, and missed opportunities for optimal patient outcomes. Some individuals are directed to exercise programs without adequate screening for underlying impairments, while others may receive rehabilitation services when supervised, independent or community-based activity would suffice.

To address these gaps, there is a …

Editorial Board Message: About This Issue, Bryan A. Spinelli

Oncology Rehabilitation in Practice

Bryan Spinelli provides a summary of the contents of the issue.

Cover And Front Matter, Volume 3, Issue 1

Oncology Rehabilitation in Practice

Cover and front matter, Volume 3, Issue 1

Dementia Detection In Low-Resource Languages: Evaluating Translation-Assisted Transfer Learning For Multilingual Clinical Assessment, Kylar A. Deloach

Honors Theses

Alzheimer's disease (AD) is a growing global health concern, with millions of people affected worldwide and cases expected to rise significantly in the coming decades. Early detection is critical for patient treatment and care, and recent advances in natural language processing (NLP) have shown promise in identifying linguistic markers associated with AD. However, most existing work has focused on English, leaving speakers of other languages with limited access to such tools. This study investigates how effective AD detection models trained on English data are at transferring to Greek, a low-resource language with limited dementia-related speech data available. We propose a …

The Role Of Dollar Store Proliferation In Influencing Diabetes And Obesity Rates In West Virginia, Kelli L. Keith

Walden Dissertations and Doctoral Studies

Dollar stores are the fastest growing food retail format and are highly concentrated in rural, low-income communities including West Virginia, where diabetes and obesity prevalence rank among the highest in the United States. Although these retailers increase physical access to food, concerns remain about their limited healthier food options and potential contribution to chronic disease disparities. Guided by the socioecological model, this three-manuscript dissertation examined how dollar store density and healthier food availability related to county-level diabetes and obesity prevalence in West Virginia. Manuscript 1 used a cross-sectional ecological design with all 55 West Virginia counties, using data from USDA, …

Ai- Ready Assignments: Using Infographics To Translate Pedagogy Into, Kim Nehls

UNLV Best Teaching Practices Expo

I developed an AI teaching infographic assignment in a doctoral-level Seminar in College Teaching (EDH 780) that requires students to design their own original course assignment for any course that meaningfully integrates AI, and then they communicate the assignment visually through an infographic.

Perceptions Of Instructional Accommodations Among Nursing Students With Information Processing Disorder, Imaobong Aliyu

Walden Dissertations and Doctoral Studies

Instructional accommodations in nursing education often emphasize testing adjustments, while classroom-based instructional support for students with information processing challenges remains underexamined. This descriptive qualitative study explored pre-licensure nursing students’ perceptions of instructional accommodations for students with information processing disorders in Southern California. Guided by humanistic learning theory, the study addressed the research question: What are the perceptions of instructional accommodations in the classroom setting among pre-licensure nursing students with information processing disorders? Seven pre-licensure nursing students participated in semistructured Zoom interviews. Data were analyzed using an inductive process consistent with Saldaña’s analytic approach. Analysis revealed one overarching theme- Instructional accommodations …

Optimizing The Charge Nurse Role To Improve Workflow And Communication In A Community Living Center, Ndidi Kalu Ibe

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project evaluated the impact of optimizing the charge nurse role on workflow efficiency and communication within a Community Living Center. Identified practice gaps included role ambiguity, inconsistent delegation, and communication breakdowns, which contributed to delays in care and decreased staff satisfaction. An evidence-based approach was used to standardize charge nurse responsibilities, strengthen leadership practices, and introduce structured communication processes. The project demonstrated that improving role clarity and leadership consistency supports more effective delegation, enhances team communication, and improves care coordination. Outcome included increased staff engagement, improved workflow efficiency, and enhanced patient safety. This initiative …

The Correlation Of Beer, Wine, And Liquor Excise Tax With Alcohol-Impaired Traffic-Related Deaths In All 50 U.S. States, Paul R. Amigh Ii

Walden Dissertations and Doctoral Studies

Alcohol-impaired driving remains a persistent public health and safety problem in the United States, resulting in thousands of preventable deaths each year and substantial societal costs. Policymakers frequently rely on alcohol excise taxes as a deterrence strategy; however, evidence regarding the effectiveness of taxation alone in reducing alcohol-impaired traffic fatalities remains mixed. The purpose of this quantitative, correlational study, grounded in economic deterrence theory, was to assess relationships between state-level beer, wine, and liquor excise tax rates and alcohol-impaired traffic fatality rates per 100,000 population in 2019. A cross-sectional design used secondary data from all 50 U.S. states and the …

Staff Education On Structured Phq-9 Administration To Enhance Depression Screening In Outpatient Mental Health Care, Zekarias F. Abessa

Walden Dissertations and Doctoral Studies

In outpatient mental health settings, inconsistent use of the Patient Health Questionnaire-9 (PHQ-9) due to gaps in knowledge and lack of standardized training can lead to missed opportunities for early identification of depression and delayed treatment. Mental health nurses play a key role in screening and early intervention, underscoring the criticality of this role in practice. The Doctor of Nursing Practice (DNP) project explored whether a structured PHQ-9 staff education program could improve staff knowledge compared to baseline practice. The project involved using an intervention-based quality improvement design to enhance staff knowledge of administering and interpreting the PHQ-9 screening tool. …

Predicting Epileptic Seizures From Eeg Signals Using Machine Learning, Hamzah Luqman, Galal M Binmakhashen, Hanan Alali, Marwa Alsleebi, Hamdi A. Al-Jamimi, Motaz Alfarraj, Shahid Bashir, Brent Hedgcock, Ali Mir, Raidah Albaradie

Neurosciences

Objective: To develop a machine learning-based model for predicting epileptic seizures by analyzing electroencephalogram (EEG) signals and classifying the interictal and preictal phases.

Methods: The EEG signals were analyzed in both the time and frequency domains using advanced feature extraction techniques. Three different machine learning approaches were employed, with special focus on long short-term memory (LSTM) networks. Features were extracted and classified to differentiate between seizure and non-seizure phases. The proposed models were evaluated using the publicly available CHB-MIT EEG dataset. The study was conducted between September 2022 and September 2024.

Results: Among the tested models, the LSTM-based approach using …

Epilepsy And Cluster C Personality Disorders: A Saudi Cross-Sectional Study, Mohammed A. Aljaffer, Ahmad H. Almadani, Ayedh H. Alghamdi, Mohammad N. Aljarba, Azzam A. Alotaibi, Mohammed A. Alorayyidh, Abdulaziz M. Alawwad, Rakan S. Alromayan, Faisal M. Alkhunein, Sohaila A. Alshimemeri, Bandar N. Aljafen

Neurosciences

Objective: Epilepsy is a neurological disorder with profound impacts on various aspects of life. It may lead to significant medical and psychiatric comorbidities, one of which is personality disorders (PDs). This study aims to assess the prevalence of Cluster C PDs among adult patients with epilepsy (PWE) at a tertiary care hospital in Riyadh, Saudi Arabia. Method: This cross-sectional study, conducted between January 2024 and April 2025, enroled 360 adult PWE using convenience sampling. The study tool included the Structured Clinical Interview for DSM Disorders criteria, along with additional demographic and epilepsy-related questions developed by the research team. Results: Cluster …

Quality Improvement Project: Impact Of An Escape Room Simulation Tool On Nursing Confidence, Farren M. Moore

Doctor of Nursing Practice Projects

This quality improvement project aims to address the need for innovative teaching strategies to meet the demands of licensure exams and the increasing complexity of patient care. Evidence supports simulation-based learning as an effective method to enhance critical thinking and clinical judgment; however, faculty members lack confidence in implementing innovative strategies in their courses. The purpose of this project is to determine whether a standardized escape room simulation tool would impact faculty’s self-confidence in developing and implementing simulation-based activities. Guided by the National League for Nursing (NLN) Jeffries Simulation Theory and Lewin’s Change Theory, the project evaluates the change in …

Current Landscape Of Mental Health Conversational Agents From A Trauma-Informed Care Lens: Scoping Review., Faye Kollig, Kira Voelker, Emily Ryan, Rachel Pfafman, Fayika Farhat Nova

Health Services and Informatics Research

BACKGROUND: Conversational agents (CAs) are increasingly used in mental health care to enhance access and engagement. However, their safe, ethical, and user-sensitive design remains a challenge. Despite growing attention to trauma-informed approaches in human-computer interaction, there is limited work on how the trauma-informed care (TIC) framework could be applied in the design of mental health CAs and no comprehensive synthesis to date.

OBJECTIVE: Guided by the Substance Abuse and Mental Health Services Administration's TIC framework, this scoping review explored how TIC principles (safety; trustworthiness and transparency; collaboration and mutuality; empowerment, voice, and choice; peer support; and cultural, historical, and gender …

Motivational Interviewing Vs. Educational Handouts For Caregiver Smoking Cessation In Pediatric Asthma Patients: A Scoping Review, Michael Stefano, Hannah Marsh, Tracy Mcclinton, Dnp, Aprn, Ag-Acnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Secondhand smoke exposure can significantly worsen asthma outcomes in pediatric patients, leading to increased exacerbations and healthcare utilization. Caregivers can play a critical role in reducing secondhand smoke exposure, however sustained smoking cessation can be challenging to achieve. Two powerful healthcare interventions to assist in caregiver smoking cessation include motivational interviewing and educational handouts, however their compared effectiveness has not yet been fully reviewed. This scoping review compared the effectiveness of motivational interviewing and educational handouts in promoting smoking cessation among caregivers of children hospitalized for asthma exacerbations over the course of 90 days.