It takes guts to pursue a field you know nothing about, to leave one’s homeland in search of a dream and to dare claim a future as a physician in a country where you don’t have any family and don’t speak the language. The phrase, “it takes guts,” comes from the idea that courage and bravery flow from deep within, and suggests that facing challenges requires strength and fearlessness. Among the recipients of PracticeLink’s Spring 2025 First Practice Fund scholarship, there is none that exemplifies these qualities more than future Gastroenterologist, Dr. Alejandro Nieto Dominguez.

Dr. Nieto Dominguez’s standout entry for First Practice Fund described a cohesive story of service, research impact and clear future goals, all with a voice that reflects passion backed by action.

From volunteering at a hospital as a teenager in Panama, to medical training and ultimately, research-backed GI care in the U.S., his narrative is engaging, concise. His entry reveals a level of professionalism that shows humility, emotional intelligence and leadership maturity — learning from feedback, advocating for patients and mentoring peers.

PracticeLink: Why did you enter medicine? 

Dr. Alejandro Nieto Dominguez: Before I knew the vocabulary of medicine, I knew two things about myself: I like untangling hard problems and I feel compelled to make that effort count for my community. Those instincts crystallized during high school summers at Hospital Santo Tomas, Panama’s main public hospital, where I volunteered at community health fairs. Dozens of people arrived after traveling hours by bus: patients whose first screening showed blood pressure in the urgency range, farmers with lesions highly likely to be skin cancer, and laborers whose edematous legs betrayed an undiagnosed course of heart failure. Each story shared the same arc—care sought too late because the public system’s bottlenecks kept early help out of reach. Watching preventable diseases advance so far convinced me that knowledge alone is not enough; expertise must be joined by advocacy and structural change.

Santo Tomás Hospital is in Panama City; edematous is swelling due to fluid trapped in the body’s tissues.

That conviction guided my path north. I chose training in the United States to learn not only the science of medicine but also how leaders turn bedside questions into studies that reshape practice. Internal medicine residency at Cook County Health—Chicago’s largest safety-net hospital—let me pair rigorous teaching with a mission that mirrors Santo Tomas. Daily encounters with barriers, such as how the absence of transportation caused a patient to repeatedly fail bowel preparation for colonoscopy and then getting diagnosed with stage 4 colon cancer due to delays in their workup, or failure of a patient to adhere to a low FODMAPS diet due to the costs pushed me to ask how social conditions steer gastrointestinal outcomes.

FODMAPs are  short-chain carbohydrates (certain types of sugar, starch and fiber) some people  can’t digest and/or absorb well.

I began noticing more and more of these and decided to start formal research while in residency.

This summer, I begin my Gastroenterology fellowship at Saint Louis University, an institution recognized for serving St. Louis’s underserved communities. The setting will sharpen my procedural skills while expanding the social-determinants research I started during residency.  My goal is clear: to become an academic physician who advances evidence-based therapies and builds delivery systems that ensure those advances reach the people who need them most.

PL: How have you demonstrated professionalism in your medical training?

Dr. NIETO DOMINGUEZ: Early in my intern year, my professionalism was tested more than at any other time: learning medicine in a new language and culture meant almost every day brought feedback on my ward presentations, medical documentation and—even as I grew into a senior—my teaching style. Instead of hearing criticism, I treated those comments as a syllabus and revised each skill until it met the team’s needs. That same posture guides how I care for patients. When insurance hurdles threaten to interrupt a heart-failure medication or an anticoagulant, I give patients my cell so they can alert me before a dose is missed, then stay on the phone with the pharmacist or insurer until their prescription is released. And when a situation exceeds my depth, I call the attending; when delays endanger a patient, I escalate through the chain of command without blaming anyone, keeping the focus on a solution. Accepting feedback, staying reachable and knowing when to ask for—or offer—help have carried me from that steep intern year learning curve to a senior resident who now mentors others through the same challenges.

PL: How have you built and utilized strong interpersonal and communication skills in your training?

DR. NIETO DOMINGUEZ: I’ve learned that clear, respectful communication is something you practice, not something you “have.”

During my palliative-care rotation, I often helped families face heartbreaking choices about life support. In one case, a patient’s daughter struggled with the thought of “disconnecting” her father. I slowed the conversation, asked what her father valued when he was well and helped frame the decision around honoring those wishes. The family chose comfort-focused care, and later thanked us for giving them the space to reach that decision together.

On the wards, I hone my craft by volunteering for morning-report presentations and asking colleagues to pick apart my reasoning. Their feedback—everything from how I sequence data to the words I use with interns—has made my teaching clearer and my plans tighter.

I bring the same mindset to research. Presenting our work at Digestive Disease Week and the American College of Gastroenterology forced me to turn dense analyses into a three-minute story and handle rapid-fire questions from senior investigators. Whether I’m talking with a family, a care team or a national audience, the goal is the same: ensure everyone leaves the conversation knowing exactly what we’re doing and why.

PL: What are your career goals and how will the First Practice Fund help you achieve them?

DR. NIETO DOMINGUEZ: I plan to build a career as an academic gastroenterologist who studies how social and economic barriers shape digestive-disease outcomes and then turns those findings into practical fixes. Right now, I am finishing two projects that speak directly to that mission: an observational study showing how malnutrition worsens outcomes in hospitalized patients with gastroparesis, and a points-based social-risk score we are piloting in inflammatory bowel disease clinics to spot patients who would have worse outcomes based on their social determinants of health. Both studies are on track for future presentations at major GI conferences and future journal submission for publication.

Support from the First Practice Fund would let me take the next step—getting these results into the hands of clinicians and researchers who can use them. The scholarship would offset publication fees, poster preparation and travel for conference presentations, turning completed projects into shared knowledge and helping me lay the groundwork for a research program focused on equitable GI care.