Pulse Check with Dean Nelson - October 2025
Sharing thoughts, laughs, and a little wisdom!
Lessons from Gall's Law: Simple Systems Evolve into Successful Complex Ones
In emergency medicine, the most effective interventions often seem deceptively simple. Stabilize the airway. Control the bleeding. Address the critical issue first. Behind each straightforward action lies years of refinement—protocols tested, adjusted, and improved through countless iterations.
This reflects Gall's Law: "A complex system that works is invariably found to have evolved from a simple system that worked." Consider the inverse: could we have built modern airplanes without first understanding birds, kites, and the Wright Brothers' airplane? Of course not. You can't design complexity from scratch and expect it to function. Excellence in any field—from aviation to medicine—comes from taking what already works and deliberately building upon it.
The same principle applies to medical education. The students begin with focused history-taking—asking the right questions, listening carefully, recognizing patterns. Over time, they layer on physical examination skills, diagnostic interpretation, and treatment planning. Rush the process, and the foundation crumbles.
The same applies to how academic health grows. Strong partnerships begin with clarity about shared objectives—improving care, strengthening education, advancing community health. The sophisticated networks and integrated programs come later, built on foundations of iterative change, consistent collaboration, and mutual success.
Our college follows this pattern. We are strengthening our educational mission, expanding research where we've shown success, and deepening clinical partnerships that already deliver value. When implementing a new curriculum component, launching a research collaboration, or improving an operational process, resist the temptation to overcomplicate from the start. Begin with clarity and humility. Test your approach. Adjust. Then layer on sophistication when the foundation proves sound. Excellence is not something you start with; it is something you build.
Lessons from Wednesday Addams
October means Halloween, and what better time to channel Netflix’s Wednesday Addams? She mastered something most of us struggle with: being unapologetically herself in situations designed for conformity.
When she declares, "I'm not sure whose twisted idea it was to put hundreds of adolescents in underfunded schools run by people whose dreams were crushed years ago... but I admire the sadism," she's identified a universal truth: most systems weren't built with you specifically in mind.
Her survival strategy? Don't waste energy pretending to be someone else. If you are pursuing unconventional research, asking questions that challenge assumptions, or seeing possibilities others miss - own that perspective. It's often where the most valuable insights emerge.
Wednesday eventually learns to work with others without losing her edge. That's the real skill: collaboration without conformity.
This Halloween, embrace your inner Wednesday. Be authentic. Be deliberate. Be effective - with a smile that says you know exactly what you are doing.