Pulse Check with Dean Nelson - February 2026
Sharing thoughts, laughs, and a little wisdom!
The Courage to Speak Up
As a clinical department chair, I learned early that the most dangerous phrase is not “I made a mistake.” It is “I did not want to speak up.” Every near-miss I reviewed, every adverse event I investigated, had the same thread running through it: someone noticed something wrong but stayed silent. Not because they did not care, but because they did not feel safe. The physicians and nurses who made the biggest difference in those rooms were not always the most experienced. They were the ones who felt safe enough and empowered to say something.
Harvard Business School professor Amy Edmondson has spent decades studying what sets high-performing teams apart. Her research reveals a surprising answer: it is not talent, experience, or resources. It is psychological safety - the shared belief that a team is safe for interpersonal risk-taking. Her work across industries, including healthcare, shows that teams with high psychological safety report errors faster, innovate more freely, and learn more effectively. The most dangerous words in any clinical setting are not “I was wrong.” They are “I was afraid to ask.”
This concept continues to shape my thinking at COM. From my earliest days here, I made a deliberate choice: ask questions openly and demonstrate that not having all the answers is not a weakness - it is a starting point. You do not build trust by pretending to be certain. You build it by making questions welcome.
I continue to see that this culture already exists here in powerful ways. I recently sat through small-group case discussions and watched faculty invite students to challenge their reasoning during case presentations. I have seen COM and engineering researchers sit down together to explore AI applications in medical education, asking, “What if we tried this differently?” I have watched residents say, “I am not sure,” and have that uncertainty met with coaching rather than criticism. What is powerful about this is not any single example - it is the pattern. When people feel safe to speak up, small observations become meaningful improvements, each one building on the last, creating momentum that no top-down mandate could replicate. As Newton observed, we see further by standing on the shoulders of giants - and in our learning environment, we become giants by lifting each other up.
That is why our commitment to collaboration and team-based excellence matters so much right now. We have spent this past year building trust and defining shared priorities. But none of those priorities succeed if people do not feel safe enough to flag problems early, propose untested ideas, or admit when something is not working. Curiosity requires courage. In medicine, that courage comes from knowing your question will be met with engagement, not embarrassment.
As we move into 2026, what matters is not whether we achieve our goals - we will. It is whether we sustain the environment that makes achievement possible: the willingness to ask, the courage to question, the safety to fail and try again. The moment we stop welcoming honest questions is the moment we stop learning. And a medical school that stops learning has forgotten its purpose.
Lessons from Ted Lasso's Locker Room
When Ted Lasso arrives at AFC Richmond, he does something counterintuitive for a coach: he tells his team they are allowed to fail. Not just allowed — expected to. He hangs a "BELIEVE" sign in the locker room and replaces judgment with curiosity. It seems naive. It is not.
Consider what unfolds. Nate, the quiet kit man, proposes a tactical strategy no one else considered. Roy Kent, the toughest player on the pitch, admits he is afraid of retirement. Jamie Tartt, the arrogant solo star, learns to ask for help. None of this happens overnight. It happens after Ted creates an environment where vulnerability is treated as wisdom, not weakness.
His philosophy “Be curious, not judgmental" — is not a feel-good bumper sticker. It is the foundation of teams that learn, adapt, and improve. Compare that to the culture Rupert creates, where fear drives defensiveness, mistakes get buried, and innovation dies quietly.
The parallel to academic medicine is direct. When students feel safe saying "I do not understand," when residents question an order without hesitation, when faculty propose something untested — that is when real learning happens. In medicine, that learning might be the difference between catching an error and missing one.
Stay curious, MedOwls.