Pulse Check with Dean Nelson - March 2026
Sharing thoughts, laughs, and a little wisdom!
The Power of Observation
Early in my residency, I learned what it means to truly see a patient. A young girl, maybe seven years old, came in with her family for what they described as sleepiness and a fever — unremarkable on the surface. After I presented the case, my attending walked over, looked at her legs, and pointed to something I had almost missed: tiny red spots that did not blanch when he pressed on them. He did not lecture. He just asked what I thought they were. I have never failed to consider meningococcemia since. She got antibiotics and did well. What stayed with me was not the diagnosis — it was watching someone who knew how to see.
Albert Bandura named that kind of learning. His Social Learning Theory establishes that human beings learn not only through direct experience but through observation, modeling, and the social environments in which learning takes place. Medical education has its own version of this principle, captured in a phrase every clinician knows: see one, do one, teach one. It is a framework built on the understanding that experiential knowledge goes deeper than knowledge transferred through reading alone.
Sir William Osler understood this more than a century ago. “He who studies medicine without books sails an uncharted sea,” he wrote in 1901, “but he who studies medicine without patients does not go to sea at all.” Clinical rotations are where the sea begins. You do not learn to be a physician from a textbook alone. You learn by standing next to someone who has done this thousands of times — watching their judgment, their communication, their composure when the situation demands it. You learn that uncertainty is navigable because you can see someone navigate it in real time.
We saw this play out earlier this month. On Match Day, our students learned where they will continue their training — and what unfolded in that room was not simply the announcement of placements. The specialty each student matched into did not emerge from a textbook. It emerged from a rotation, a mentor, a moment when something clicked because they were present for it. Every attending who modeled clinical excellence on a rotation, every faculty member who stayed to talk through a difficult case, every resident who took the time to teach instead of just do — those moments were in that room on March 20. That is social learning at scale.
This is what we are building here: an environment where learning moves in all directions. Students learn from faculty in the classroom and at the bedside. Faculty learn from trainees who challenge them with questions they heard on a podcast — or read on social media at 2 a.m. Researchers build on questions their colleagues first raised. Each of our pillars — education, research, patient care — depends on this kind of learning to sustain itself.
The institutions that endure are the ones where observation is intentional and modeling is visible. The moment any of us assumes there is nothing left to learn from the person beside us is the moment we stop advancing.
Eleven, the central character of Stranger Things, has no instruction manual. No parents, no school, no framework for what she is feeling or why the world works the way it does. What she has, when she stumbles into Hawkins, is a group of kids who let her watch.
That is how she learns everything. She watches Mike navigate a conflict and learns what loyalty looks like in practice. She watches Dustin explain something he loves and learns what curiosity without embarrassment feels like. She watches them protect each other and decides, without anyone telling her, that this is what she wants to do too. It is Bandura’s observational learning in its most basic form: behavior, judgment, and values acquired by watching others, not by being told.
The parallel to clinical training is direct. A student on their first rotation does not yet know how to read a room, catch what others overlook, or make the quiet observation that changes everything. That skill cannot be downloaded from a textbook. It is built the way Eleven built her understanding of friendship: by watching carefully, over time, in the presence of people who already know the way.
The most important things in medicine are rarely the ones you can memorize. They are the ones you have to see.
Stay curious, MedOwls.