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The clinician–educator has no clothes

“... actually see patients in respiratory failure on ventilation” (O’Connor et al. 2017). These are experiential learning phenomena, which can, if recognized, be enhanced by encouraging students to reflect on and to form learning concepts from their experiences. A social learning construct can also help explain student learning in the ICU. Vicarious learning occurs when students observe the behaviors of healthcare staff managing time-critical aspects of acute illness, such as collecting and applying clinical information, and conducting therapeutic interventions (O’Connor et al. 2017). We employ strategies to maximize learning when this occurs. With sufficient clinical staff present to manage an acute event (for example an inpatient with hypotension), we run a parallel “tutorial commentary” with students, noting the actions and behaviors of the healthcare staff, discussing how and why they are performed. If staff numbers prohibit this approach, students observe the scenario and participate in a subsequent “clinical debriefing”. The unwell, non-communicative ICU patient also presents challenges to students learning the art of historytaking and clinical examination. Clinical reasoning instead becomes a constructivist process of discovery learning and problem-solving, whereby an adjustment in learning method makes the student “...more like a detective than if you had someone who could talk to you” (O’Connor et al. 2017). Clinicians should provide students with opportunities to construct differential diagnoses and management plans for unwell patients during ICU clerkships. In summary, patients with acute illness can be at the center of undergraduate observational learning episodes in the ICU without jeopardizing their safety, dignity or acute care.