U-EXPLORE Partners with Medicine to Teach Clinical Judgment
How a backcountry classroom is shaping the way future physicians learn to make decisions under uncertainty.
Three University of Utah departments are teaming up to help aspiring physicians learn one of medicine’s most essential—and hardest to teach—skills: decision-making under uncertainty.
For Sarah Petelinsek, a third year medical student and previous ski patrol, the idea began with a half serious joke.
“I’ll admit, at first I was trying to figure out how to get the university to pay for my friends and I to backcountry ski,” Petelinsek says with a laugh.
But what started as a lighthearted pitch has evolved into Decision-making in Avalanche Terrain and Implications for Clinical Practice—a unique learning experience that takes medical students and residents out of the classroom and into the backcountry. There, amid snow covered terrain, incomplete information, and real world risk, participants explore how people make decisions when the stakes are high and certainty is low.
“Being out in avalanche environments is similar to what emergency physicians face,” Petelinsek explains. “There is missing and incomplete information, time pressure, and doctors have to make decisions with what they have.”
Petelinsek initiated the course and research program to study how outdoor experiential learning can improve clinical decision-making among medical students and residents. She partnered with Theodore “TJ” Hartridge, an emergency physician and assistant professor in the Department of Emergency Medicine, and Nate Furman, professor in Parks, Recreation, and Tourism (PRT) within the College of Health, to bring the program to life.
A key element of the course’s success is its partnership with U-EXPLORE, housed in the PRT department and directed by Furman. U-EXPLORE designs and delivers custom experiential outdoor programs across campus, including for the School of Business, the Honors College, and the School of Medicine. The program is grounded in the belief that outdoor experiences can foster confidence, resilience, sound judgment, and strong social bonds.
“This kind of learning is what we specialize in,” Furman says. He oversees instructor hiring, risk management, logistics, and field implementation—and is present throughout the program.
“Sarah, TJ, and I develop the curriculum together,” Furman explains. “We design the scenarios, chart the travel routes, and build structured reflection into the day.”
Furman brings together scholarship on judgment and learning in complex outdoor environments with years of professional guiding experience.
“My role is to help bridge rigorous academic ideas with lived, experiential learning,” he says. “The backcountry becomes a living classroom where participants can see their own thinking unfold in real time.”
The course uses outdoor, experiential learning to explore decision-making concepts that also shape clinical care. Participants encounter uncertainty, physical fatigue, group dynamics, and evolving conditions, then reflect on how those factors influence their judgment both in the backcountry and how it would translate to clinical care.
How the Course Took Shape
The program evolved over several years, growing from a small pilot to a recurring experiential component across levels of medical education.
- The first iteration began as an evening lecture followed by a day of backcountry skiing with a small group of medical students.
- A second version expanded to an entire class of approximately 125 incoming medical students. Participants went hiking and intentionally “got lost” in the woods—while course leaders quietly ensured safety. Students worked together to problem solve, then reflected on how their decision-making mapped onto clinical scenarios.
- The next evolution became a recurring “snow day” for emergency medicine residents, now held annually and integrated into residency training.
None of the experiences function as standalone, credit bearing courses. Instead, they are embedded within existing curricular moments—such as the transition to medical school (SCoPE) and emergency medicine residency education—where reflection on decision-making is especially timely.
Studying the Impact
Beyond anecdotal enthusiasm, Petelinsek is studying how the course affects decision-making. Participants complete pre and post course assessments, including clinical vignettes that evaluate how individuals reason through uncertainty. Responses are scored by panels of clinicians, allowing researchers to examine changes in judgment, structure, and awareness of bias.
For Petelinsek, one theme continues to stand out.
“The biggest ‘aha’ has been the importance of clear and consistent feedback,” she says. “One of the biggest reasons biases persist is these environment—you don’t know if you’re making good or bad decisions.”
The course intentionally draws on strategies from avalanche education and behavioral economics to strengthen feedback in clinical decision-making, and applies clinical lessons back to the backcountry as well.
As a distinctive part of the University of Utah experience, U-EXPLORE reflects the institution’s close relationship with the Wasatch Mountains and surrounding public lands. For medical trainees, that setting makes abstract concepts tangible—and memorable.
What began as a tongue-in-cheek proposal to ski has become an innovative educational model for teaching future physicians how to think, decide, and reflect when it matters most.
Concepts Taught in Course
| Concepts |
What It Means |
In Avalanche Terrain |
In Medicine |
Why It Matters |
|---|---|---|---|---|
| Dunning–Kruger Effect | People with limited experience often overestimate their competence, while experts are more aware of uncertainty and limitations. | New backcountry travelers may feel confident assessing snow and avalanche hazards after minimal training. | Early trainees may overrate diagnostic certainty or procedural skill. | Recognizing this effect encourages humility, structured feedback, and safer decision-making, ultimately improving patient care. |
| Heuristic Biases | Mental shortcuts that speed decision-making but can lead to systematic errors. | Examples include familiarity (“we ski here all the time”) or social proof (“others are going there”). | Can involve anchoring on an early diagnosis or conforming to group consensus. | Awareness of these biases helps clinicians pause, reassess assumptions, and avoid premature or unsafe decisions in high stakes situations. |
| Wicked Learning Environments | Environments where feedback is delayed, incomplete, or misleading, making it hard to learn accurate cause and effect. | Poor decisions often go unpunished—until they result in an avalanche—reinforcing risky habits. | Outcomes depend on many factors beyond a single decision, making it hard to judge decision quality from results alone. | Highlights the need for structured reflection, simulation, and feedback rather than relying solely on experience. |
| Normalization of Deviance | Gradual acceptance of increased risk after repeated exposure without negative outcomes. | Traveling in hazardous terrain becomes routine after several uneventful trips. | Workarounds or deviations from protocol become normalized when they appear to “work.” | Recognizing this effect helps teams maintain standards, questions drifting practices and prioritize structured decision frameworks even when previous risky decisions had good outcomes. |