Walking onto Dartmouth’s campus in 1998, Thom Walsh felt a gnawing sense of imposter syndrome. The first in his family to attend college, he’d just left a small-town physical therapy clinic to join an Ivy League medical center. His new boss, renowned surgeon James Weinstein, had recruited him to help build something unprecedented: the country's first comprehensive patient outcome measurement program for spine care. Walsh had been tracking his own patients’ outcomes for years—a practice virtually unheard of at the time—and when Weinstein advertised his ambitions in the journal Spine, Walsh reached out. Days later, Weinstein called, impressed, and invited him to Dartmouth. 

“I sure felt like people were going to find out that I shouldn't be here,” Walsh recalls. 

Yet as a senior physical therapist at Dartmouth Hitchcock Medical Center, he found himself immersed in research and began publishing papers in leading journals. By 1999, in addition to the Spine Center, he had helped launch the first center in the United States for shared decision-making—a revolutionary approach that put patients at the center of their own care decisions. Three years later, Walsh earned his MS in Clinical Evaluative Science at the Geisel School of Medicine at Dartmouth. Directing patient care, along with his new degree, opened his eyes to “how the policy environment shapes what you can and can’t do within a system,” he says; how it “creates the space where improvements flourish or fail.” 

That realization propelled Walsh toward his PhD at The Dartmouth Institute for Health Policy & Clinical Practice, which he completed in 2012. As a postdoctoral fellow, he helped develop the first hybrid education program for healthcare delivery science in the United States, translating complex research into practical tools for improving patient care. Alongside his ongoing work at Dartmouth, Walsh applied this expertise through consulting with healthcare systems nationwide and teaching in a range of academic settings. He is now a Professor of the Practice of Health Policy at The Dartmouth Institute, a role reflecting the integration of scholarship, teaching, and system leadership. 

Walsh came to see that he belonged. And that realization now shapes how he helps students feel the same. 

Creating Space to Think 

The feeling of not belonging, Walsh had realized, makes learning nearly impossible. “When you’re constantly worried about being exposed as inadequate, you’re too busy managing anxiety to absorb new knowledge,” he says. 

For that reason, Walsh begins every course by thanking students for choosing to be there, acknowledging their courage to enter a field that’s “getting harder, not easier.” Then he makes it a point to remind them that they, too, deserve to be at Dartmouth. 

This isn’t empty encouragement. Walsh shows his students “a slide of all the times I’ve failed at something in my career,” which is “not fun for me,” he admits. “But I say, ‘If I can be here teaching you after all of that, you certainly deserve to be in your seat.’” 

If humility forms the emotional bedrock of Walsh’s pedagogy, critical thinking is the quarry of that philosophy. When vulnerability creates the psychological safety students need, they can relax into learning. Students worried about looking stupid, or afraid to stand out, are less apt to scrutinize assumptions and question the status quo. “Before students can challenge healthcare systems, they first need a space to learn how to challenge ideas in the classroom,” he says. Belonging and rigorous thinking aren’t separate goals; for Walsh, they’re inextricably linked.  

Walsh teaches students to become healthcare navigators by developing “healthy skepticism”—the ability “to look at any claim and ask, ‘Really? Is it that way all the time? Does it change for different groups? What are the edges where this breaks down?’” 

What he instills is a methodical way to “decompose a system” into steps, “precisely define the terms, examine the connections between each term individually, and assess the strengths and limitations across the distribution,” Walsh says. “You can teach all that.” 

Having taught at multiple universities, Walsh has noticed “a tendency among many to teach health systems and policy formulaically, a pattern that can dull critical thinking.” Under the spell of well-worn syllabi, students fall into ruts of lazy analysis and trite solutions, shallow perspectives that inevitably influence their future work in real-world scenarios. Without furrowing their brow, many risk losing sight of what matters most: Are patients getting better? In the absence of intellect as a compass, even those with best intent may find it easy to lose compassion—and themselves in the business of building margins, but forgetting the mission. 

In contrast, and to ground students, Walsh teaches healthy skepticism as a “discipline,” a practice of nuanced thinking that is often slower, if more deliberate. Cultivating this kind of mind is “critical,” Walsh says, for the younger generations to learn, particularly as the pull to think faster grows ever harder to resist. 

Thinking with AI 

Students today are drawn to AI, often for its quickfire answers, the repeated use of which can, and often does, bog down critical thinking by outsourcing the tedium of creativity and arduous tasks of problem-solving. Walsh—who is an advocate of AI—deliberately structures his assignments “so that it's really hard to have ChatGPT spit out an answer.” This unsettles some students. “That's why it’s crucial to create a supportive learning culture quickly, so people don’t feel threatened when you make them uncomfortable,” he says. 

The discomfort serves a purpose. Walsh wants students thinking with AI, not through it. “AI typically reinforces bias and shortcuts the art of thinking well,” he says. “But you can also use it for slow thinking, to examine definitions, explore alternative viewpoints, stress-test ideas. It’s like having the benefit of working in a lab with other scientists to bounce ideas off.” He reframes AI use from “generative” to “deliberative,” treating it as a research assistant and editorial strategist—never a decision maker. “I don't want artificial intelligence to think for me,” Walsh says. “I want one that helps me think like myself at my best.” 

Ultimately, students thank him. At the end of many courses, there are always some who marvel, telling him: “‘I’ve never thought this way. I’ve never been taught to think this way.’” 

Second Thoughts 

For graduate students, executives, and future policymakers, mastery of Walsh’s method transfers to any field. “Health systems flourish or fail depending on the policies and choices leaders make under the stress of those policies,” Walsh asserts. “Training leaders to use critical thinking to make better decisions” is paramount. 

Walsh practices what he preaches. As a member of Vermont’s Green Mountain Care Board, he applies this way of thinking daily, overseeing the state’s hospitals’ budgets, insurance pricing, and healthcare reform initiatives—decisions affecting hundreds of thousands of lives and billions of dollars.  

The stakes are real. Trust in healthcare is low, and only humans can rebuild it—creating transparent cultures that value finding errors over hiding them, celebrating differences rather than stifling them, and understanding that leadership is an act of serving people, not systems. This lived experience gives weight to what Walsh tells students: “You are going to make decisions that matter.” 

Written by: Jeremy Martin