What happens when life-and-death decisions must be made by a team rather than an individual? In this episode, Dr. Mark Ramzy — cardiothoracic intensivist, emergency physician, and Co-Editor-in-Chief of REBEL EM — joins Dan to explore how teams think, decide, and act under pressure inside the ICU.

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In this episode, Preston discusses mission critical teams with Dr. Dawn Kernagis, the Scientific Director at DEEP. DEEP is an extreme environment technology and exploration organization with a mission to "Make Humans Aquatic." They explore the complexities and dynamics of individuals and teams working in undersea habitats and submersible systems. Dawn shares insights from her extensive experience, including participation in NASA's Extreme Environment Mission Operation (NEMO) project as a crew member for mission 21 and research on optimizing human performance under pressure.

Preston and Dawn cover an array of topics, including the importance of team cohesion, situational awareness, and the psychological and physiological challenges these teams face. Dawn also emphasizes the critical role of effective communication and leadership in maintaining team safety and performance. The episode concludes with practical advice for building and managing resilient, high-functioning teams.

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This week’s episode is a Recast as we review a fundamental conversation between Preston and Coleman Ruiz (MCTI’s co-founder and former Director of Performance) on the concept of "Residue"—the psychological and emotional substance left behind after immersion in high-stakes environments.

As we approach the end of the year, we are revisiting this episode to help our listeners navigate the transition from one year to the next and to continue or begin a ritual of reflection. Coleman and Preston explore how the "residue" of our experiences is neither good nor bad, but rather a byproduct that must be processed. Without intentional routines, this residue can "harden," inhibiting our ability to move into a new year with clarity.

The conversation covers various aspects of professional and personal life, including the impact of extreme experiences, the importance of intentionality and self-compassion, and the value of a 'third thing' to help balance life.

This thought-provoking discussion is essential for anyone involved in mission critical fields, as it emphasizes the need for better tools and self-awareness to manage the residue of intense experiences. Whether you are coming off a high-intensity deployment or simply looking to reset after a demanding year, this episode offers a framework to help you leverage your past to build a more resilient self.

1. Find the featured paper on our website: https://missioncti.com/resources/

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In this episode, our Chief Medical Officer Dan Dworkis works with Alex Hodson, a seasoned critical care physician assistant, to explore the dynamics of high-functioning multi-professional healthcare teams, the training pipeline for APPs, and the importance of feedback and teamwork across disciplines. Gain insights into the challenges and rewards of working in high-stress environments and understand how multidisciplinary and multi-professional collaboration shapes effective patient care.

This week, we’re revisiting a conversation between Preston and Dr. Art Finch, a veteran psychologist from the US Special Operations Command. This episode (previously published in 2020) covers the unique psychological profiles of mission critical teams. 

Channel a beginner's mind and re-explore why some individuals choose the extraordinary path of high-risk, immersive environments while others opt for more conventional lives. Listen to Art share his experiences and insights from working with special operations units, highlighting the exceptional intelligence, low anxiety, and emotional compartmentalization abilities of operators. Consider the impact of these traits on personal relationships and daily functioning, offering valuable perspectives for both operators and their families, foundational knowledge for the recent Teamcast and accompanying workbook “On Coming Home”. 

The episode also touches on the challenges of transitioning back to civilian life and the importance of understanding and leveraging one's unique cognitive and emotional strengths.

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In today’s Teamcast, Harry and Martin Jones discuss the role of psychologists as servants in high-performance environments, the rule of thirds in learning, psychological performance and speed cameras, and how high-quality sleep is still a work in progress and is not the last thing we do at night, but the first thing we do in our day.

Martin is a sport and exercise psychologist. He is also a sleep specialist with over 20 years of experience supporting coaches, performance directors, elite athletes, military personnel, business leaders, and recording artists. He holds postgraduate degrees in sport psychology from Loughborough University and sleep medicine from the University of Oxford. Martin has published over 50 peer-reviewed papers and taught at universities in the UK and Canada. He holds an honorary professorial position at Hartbury University and is the creator and co-host of the Optimising Human Performance podcast.

Check out Martin’s own podcast – Optimising Human Performance – at https://www.ophp.co.uk/.

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Dr. Dan Dworkis and Dr. Art Finch, MCTI's Director of Psychology, discuss the complexities of reintegrating into family life after high-stress, mission-critical work. They introduce 'On Coming Home,' a workbook designed to help both operators and their families navigate the reintegration process. The conversation highlights the importance of patience, gratitude, and understanding that coming home is a process, not an event.

Access the On Coming Home workbook here.

This episode was published in partnership with The Emergency Mind Podcast. If you find value in this discussion, the best way to support our work and stay up-to-date with future episodes is to subscribe and leave us a quick rating or review. It helps us reach more people who need to hear these conversations.

Today, we welcome Dave Robson, Chief Engineer at Atlassian Williams Racing. Dave shares his extensive career journey spanning 25 years in F1, starting with McLaren and now at Williams. He delves into topics such as leadership, team organization, and the balance between data and intuition in high-pressure environments. The conversation also explores the challenges of training new engineers without traditional test teams, the importance of building intuition, and maintaining high performance under stress. Dave and Harry discuss  the dynamics within racing teams and strategies behind building instinctual decision-making in pit teams, toggling between flat and hierarchical team structures. They talk about the need to build a “war chest” of social capital to spend in the hard time. Dave closes by sharing some of the books that have influenced his career.

Dave holds a Master of Engineering from the University of Oxford and has deep experience and expertise in stress analysis, laboratory testing, F1 engineering and racing, as well as how to lead and manage teams in one of the most high-pressure environments in sports.

This episode has insight into high performance, engineering, leadership, and the inner workings of teams in demanding environments.

Dave’s book recommendations: The Art of Action: How Leaders Close the Gaps between Plans, Actions and Results by Stephen Bungay; Legacy: What the All Blacks Can Teach Us About the Business of Life by James Kerr

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Eric Benoit, acute care surgeon at Lahey Hospital, and Andrew Petrosoniak, emergency physician at St. Michael’s Hospital, join Chief Medical Officer Dan Dworkis on the Teamcast to discuss operating with uncertainty in high-stakes medical environments. This episode, released in collaboration with The Emergency Mind podcast, addresses managing risk, performing under pressure, and the importance of decision-making and reflection. Discover how Eric, Andrew, and Dan balance technical skills and knowledge with handling ambiguity in critical situations. Learn valuable insights on improving clinical decision-making, teaching trainees to cope with uncertainty, and operating in highly uncertain environments.

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“Find those people who are your allies, have confidence in yourself, have confidence in your competence.”

This episode features an in-depth conversation with FDNY Deputy Chief Michele Fitzsimmons, who shares her career journey and discusses the evolution of the department. 

Michele shares her journey from working with HIV/AIDS patients to becoming a firefighter and eventually rising through the ranks to Deputy Chief. Preston and Michele discuss the critical role of trust, teamwork, and communication in mission-critical situations, as well as the fundamental changes that followed the events of 9/11.

Michele offers valuable insights into the significance of training and communal meals, as well as the evolving safety protocols for modern firefighters. This episode is an inspiring look into the life and career of a dedicated leader who has helped shape the future of fire service.

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