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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. If you value this discussion, the best way to support our work and stay up to date on 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.

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. If you value this discussion, the best way to support our work and stay up to date on 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.

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. Find the featured paper on our website: https://missioncti.com/resources/ If you value this discussion, the best way to support our work and stay up to date on 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.

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. 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.

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/. 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.

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 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.

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. 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.

“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. 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.

After a brief summer break, The Teamcast is back! In this episode, Preston sits down with Harry for a deep dive into the philosophy of high performance, resilience, and the human psyche. They explore a range of topics, from the role of Stoicism in modern life and the journey from a military mindset to psychology, to the concept of adaptive learning and the importance of social connections for team performance. Harry also reminisces about his time in the military, his influential travel experiences, and his involvement with the special operations punk rock band, The Externals. The episode ties practical insights with deep philosophical reflections tailored for individuals in mission critical teams. Check out these moments for specifics. 00:47 Harry & Preston meeting at Fort Bragg + Human Performance 07:36 Transitioning to Psychology 09:23 The Importance of Philosophy and Ethics 33:04 The Praxis of Wisdom 39:54 The Importance of Social Connections 40:48 The Role of Debriefing in Performance 48:04 The Wild West of Human Performance 57:47 Training Intelligence and Adaptive Learning 01:16:45 The Power of Reflection and Mind Wandering 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.

In this episode, Chief Medical Officer Dan Dworkis interviews Dr. Sean Griffiths, who shares his experiences and insights from his training and career in emergency medicine, both within the United States Air Force and civilian practice. The two talk through the stark differences between various emergency care environments, the importance of leadership, and the challenges of preparing for high-stakes medical emergencies in diverse settings. Dr. Griffiths emphasizes the significance of character in medical training and offers practical advice on creating a thriving medical team culture. This episode is ideal for anyone passionate about improving emergency care and leadership in healthcare. If you find value in this discussion, the best way to support our work and ensure you don't miss 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.

This week's episode features Preston's conversation with Dr. David Gens, who is best known as the trauma surgeon who treated Ronald Reagan after he was shot in 1981. Dr. Gens remains an attending surgeon at Shock Trauma and is also one of the most influential trauma resident educators worldwide. [10:25] Residue, Acute Stress, & Long-term Stress - Dr. Gens gives his experience with managing stress and residue. "I slept in the dialysis unit, and it finally dawned on me - this is an international event." [17:25] Working with the First Family in the aftermath of the shooting [31:40] Tacit Knowledge Transfer - Dr. Gens covers how he knows a learner is gaining or has gained tacit knowledge and what instructions he gives to support them in the moment. Dr. Gens is a respected leader who has made significant improvements in trauma and critical care medicine, ultimately enhancing the lives of many patients. He's known for his commitment to top-notch patient care, considerable research, and thorough training of future trauma experts. His teaching covers a wide range of crucial topics, from basic anatomy to the full scope of trauma patient evaluation and treatment. Want to learn more about Dr. Gens? Read the Washingtonian's minute-by-minute account of the actions after President Reagan was shot on March 30, 1981. Watch a video tribute from MedSchool Maryland Productions. The video, featuring narration by Dr. Thomas Scalea, includes praise from faculty, students, and colleagues.

On this episode, initially released in March 2025 as a collaboration with The Emergency Mind Podcast, Chief Medical Officer Dan Dworkis speaks with Dr. Jeremy Cannon. They delve deeply into military medical readiness and the intriguing concept of the "peacetime effect”. Whether you're in the military or a civilian, you'll gain insights into optimizing medical readiness and saving lives on and off the battlefield. Dr. Cannon is a Professor of Surgery at the University of Pennsylvania, where he champions the Penn Medicine-US Navy Trauma Training Partnership. A graduate of the US Air Force Academy and Harvard Medical School, Dr. Cannon also holds a Master of Science in Mechanical Engineering from MIT. He's a former President of the Excelsior Surgical Society and edited the 2024 Edition of Edward D. Churchill's Surgeon to Soldiers. Currently, he's a Veteran Fellow at the Hoover Institution, Stanford University, focusing on military health policy. Listen and explore the steep learning curves experienced in past conflicts and why it's so crucial to maintain and improve readiness in military medical systems. This conversation covers the necessity of military-civilian partnerships, the evolution of trauma care, and the critical need for effective policy.

This Teamcast episode is brought to you by Harry Moffitt, MCTI Director for Australia and New Zealand. During the last NFL season, Harry had the opportunity to speak with Will Greenberg, the Buffalo Bills' Head of Performance and Strength and Conditioning (S&C). Will is a wonderful human being and a great friend of the MCTI community. He describes his journey through baseball, his passion for S&C, and the positions he held prior to the Bills, from West Point to Utah State. Will has a human-centered approach to human performance. This refreshing perspective is emerging across the field and counters the approach that can overweight outcomes and treat humans as resources to be deployed for wins, profit, and utilization. Listen to Harry & Will discuss programming now and how it might be decentralized, more multidisciplinary, and less wedded to the scientists in the future. They also cover how science and scientists, though critical to the operator, should always aid a good program, never control it, and the importance of ‘struggle’ in the gym, and the concept of flow, although not as something we must conjure up, but rather as something we are always in and must fight to return to consistently. They explore the role (and reemergence) of philosophical conditioning in humans and its implications for performance as Will shares a fantastic story of "The Philosophy Booth". In a tough industry – to insiders, NFL stands for Not For Long – Will provides a uniquely relaxed perspective, with many implications for MCTs.