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Hello, good evening. Good day. Good afternoon, wherever you are in the world and welcome to the Black Belt Academy of Surgical Skills. My name is David Regan. I'm a retired cardiac surgeon in Yorkshire in the United Kingdom. The past director of the Faculty of Surgical Trainers for the Royal College of Surgeons of Edinburgh and a visiting professor at Imperial College, London. I'd like to welcome you to this very special broadcast this evening. If it's the first time for the Black about Academy of Surgical Skills you are in for a treat. Thank you to the 3290 for people who follow on Facebook and the 545 followers on Instagram the Black about a calorie this evening is privileged to welcome Rich Deveny is the best selling author, leadership, and human performance expert. This is a result of his career as a navy seal commander. Spanning more than 20 years, he completed more than 13 overseas deployments. He was the officer in charge of seal training and selection for specialist specialized command and was intimately involved in the extremely specialized seal selection process which pared down the best of the best. From Rangers green Berets to a small cadre of the exceptional most optimal performers rich has spearheaded the creation of a directed that fused mental, physical and emotional disciplines and let a small team to create the first ever mind Jim that helped special operators train their brains to perform faster, longer and better in all environments, especially high stress ones. Currently, rich speaks and consults on leadership, high performing teams assessment selection and optimal performance. And I'm going to make an unashamed plug for his book attribute the 25 Hidden Drivers of optimal performance that was released in January 2021. It's a fabulous and stimulating read. Rich joining us this evening is very apt because in the February issue of the surgeon, there's the article exploring the surgical personality and this is from Steer at all in the Netherlands. And the conclusion by way of introduction, I'd like to read to you because it touches on what we're going to exploring the demanding nature of surgical specialties requires certain levels of willpower, emotional stability represented by traits such as high conscientiousness and low neuroticism. Besides the necessity of fairly high levels of emotional stability and conscientiousness, there should always be room for a very grange of personality traits, enabling the formation of strong, capable and diverse surgical teams in the future. I personally however, feel that the personality trait taxonomy ocean which is open to uh experience conscientiousness, extroversion, and agreeableness and neuroticism is a rather simplistic way of looking at what is needed. And that's why I was attracted to attributes as described by rich, welcome, rich and thank you very, very much for joining us this evening. Thank you, David. Pleasure to be here. We have discussed this before in relation to what is needed for surgeons, but for the audience and help clarify, are thinking what are my attributes and how are they connected to skills and behaviors and values? And as I've alluded to already personality, yeah, it's a, it's a, it's a great place to start. And I think one of the things that we have to recognize and one of things I really was fascinated with and, and really almost directed to kind of look into was what makes up performance. And when we talk about performance, especially performance at the, at the most raw levels. In other words, our performance, when, when, when there's a real uh heavy amount of uncertainty, challenge and stress in our environment, where does that performance come from? And, and to do so, I had to really dive into this difference between skills and attributes because a lot of times these two things get conflated. And so so just to lay it out for the audience, uh you know, kind of briefly is that skills are not inherent to our nature. In other words, none of us are born with the, the ability to ride a bike or throw a ball or, or, you know, or even conduct surgery, you know, we were trained to do those things, were taught to do the things, right? Skills also, uh direct our behavior uh in known specific environment. So here's how and when to throw a ball or ride a bike or, or, or complete this procedure. Um And then because skills are very visible skills are very easy to assess and measure and test. And you can, you can see how well anybody does any one of these things and you can, you can put scores around them and statistics around them, you can put them on resumes, which is why we often get seduced by skills when we're in a hiring process or picking teams, the problem with skills, they don't tell us how we're going to show up and perform in stress challenge and uncertainty because in an unknown environment, it's very difficult if not impossible to apply a known skill. And so this is when we lean on our attributes, attributes, on the other hand, are inherent to our nature, all of us are born with levels of patient's situation awareness, adaptability. Now, we can certainly develop these things over time and experience, but you can see levels of this stuff in very small Children, which means there's a nature nurture element to attributes. Um, attributes don't direct our behavior. Attributes inform our behavior, they tell us how we're going to show up to specific environment. So, so for example, my son's levels of perseverance and resilience informed the way he showed up to the uh to the idea or the act of learning how to ride a bike, learning the skill of riding a bike and he was falling off a dozen times doing so. So they inform our behavior. And then finally because they're kind of hidden in the background there, difficult to see that means they're difficult to measure, assess and tests. It's hard to, it's hard to tell someone's levels of patience or adaptability. And so, so they're, they're hard to see. But if we're not, if we're not counting attributes into our performance, uh we're missing a huge part of the performance picture. And so when we talk about where these fall on the performance kind of met uh matrix, they're really at the very foundational element of all of our performance. If we think of uh the way I describe this visually as we think of an iceberg and that, um that part of the iceberg, you see, that's above the water. We all know that there's a huge, in fact, most of the iceberg is actually below the water that we can't see. Um And that's all the stuff that informs that iceberg, that's our behavior behavior. What we see is that's just the visible piece, everything below the water is what informs that. And, and so there's things that inform our behavior and all the way down at the bottom of that piece of ice comes, attributes, attributes come first, attributes inform amongst other things are values, our values inform the way we feel about something, the way we feel informs the way we think and the decisions we make. And then of course, that all informs the behavior that other people see. So so the idea behind attributes is if we start looking at attributes, we start to get to the most raw levels of our performers just start to understand how we show up both as individuals and as teams during the most raw environments, which is really what we're talking about when we're talking about surgical performance or er performance or navy seal performance, we want to understand how people perform when things are really, really not going as planned. All right, that's what we need to understand. And you know, the only way we can understand that is to start looking at attributes. Thank you very much indeed. And I think that leads us very nicely into starting to tease out these attributes because as I've already said, it certainly seems more detailed than the, you know, five level ocean taxonomy that was alluded to in that paper. So the first one is for surgeons, you certainly need to have a lot of courage and perseverance and adaptability of surgeons because we're in a very potentially rapidly changing environment. And I like the way you say success is defined by how many times you get up there's a lot of us are being knocked down, but the one in the grit domain is resilience and that often implies you have to suck it up. What does it actually mean? Yeah, we, we often get resilience, uh, conflated with perseverance. Um, and, uh, and it's not perseverance is more about kind of powering through and, um, and kind of making things happen as you, as you power through these things. That's what perseverance is. Resilience is quite literally the ability to when you get knocked off baseline, uh through a challenger, an event or something, how quickly and efficiently can you get back to the baseline if we think about a rubber band when you stretch that rubber band and you let it go, how quickly does it go back to its original shape? That's how we think of resilience. And so, so whether or not we're getting knocked off our baseline or something great happens and we're getting knocked off, you know, it could be something bad could happen or something great could happen. Are our levels of resilience speak to our ability to get back to normal and continue and continue working and continue operating, continue, continue doing what we need to do. That's what resilience speaks to and it speaks to both the idea of you get, you get hit with a challenge or hardship, how efficient you can get back to baseline as well as you get hit with a success or a or an accomplishment, how quickly and efficiently can, can you get back to baseline? So the, so the resilience is necessary in your ability to continue persevering and your ability to continue adapting your ability to continue to execute courage. Because if you keep on getting knocked off your baseline and you can't get back to normal, you will slowly fall into entropy and you'll burn out or, or fail or whatever. And on the other hand, if you keep on having successes and you can't get back to your baseline, you'll slowly gain arrogance and complacency and things like that. So that's how, that's how resilience kind of fits in the grit model. You have to, it has to be present so you can kind of continue on perpetually. But then how does it fit with your seal training and hell week? Uh, and as, as asked for one of our audience, the intimidation that comes from a train or a teacher. And in American football, the yelling shark attack type of incrimination. Yeah. The, uh, the, uh, the intimidation is simply, um, an environmental cue to see how one responds. Um And so, uh, and so you can intimidation can come in several different forms. Intimidation can come from a person who's, who's yelling at you or, or get, or, or, or asking you to do things. It could come from an environment, right? I mean, there's nothing more intimidating than, than an ocean environment where the waves are big and there's, you know, sharks in the water, right? So, um, it could come from a, uh, something that happens on the, in the surgeons in surgery, something unexpected can happen that, that intimidates the, you know, that agitates the system. So, so when we talk about intimidation, our ability to effectively, um, uh, I don't, I, I don't want to say ignore, but certainly not be affected by intimidation at any level is really part of the resilience training. And so I think seal training, whether it be hell week or any other type of steel training is designed to put you into such, um such, such uh such hard and in intimidating environments that you start to get used to, hey, regardless of how intimidating this environment is, I have to, I have to move on, I have to perform, you know, and I have to keep going and that's what that is designed to do. So, um, so I think intimidation as, as, as described by the, by the comment there by a teacher or a trainer, uh uh is it can be degrading if used ineffectively? Right? Because often it's not used, it's not used in the context or in the, in the, in the way it should be used, it's just used because someone is trying to usually show their uh knowledge or place themselves above the, the student or whatever. But if, if it's done in a way that that is designed to agitate the environment so that the the receive er can work on and train moving through that agitated environment. Then it becomes a very effective tool. I see. So this this then obviously sits with adaptability. But how does adaptability fit with uh intuition or improvisation? Because as you alluded to in the book, you train for certainty but you educate for uncertain. Right. Yeah. Yeah. Well, so I think improvisation uh it can be a result of adaptability, but adaptability quite literally is the is the ability and the effectiveness with which one can adjust to an environment that's changing outside of their control. Um That's what adaptability is, right? So it's so it's a very reactive, it's a very reactive state. Um because, and, and regardless of what profession we're in but certainly in special operations or in the surgical profession, things are going to happen that we didn't expect and suddenly we have to adapt. It's not that the world is not going to do what we tell it to do, right? The world is gonna do what it does and we have to adapt. So, so the adaptability factor is the ability to understand that environments are going to change outside of our control and how do we effectively react and adapt to that now, that might, that might require some innovation, right? Or it might require some flexibility, it might require some change, it will often require some sort of change. Innovation could be just one of those factors. Um, I think when we talk about intuition, that's a really interesting, uh, it's a really interesting factor. I, I tend to, you know, we can get because they're getting a deep into the neuroscience behind this. But I tend to believe that intuition comes from this idea that we, we go through experiences in our lives that, that give us context and categories and patterns in our brain and sometimes those patterns and, and categories aren't necessarily, they're, they're, they're, they're designed and created with our, without our conscious knowledge, right? So, in other words, we, if we, if we find ourselves in environments uh that are uh that are quite frequently uh a certain way, um We're not necessarily always picking up how much that's imprinting on our system. So um when we're walking through another scenario, our, our unconscious mind is picking up cues based on those patterns that feel like intuition in our conscious mind because it's like, oh, wait, I, something feels bad about this. I think part of that has to do is that our brains have identified patterns and experiences in context that we're not consciously recognizing. So that kind of helps us understand that it helps us feel like, oh, I feel like this is, I feel like something's wrong here. OK. Uh The example in the military sense, I probably couldn't give a surgical example, but the example would be are, you know, the point man, that the leader of our patrol who's been on hundreds of missions and has, has led us in many, many different areas and has through that time frame picked up on different cues in the environments that could be threatening or cannot be threatening. And so at one point during one of the patrols, the, the point man says, you know, it stops and says, you know, I, something doesn't feel right here, right? And sure enough that we find, you know, 5 ft later there's a trip wire with a booby trap. Well, you could call that intuition and things like that. And I think, you know, in many cases it could be. But part of that is because that, that point man, subconscious was giving him cues to the environment that, that were already imprinted, but he wasn't necessarily aware of. So I think that's where intuition may fall into the, into the category. So that's sort of inextricably linked with situational awareness. So how do you grow this ability? And how do you teach this? Yeah. Well, you can't teach it. That's the, the, the, the, the the key between the key difference between attributes and skills and just you can, uh so the audience knows is the way you, the way you understand or decide whether or not it's an attribute or skills you actually, you actually ask the question, can I teach it or can it be taught if the answer is? Yes, it's probably a skill. The answer is no, it's probably an attribute. So the example, Dave would be, you know, say you, you say, hey, Rich, I'd love to learn how to shoot a pistol and hit a bull's eye on a target, right? Well, I can take you to the range and teach you how to do that within a couple hours. That is a skill. Or you could say, hey, Rich, I want to learn how to be more patient. Well, I can't teach you how to be more patient, right? And so when it comes to an attribute, it's really about um about developing it. But it takes, it takes three criteria, develop an attribute that you might be low. On. The first one is an awareness that you're low on it. The second one is a motivation to develop it. And the third one is the deliberate decision to step into environments that test and peas and develop that attributes. So, so for example, if someone wants to develop their patient's um then they have to go find environments that test and teas there patient's whatever that looks like for them, it could be, I'm gonna go deliberately driving traffic or I'm gonna uh choose the longest line in the grocery sort of stand in, you know, I always say having kids have kids, having kids will develop patient's right there. Um But this goes for any attributes. So if we want to develop our situation awareness, right, we need to then walk, you find, find our way into environments that are allowing us to practice our vigilance and start noticing things in our environment. This is how we develop situation awareness. If we want to develop our adaptability, we have to go find environments that are going to be changing outside of our control and then just adapt with them and practice that. If we're low on an attribute, it's going to feel uncomfortable, right? But that's the point. If it feels uncomfortable, that means you're going to be developing it, right? So that's how you, that's how you would do that. So in your book, you described that you took the New York subway, subway and you're, you're taking this to develop your observation skills, really an awareness skills, but implicit in what you've said from the point man having that inverted commas gut feeling. This is not quite right. You mentioned he'd been on many sorties and had lots of experience. So, is this something, this is a variable on a real estate that can be ramped up with experience? That I, I think so again, I wouldn't, I mean, I wouldn't uh I wouldn't say this definitively, but it, it, for me, uh it tends to be the case that you find the people with more quote intuition are the ones who tend to have a little bit more experience in those fields. Um And uh so I think, I think, I think that that theory could hold true that the more experience you develop in a, in a genre, the more quote intuition you're going to probably experience in that genre. Uh that perhaps is, you know, Malcolm Gladwell's blink instants, pattern recognition. Right. Right. Yeah, I would agree with that. All right. So you also in your book started, which I thought was very interesting on calm compartmentalization. And your story was you had fear of heights. So you got on a plane and you had a high altitude, high opening jump and your parachute fell failed and you went through a process that I thought was fascinating how to deal with uncertainty, so to speak. What was that? So, compartmentalization really is um is the ability to uh inside of an environment um understand immediately understand what's in the environment, prioritize that what you're what you're noticing in context of what your, what your goal is in the moment. Um And then focus in on the thing on the one thing that you need to focus in on and block out everything else. And then once that's complete, then you come back out, you pick something else and you go back in and you focus in. So compartmentalization is really the ability to, to prioritize focus in, block out everything else until that, until that that task or what that that endeavor is complete. And then once it's complete, you come back out, you pick something else. And so in the context of, of dealing with uncertain environments such as a parachute malfunction that the the ability to effectively compartmentalize allows uh someone and their brain to begin uh what I call chunking certainty into your environment. So, so we take uh so you and I were in a situation and we have 100% uncertainty, write complete chaos. Okay. The way we start to move through that we ask ourselves in that moment to say okay, what do I understand? Okay. Well, that list might be really short, it might be one or two things and then you say okay, based on what those, what I understand, what can I focus on in this moment? You pick something to focus on you move, right? You could you, you create that moving, go to that, you complete that and then you stop and you do it again. And this is how you can, you can step through uncertainty and challenge and stress, right? Because we're basically chunky our environment, we're using, our brains are are compartmentalization to chew chunk the environment and move through. Now, some people um do this quite naturally better than others. And so one of the things I want to make sure people know um is that when we talk about these attributes, all of us as human beings have all of these attributes, we all we all have all of them. The difference between each one of us are the levels to which we have each, right? So let's to take adaptability, for example. Um If 10 were high and one were low, I would probably uh score about a level eight on adaptability, which means when the environment changes around outside my control, it's fairly easy for me to go with the flow. Someone else might be a level three, which means the same thing happens to them, it's difficult for them to go with the flow, right? So, so they're still adaptable because human beings are all human beings are, but it's just your levels are speak to the difficulty with which you have. So if you're gonna line up the attributes like dimmer switch is on the wall, all of us would have different levels of dimmer of our dimmer switch is that starts to speak to our individual performance. Some of us are a little bit lower on commercialization. Some of us are higher. I would, I would maintain that most. Almost every guy who shows up to Navy Seal training and makes it through. We showed up with a decently high level of compartmentalization because you're not gonna be able to make it through seal training unless you can effectively compartment wise. Some people, it's a little bit more difficult. It's hard for them to focus in and move through and step through. So, so, but in terms of, in terms of I think the, so I think let's let's go to your genre surgical, uh the surgical field and in surgery, right? You are quite literally, uh, in a, in a, in a situation where you have to pick something to focus on and you focus on it. Now, there's, you're still maintaining a little bit of an awareness of what's going on. Right. But because if something happens, that shift your priorities, you need to shift. Right. But your, your focus is on doing something this and then doing this and then doing this. And you're not, you're not necessarily thinking about the enormity of, I mean, if you're, if you're starting an 8 to 12 hour surgery, you're not thinking about all 12 hours, right? You're, you're saying okay, what do I do now? What do I do now? What do I do now? And so, so, you know, one of the great example, uh when it comes to the parachute, uh that you're talking about this Hayhoe, this high altitude, high opening parachute evolution where we jump out of the airplane about 22,000 ft and we'd have to fly to an unknown drop zone. We'd have to land, we'd have to go on patrol to a mission. Do. The mission is a huge, hugely complex environment. Uh, hugely complex mission. When we are standing at the ramp, they're getting ready to jump out. There's only one thing we're thinking about and the only thing we're thinking about in that moment is nail the exit. In other words, I need to get out of this plane and stable. I need to nail this exit. That's number one, once I nail the exit, the next thing I'm thinking about is like now open my parachute, opened my parachute. Now I'm saying okay, now steer my parachute, okay. So you're just stepping through your compartmentalizing your way through these, these uh these events and these wickets. So, so that it allows you to step through these environments and not basically take on the enormity of what's going on. This is really the quite literally, it's the it's a neurological uh way that you eat the elephant one bite at a time. That's what it is. But the compartmentalization allows us to do that. I'm just thinking aloud. Chunking and operation into teaching chunks enables the training surgeon to progress through each bit in chunks, like learning a bar of music rather than playing the symphony. That's right. That's right. And so, and so you have to be, you have to be an effective compartment laws er to be a surgeon. That's one of the key attributes in my belief. That would be my, that would be my guess. So you are also in this mental acuity category, multitasking context switching. So how you do, how do you deal with distraction then? Yeah. Yeah. So, so uh yeah, task switching is this, I, you know the idea that we're changing, changing up focus points. And so, so the best um the most effective task switching is uh is uh is metabolized with a healthy amount of compartmentalization attached to it, right? So in other words, and situation awareness, these, these, these mental acuity attributes are fairly um uh they're fairly synergistic and uh in terms of the way they use, in other words, they don't, they don't operate independently of each other, of each other, they operate uh together. So, so the example would be again, you are, you are in surgery, okay. You, so you have a sit your situation, aware of everything going on, but then you compartmentalize. So what you have to do in the moment, right? As you're, as you're focusing on what you have to do the moment, you're maintaining a slight awareness of the, of the, of the environment. Because if something shifts, right, something something happens to the patient, the uh you know, whatever, then you have two tasks switch and do something else. You have to immediately go from what you were doing to the to to something else, right? The ability to effectively shift focus points without much um uh issue or, or distraction speaks to your level of task switching. Some people are really bad at task switching. In other words, they, when they go from one thing to another, it's hard for their brain to kind of lock into that thing. It's hard for them to pull out of what they're doing and lock into the next thing. Some people are really good at it. They, they actually can go from this, this, this, this, you can be too good, which means you almost have A D D, you're, you're shifting focus points to rapidly, right? But, but the best balance is to be able to, to be focusing on something and then once your complete you switch or if the priorities change, you switch, this is your ability to tax, which is just getting a neurologically, they've kind of proven that you can't really, for the conscious mind can't really focus on more than one thing at a time. So, so task switching becomes a very necessary part of performance. It's interesting because I reflect back on an interview with Professor Harold Ellis is a guru and surgical training with his 96 now and he referred to a few surgeons are not going to make it because they lacked imagination and thinking about it. He's probably thinking of task switching. Yeah. Yeah, I would say so. Yeah. So drive is your next category now, self efficacy and discipline are needed to pursue a career in surgery. But under this category, you include cunning and narcissism, which to me have somewhat negative connotations and my colleagues and I can perhaps think of others who perhaps fill these in that category. But what do you mean? And where is the balance? Yeah, I'm glad you brought that up. So we'll start with cunning. Cunning quite um simply put is the ability to think outside the think outside the box when it comes to problem solving. So cunning as an attribute and always involves a problem to solve. And what cunning, what the cunning mind does is the cunning mind approach is a problem and immediately ask three questions. The first question is, are there rules and boundaries? The second question is um if there are rules and boundaries, are they real or are they just perceived? And the third question is if they are real, what happens if I break them? All right. And then that, that cunning mind begins to start thinking about ways around the problem where they're either disregarding rules that are just perceived or even bending, maybe even depending on the consequences of breaking, maybe even breaking some rules to try to come up with a solution, right? So, so cunning becomes a very, very powerful attribute. When we're, when we're talking about a drive category, we were talking about solving problems in a creativelive imaginative way, right? Uh This is where imagination and innovation can come in. They're all parts of their always to metabolize cunning in many cases. Now, cunning, you know, it's sometimes thought of as a pejorative cunning can certainly be used Manevitz lately, right? That is, that's Bernie Madoff, right? But it can also be used benevolently. That's Oscar Schindler, right? So, so cunning doesn't come with a judgment. Cunning just is thinking outside the box problem solving. And I would imagine um certainly in the Navy Seal field, but certainly in the surgical field, there's certain times where you have to really say okay, how can there's a problem here? How can we actually think about solving this problem that's outside the box? That is, that is cunning. So that's coming. Um, narcissism is a little bit more difficult because, because we know that it's a, it's a codified disorder, right? A personality disorder. But again, narcissistic Personality disorder, uh, if you, if you look at the D S M five, only about 10% of the population has it, I think, I think it's six or 10. Um, and, um, and you know, when I got a copy of the D S M five, just to kind of look at it, uh, in the D S M five, there's nine criterion that you have to look at. Um, the doctor will look at these nine kind of sentences. And, and the, the idea is if, if they, if they look at these nine sentences and the patient has, can say yes to five or more, then the patient is considered disordered, considered that, that they have, that they have the disorder. So I, I got a copy of the D S M five and I started looking at these things and when I looked at the nine things, I certainly did not have five or more, but I was not innocent of everything I was reading. Okay. So I said, okay, wait a second. Um, what does this mean? And then I started really asking myself what's, what's the elemental definition of narcissism, right? It's really at a very elemental basic level. It's the desire to stand out and be, and be recognized and, and, uh, then I'll be recognized, um, every human being on this planet at some point in their lives wants to stand out and be recognized every single one. And so, uh, so narcissism, so narcissism is in every one of us and in some cases, it's the impetus to some very audacious goals. For example, I ask myself, why the heck did I become a navy seal in the first place? Certainly was a patriot and certainly I wanted to serve my country. But I really, as a 22 year old kid, I also wanted to see if I could be a badass, if I could, if I could do something very few people could do. Right. And my buddy said the same thing. But again, I would say, why, why would someone want to be the best surgeon in the world? Why would someone want to be the best singer, best teacher, best, whatever. There's a, there's an elemental part of us that wants to be recognized and stand out for being, for doing good stuff. There's nothing wrong with that, nothing wrong with that at all. Um, and, um, and I think, I think we have to see our narcissism for what it is and we have to effectively and then the healthy way metabolize it obviously can get overboard. But, but I think narcissism metabolized correctly could be the, the impetus to some very audacious goals. I suppose that fuels drive. That's right. That's why it's a drive attribute. Yeah. So, moving on, then you've included open mindedness in this. Can you explain? Yes, open mindedness is really quite necessary for drive because, um, if you are closed minded that you're not going to go very far in your, in your goals and endeavors, you know, because you're because again, you're not gonna recognize that there's different ways to, to, to accomplish what you're trying to do. So open mindedness and I would, I would describe open mindedness as a, as a passive attribute. In other words, it's just this idea that I am open to things around me in my environments different than curiosity. Okay. Curiosity is different. Curiosity is an active attribute. So in other words, you and I, so the example David, you and I go to Thailand and we meet our local friend there and a local friend says, hey, I'm gonna take you to the most authentic Thai restaurant and you and I are like, great. That's open mindedness or you and I go to Thailand, we meet our, we meet our, our local friend there and we tell our local friend, take us to the most authentic Thai restaurant. That's curiosity. Okay. So 11. So, but you don't necessarily need to be curious to be driven all you need. I mean, if you're gonna be one, if you have to have one, you have to have open minus a lot of, a lot of people who are driven are also curious, of course, but it's not a necessity, but open minded is certainly is a necessity. Your career within leadership and selecting people and officers for the leadership program. I'm interested in your comment that leadership is behavior and not a position. Can you explain? Yeah. Yeah, of course. Um The we, we often, we often get leadership conflated with the noun and not the verb okay, leader, noun means in front, in front of the pack, all that stuff. And, and we know that's not the case. The greatest leaders are not always in front. The greatest leaders are actually sometimes in the back and they're encouraging and they're inspiring and they're, they're helping, right? So, so leadership is really when it comes to, when we come to, you know, people following you, all right. It's about behavior, all right. And so in other words, you get, you don't get to call yourself a leader. You know, that's like calling yourself good looking or funny. Other people decide whether or not you are someone they want to follow and they do. So based on the way you behave. So leadership when it comes to being, having people in your span of care comes to, comes down to the way we behave and these behaviors uh stem from these essential elemental attributes, things like selflessness, empathy, accountability, authenticity, decisiveness. These behaviors are things that tend to make people say this is someone I actually want to follow. And we believe many of us have probably experienced, I know I experience this in the military where the person who was in a hierarchical position above me. I looked at and I said to myself, I wouldn't follow that person anywhere. Right. Meanwhile, I'll look over to my right and there's a person over to my right who has no hierarchical position whatsoever. And I say I would follow that person to Helen back. Okay. It's because of the way we behave. And so that's why these, these, that's why leadership and these attributes are so important in, in this stuff. It's, that is interesting in, in surgery, in particular as well because the surgeon is leading the operation in leading the team. And there's a lot at the present moment being talked about in our colleges and profession, about behavior in theaters. Um But it's the behavior when you're stressed. Yeah, as you've pointed out is the person that you, that you really are. This is this, by the way, David, I actually love, I love the ocean personality stuff and I actually like all the personality assessments. I think they're really great. Um But I'm what I'm really into interested in is what I call elemental human performance. So, in other words, who are we at our most raw? Okay? Because, because when the, when the, when the, you know what hits the fan personality often goes out the window, okay? And I use my wife as an example. My wife is a wonderfully gregarious, cheery friendly person. Okay. When the, you know what hits the fan and things are really stressful that all goes away. All right, she just starts taking Axion, right? So, so these personality assessments can certainly be helpful in telling us how we behave in regular, every day, day to day life in situations. Uh If we want to know how we behave, when the things are really going sideways, which often happens in uh in surgery or even in the spec ops community, we have to understand our attributes and that's something you can develop, not teach, but that's why you select. That's right. You can't, well, you can develop attributes. Um It's difficult though and uh and you want to select, you want to select people with the again. So, you know, depending on the context here, whether you're a surgeon with your Navy Seal. I mean, the, the list of attributes required to be a great surgeon is gonna look a little different than a list of attributes required to be a Great Navy Seal is going to look different a little different than the list of attributes required to be a great teacher or comedian. So, so it's not a matter of being high on all of these things. It's actually being, having the, having the combination that fits inside of your niche. All right, because in some, in some professions, too much of an attribute could be a bad thing. Right? Always stand up comic. The stand up comic with too much empathy is not gonna be a very good stand up problem. Okay. Um And so, so it can be detrimental to be a little bit too, too high on this. In fact, I've talked to people in the medical fields and nurses who say if they have too much empathy, they actually can't do their job very well. They have to actually tone that down, right? So, so too much empathy even in the nursing profession can be negative, right? So, so it's really about understanding where your attribute list lies how that fits inside of your, the niche that you're in and then you do that. And if you enjoy what you do, it's likely that you'll only have to develop maybe a couple of these things, right? Um And so it's not a, it's not an overwhelming task. So decisiveness then yeah, we we you're either decisive or indecisive but you but not making a decision is also correct. It can be decisiveness is interesting because I want to separate, I try to separate in the, in the book, I do this uh the the the act of making decisions versus decisiveness. Okay. Decision making is in fact, a skill and you can actually teach people how to make better decisions. Decisiveness adds an efficiency in the speed to that whole process. In other words, the decisive person tends to be able to make decisions in a more efficient, rapid manner. Okay. Um And so, and, and, and again, like you said, it doesn't, you know, decision, decision means I'm deciding to do something, it could mean movement in some way. But your decision in the moment, it could be like, hey, I'm not going to do anything right now. I'm going to pause. That is still a decision. But again, that's different than someone just pausing because they don't know what to do. Sometimes the decision is, I'm stopping right now. I'm pausing. That's a decision, right? So decisiveness speaks to the ability to make decisions in a more rapid efficient manner. And some people are just naturally more decisive than others. Of course, in any of these afterwards, as you can imagine, too much is a bad thing and too little is a bad thing, too much decisiveness, right? And you're gonna be, you're gonna be making decisions to rapidly without actually uh collecting enough data to, to do so. Right? And of course, too little decisiveness. Now you're just, you're, you're never, you're never deciding on anything and you're basically paused into inaction or, or paralysis through analysis. And again, how would you develop that skill? How would you turn up the real estate. Yeah, that's a good, that's a really good question. Well, first of all, I think it'd be, it'd behoove someone to understand what decision making if they're, if they're unaware of the decision making process, I think understanding decision making process would be helpful. Um It's, it's going to involve gathering data, understanding and asking some questions about your environment. Um but then, um you can really, uh you can, if you don't find yourself high on the decisive attribute, then I would just say start making more decisions faster and they could be small ones, right? I mean, it could be like, hey, decide what to wear, decide what to, you know, which direction to drive to work, decide what to eat and stick to it, right? It's the key is sticking to it because you know, it's not a decision unless you move out on that decision, right? But you can practice making faster uh decisions just in regular everyday life which should at least help to exercise that muscle little bit. So it's uh as you say, it is a muscle. Yeah, you've added in your book, you said ego is good. Uh Had to smile thinking about surgeons and surgery. Yeah. What do you mean? Well, ego again, ego, all, all the ego is, is sense of self. It's the sense of I am. That's all the ego is. And so ego I think has gotten a bad rap over the years because people with ego, we all have ego by the way, as long as we, as long as we can say I am and put something after that, there's, that's ego, that, that's what it is right now. Arrogance is often confused with the ego, okay? And arrogance is bad. Uh But, but people who have big egos tend to um show as arrogant, okay? And that's what I think too much ego or big ego equals arrogance. Um But again, you can be uh and arrogance is bad in any situation, right? Arrogance is really this idea. I'm better than you. Whereas confidence is I can, I know I can do this. Arrogance is I'm better than you. So, so, so arrogance is, is projected outward on others and it, it tends to be a result of, of too much ego, I guess if you will. But I do think the word ego gets a bad rap. It's really just sense of self confidence is, yeah. Confidence as I know. Yeah, I know I can do this but confidence, you could be very humble and confident, which means I know I can do this. But I also know I can, there's stuff I can learn, you know, I mean, that's, that's a humble confidence, which is really the sweet spot. Absolutely. So you've worked in teams where your life depended on it. What makes a good team and what is the high performing team? Yeah, high performing team. Um We'll put, put put, put quite simply a high performing team is a team that not only does great when things are going great but also performs when things aren't going great. That's what a high performing team is. Um If you want to think about how a high performing team actually metabolizes in the real world, I would offer this concept that I called dynamic subordination where where dynamic subordination implies the team rather than being like a hierarchical pyramid or a or a flat line or even an upside down pyramid, right? A team is in fact more like a flock of birds or, or a blob or a moron amoeba, right? Where where the team understands that challenges and issues and problems can come from any angle at any moment. And as soon as as soon as one does, the person who's close is that problem? Uh and the most competent immediately steps up and takes charge, right? And everybody follows, right? So it's a constant swap between leader follower. Also call it alpha swapping that alpha position hops, right? That's how the highest performing teams operating. So you an example I often use for this is the is the commercial airliner, right? All of it, none of us would debate the fact that the captain is in charge of that aircraft. Everybody's okay with that. Everything's good with that. All right. But if the captain's taxing out to take off and gets a call from the maintenance person and the maintenance person says, hey, I found a problem with your aircraft. You need to turn around. No captain worth their wings is going to ignore that call there immediately to subordinate to that maintenance person, turn that plane around and park it and then they're gonna realize they have to deplane. The aircraft captain doesn't step up and take charge of that either. Now, the flight attendant steps up and takes charge. Right. And so, so this is a very simple example of how dynamic subordination on operates, I would imagine in the best surgical environments, this is exactly what happens, right? Sometimes the surgery is in the lead of what's going on, but the environment might shift and sometimes a nurse might have to take over or whatever. I mean, this is how it happens, it happens very rapidly um and very dynamically and that's exactly how special operations operate. That's how exactly how the highest performing teams on the planet operate. Indeed. And that's how it should be in theater and, and certainly a cardiac theater, you know, the scrub gnosis, oh DPS, perfusionist anaesthetist. And anybody can sort of stop the process and say, well, this is not, not happening or working and you've got to shift your focus to deal with the problem in that area. I was, I was talking to a friend of mine who was actually one of the top heart surgeons at the Cleveland Clinic and he one of his rule Yeah. One of, one of his rules in the O R was no uh no title's in the are only first names in the O R. He would only allow people to call each other rather first name because he wanted to break down that idled hierarchy and make sure everybody understood. You know, it's a lot easier to say, hey, Bob, that's wrong versus, hey, doctor, that's wrong or whatever. So that's one of the ways he would do it. Yeah. Now we always put first name's on the white board as well. And it's, it's very difficult, it's much easier to refer to people by first names, which it's interesting. You put humor into this uh in your team ability. And I know in theaters we have a very dark sense of humor, uh sometimes frowned upon by people from the outside. Yes. Uh The environment we have to be cognizant of visitors in. They're not quite understanding our platform. How did it work for you? Same way. That's one of the things I miss most about the Seal teams is the, is the level of humor. I've never met a high performing team that doesn't have humor as a, as a key part of it. And oftentimes, especially, especially given the, if the, if the environments that the team operates in are more, are more dangerous and uh in some cases uh depressing or dark, the darker the humor. Um And it's because it's, it's actually, it's biologically, neurologically based, when we laugh involuntarily, we'll get juiced with dopamine, uh endorphins and, and Oxytocin. So dopamine, obviously, the motivation chemical this keep doing this. This is good. Uh Endorphins masks are pain. It's our human bodies opiate, right? It allows us to, to get to go longer times. And then of course, Oxytocin, the bonding neuromodulator, right? That, that bonds us and binds us, right? So when we laugh with, without even asking for it, when we laugh, we get all three of those. And so so when we're in an environment with a team and it's a miserable situation, someone cracks a joke and we laugh immediately were juiced with chemicals that tell us this is good. Keep doing this. This doesn't feel that bad and we're all in this together, okay. It's actually why uh sense of humor is one of the most desired qualities in human beings when looking for a mate because we know that if, if, if our mate can, can, can make us laugh, right? It'll, they'll help us. It's a courage hack, right? Cause even when we're, we're stepping into our fear, we're getting dopamine, right? So, so I've never experienced high performing team that does not have a healthy dose of humor. Oftentimes it can be dark, at least two outsiders. I mean, uh some of the jokes we would make outsiders my looking at like what the heck are you guys thinking? But it, but it's really, it has to be contextual to the environment. And as long as you have an environment where laughing exists, you are actually hacking into courage and a whole host of positive neuro modulators. Certainly in your book, you referred to being the cold sir for the Pacific and your body joked about you'd only ring the bell if you had this certain ice cream recommend with the bell and then you burst out laughing and you, you know, gritted your teeth and obviously got through hell week. Many surgeons and training feel evolved have been through hell week. But of course, we have to think about well being and work life balance in all of this. How when you're selecting high performance teams and things, where does well being and work life balance come into or? Yeah. Uh Yeah. Unfortunately, the, the the curse of many high performing teams is that we're actually a lot of us are lower on the resilience attribute. And I say resilience, it's really, it's not necessarily the in the moment resilience, we can actually snap ourselves back and keep moving. It's actually the long term resilience. In other words, um we uh typically high performers, we get um we get that dopamine reward from powering through the thing. And then as soon as we're through were high on dopamine and say, what's the next thing we hop in the next thing and we don't allow ourselves to recover. So, so one of the risks that we all have to be cognizant of in high performing teams, whether the seal teams or, or O R teams or surgical teams or whatever is that we have to actually encourage an environment of recovery. Um And understand that, hey, recovery is really important, oftentimes recovery takes twice if not three times as long as the actual event that you went through. Right. But um but this idea of powering through, I think I've talked to many folks in the, in the, in the surgical field who talk about their training and the, and their own versions of hell week where they're interning or whatever and they have to, I mean, they're just, they're on no sleep and things like that. And that's okay in terms of the initial selection, right? Perhaps, right? You could, you could make an argument with for the fact that you're, you're, you're helping this person understand that they can do things. Uh and they can be, they can perform even when they don't think they can. Right? That's a, that's a good thing. But once that's over and once you're in the, you're in the job, if you want to be kind of be in the infinite game of the profession, you have to have to have to start implementing many, many more recovery tools and making sure we take, make sure recovery is a priority because otherwise the, the human being will fall into entropy and slowly burn out. Um And, and you know, everything is affected physical health, mental health, all that stuff. So, so it's, it's really this idea, this idea of long term resilience that we have to work on and be careful of and cognizant of in the highest performing teams. So you are currently looking in your attributes program, looking at collecting data from a number of professions and individuals and on this uh web webinar, we're going to put up your website. Do you have any inclination to date of the attributes pertinent to surgeons? Unfortunately, not yet. Um We, what we do on the, on the assessment tools, we ask, we asked some, some demographic questions and uh what, what professions we haven't collected, we haven't looked through that data yet. Um uh but I would say given the nature and in some cases a similar nature of surgery and seal team stuff. I mean, these are, we're talking about life and death situation, right? You're talking about, you know, you have to perform in a way that there's, there are lives on the line and that actually think takes a set of very similar attributes. Um People think of Navy Seal stuff as highly physic and so often times when they think of that they're like, oh, we don't compare the Navy Seals, but the Navy Seal profession is much, much more mental than it is physical. And I think the same thing goes with a surgical profession. These are, these are, these are these are attributes that allow you to adapt to persevere, to uh to task switch to compartmentalize all these things, right? Uh And even getting to those positions initially requires all the drive attributes, you know, as well. So, so I think the attribute lists, I would imagine that the attribute list, the Navy Seals have looks somewhat similar to the surgeon, the list for the surgeons. Uh But we haven't been, we haven't pulled that data just yet. I think we're, I'd be intrigued because my inclination is to say, I think it looks very much the same. Are there any attributes that are not included in the 25? There's a hint that there are many, there's some more. Oh, indeed. Yeah. We um we do work with organizations where we help, we go into organizations and we help them figure out what their attribute list looks like and help them with hiring assessment selection. And when we do that we use about, I think we have 46 attributes that we draw from. Not just the 25. You know, again, I, I there the, I needed to focus on the specific attributes for optimal performance. Keep a little bit more simple in the book. And you, even when I did the book is, is rather dense even with 25. Uh Yeah, but yes, there's definitely more than 25 right now. We're, we're right now. We're working with about 46. There's probably more, we're continuing to kind of explore that. So I, I think, I think we should watch this space and would like to thank you very much indeed for joining us. The Seals motto is the only easy day was yesterday. And I think of some of the operations and the training we've gone through a surgeons and think the same. The other thing I'm mindful of remembering is the ultimate of human studies is knowledge of yourself. And I looked through these attributes and felt it was a great opportunity to reflect on what works, what could do better and what needs to be ramped up. I hope you enjoy the book. I hope you go to the site and explore your own attributes. And I'd like to thank Rich very much for joining the Black Belt Academy this evening and thank you the audience for joining us. Rich. Thank you very much.