Firearms Training, Neuroscience, and the Culture of High Reliability

People often ask me what I teach in healthcare.

I know they are often expecting a description of how someone who is not a clinician came to be teaching about high-reliability performance to physicians, staff, and administrators.

Once they understand the pathway that led me to do what I do, they get very curious about the specific techniques, skills, and processes I provide to clinicians, and how I learned to teach those things in a way that clinicians find meaningful and useful.

As much as I like talking about them, the techniques, skills, and processes are definitely not the important parts. They are a means to an end. They are necessary but not sufficient to achieve the real key result I'm striving to accomplish during my consulting engagements.

What I do is teach healthcare professionals how to implement a system for changing how people think and behave under high stress so they can reduce error and perform at their peak.

What I want for my clients is for them to seamlessly work together as a team to catch and neutralize one another's inevitable errors, and on an even larger scale, to build a culture of accountability throughout the entire service line. Why? Healthcare is a team sport and achieving its desired results of providing the safest, high quality care sinks or swims on teamwork and culture.

At its core, the methods I teach are a fusion of neuroscience, motor learning theory, and evolutionary psychology applied to the goal of achieving high reliability by focusing on the problem of providing safe, high quality care while under stress.

The techniques, skills, and processes are just the medium, the vehicle through which we train the mind, the nervous system, and the healthcare team to stay functional even when the stress of patient care is at its highest.

At least half of the foundation of what I teach comes from my 40 plus years of getting and giving firearms training - learning to effectively use deadly tools where the price of mistakes and failure can include dismemberment and death.

Firearms training to control stress and maintain clarity in chaos.

The Real Objective of My Coaching: Training the Brain, Not the Body

In firearms training, when operators first step onto the range, especially when working together as teams, they think they’re learning how to use weapons to accomplish a mission. In reality, they’re learning how to control stress and maintain clarity in chaos.

Every human being has the same basic neurological response to stress: heart rate spikes, tunnel vision narrows perception, and fine motor control deteriorates. When stress passes a certain point, we humans can’t think our way through that. We have to train our nervous system to act correctly when the prefrontal cortex, the part responsible for slow, conscious thought, goes offline.

Firearms training has unlocked for me the bridge between biology and behavior. It’s shown me how we rewire the human animal to perform complex actions under stress.

How It Works: Building Implicit Procedural Memory

From a neuroscience standpoint, effective firearms training builds implicit procedural memory, the kind of memory that allows skilled performance under stress without conscious thought.

In healthcare, whether in the emergency room, the surgical suite, the ICU, or the delivery room, those events happen when there is no time for drawn out deliberation. The nervous system must act on conditioned schemas, not conscious plans.

That’s why in firearms training we learn through repetition, variation, and context, because those are the ingredients that shape the nervous system’s automatic responses.

The classic drills - like handling a malfunction of your firearm - are not about memorizing techniques. The drills are a neuropsychological tool for encoding the schema for the flow state of observe, orient, decide, and act when under stress.

Every repetition engrains that hierarchy into the body and nervous system.

Under stress, that knowledge isn’t recalled, it’s expressed. Movement flows naturally from one step to the next because the hierarchy has been burned into procedural memory through experience, not words.

This is why I include so many drills and exercises in my classroom training on teamwork and communication skills for healthcare teams. I've seen how effective it is in firearms training.

The Neuroscience Behind It

Myelination Through Repetition

Every repetition of a movement builds myelin, the fatty sheath that insulates neural pathways. More myelin means faster, cleaner signals. It’s what allows teams equipped with firearms to execute complex movement under stress with apparent ease.

Firearms training is built on patterned movement under pressure. Each drill engrains efficiency not through theory, but through repetitions within the movement pattern in realistic, stressful conditions.

This is also why healthcare sim labs are the BEST place to learn teamwork and communications skills - because sim labs, when used with well constructed scenarios, are the best places to introduce realistic, stressful conditions.

Sim labs: the best place to learn patterned movement under pressure.

Contextual Interference

The next layer is contextual interference, deliberately adding variation and unpredictability to make skills more adaptable. If you always drill in a perfect environment, you become perfect at the drill, not the action you need in the real world.

In firearms training, we change partners, alter conditions, add malfunctions, use different firearms, and shift starting positions to create desirable difficulty. It’s not chaos for chaos’s sake, it’s how the nervous system learns to generalize within the movement pattern across infinite situations.

This is also why creating the proper scenarios in healthcare sim labs are critical. The best scenarios create desirable difficulty, and refrain from always creating maximum chaotic overload in every sim event.

Embodied Cognition

Finally, firearms training rests on embodied cognition, the understanding that thinking and moving are not separate systems. Cognition emerges from the body in motion. In healthcare, the "body in motion" is both the things you do with your arms and hands for patient care (e.g., performing CPR) and the sounds you make come out of your mouth when communicating with your team. The tongue is a muscle and must be trained to form the correct words when communication is paramount.

There is really no separation between your brain and the rest of your nervous system. When you’re shooting, your hands, hips, eyes, and balance are your brain. Decision-making is distributed through your entire nervous system, not confined to your skull.

That’s why our foundational drills matter so much. They don’t just teach the schema of draw, stance, grip, sight alignment, trigger control, and the like that build effective movement literacy, the drills become the foundation for teamwork excellence.

The same is true for healthcare professionals: classroom drills for formatting a 4-part assertive statement when you must stop-the-line, or using team problem-solving when you need to make a decision in a complex situation, build the foundation for teamwork excellence.

Building Culture, Not Technicians

The goal of firearms training as I have experienced, and am experiencing it, is not really to create an “expert shooter” in the narrow sense.

The goal is to create a high performer operating in a culture of accountability... men and women who can control their bodies, their emotions, their teamwork, and their communications when under stress.

Firearms training gives professionals a safe, structured way to confront chaos, stress, and the after-effects of failure. It inoculates them against stress-induced panic and performance failure. It teaches them to operate under pressure.

That is why I design my healthcare classroom training like I do with multiple scenarios that require learners to practice what they've just learned, and to do so under the watchful eyes of their colleagues.

I often tell them, "If you can't do it in here, you'll never do it 'out there.'"

The Cultural Mission

What I have learned from firearms training is that it is not just about "shooting." It is about changing the culture of the team and the organization.

You can’t build a professional, high reliability, high performing hunting, law enforcement, or military team on PowerPoint slides and platitudes about teamwork and communication. You build those kinds of teams and organizations through the cultivated skills of crosschecking, speaking up, giving "readbacks," using team problem solving, providing performance feedback, and implementing and diligently employing user-built "best-practice" processes. The same is true of healthcare teams and organizations.

When either professionals who use firearms, or clinicians for that matter, train those skills together in realistic scenarios with desirable difficulty and implement user-built processes that require a change in their practice patterns, they learn humility, trust, and the reality of performance on demand to complete the mission or provide high reliability care. In doing so, healthcare teams find out who gives up on the change initiative, who endures, and who will fight for their patients and their teammates.

That shared experience forges cohesion and the ability to predict the next action, the critical bond that great teams need.

But its more than that. Great teams also require a great organizational culture in which to operate.

In healthcare, a culture of accountability can reliably provide the safest, high quality care in ways that a soft, "I-just-want-to-be-liked," culture never can. High-performing professionals coach and mentor new high-performing teammates in the art of demanding accountability to "perform to our mutually agreed-upon standards." In so doing, they intentionally maintain their culture and raise the next generation of great care givers.

The Ultimate Lesson I've Learned from Firearms Training?

At its deepest level, great firearms training taught me this: Expertise and virtue (being a good human and teammate) are inseparable.

Expertise without virtue often ends in tyranny; virtue without expertise leads to errors. Both ultimately end in organizational failure.

In healthcare, the high-performing professional's path is to unite the two, to be both a clinical expert and a good human.

That’s why I train teamwork and communications skills like I do. That’s why my training includes scenario-based drills with multiple repetitions.

That’s why I insist on implementing user-built, "best-practice" processes that embed teamwork and communication as forcing functions.

It's why I train the system I do, to create a culture of accountability by design.

Because everything healthcare organizations want to achieve in high-reliability depends on it.