Yin Yak The Podcast Episode 1 Transcript
Episode 1: Muscle Memory Under Pressure – From Ice Rinks to ERs (audio episode)
Guest: Julian Cha | Nurse & Healthcare Learning Strategist
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Part 1: Yak of the Week – Setting the Stage00:14 Yin: Hi there, welcome to Yin Yak The Podcast, where curiosity has no borders and learning happens at unlikely intersections.
Today’s curious question is: ‘How do we help learners develop the kind of muscle memory that professionals can rely on when it matters most?’
To explore this, I’m joined by Julian Cha. Julian, please tell us a little about yourself.
00:38 Julian: Hi Yin, thanks for having me. I’m a nurse by trade and I have went through several intensive training environments that have helped me and my team be prepared for some of life’s most critical moments. And in my 12 years as a nurse, I’ve also helped many teams design training and systems to improve clinical team performance under pressure and reduce errors in healthcare settings.
01:01 Yin: Welcome to Yin Yak, Julian! I’m so glad you’re here.
01:05 Julian: Glad to be here.
01:06 Yin: Let’s set the stage for today’s theme.
Not long ago, American figure skater Ilia Malinin landed six quad axels in competition. A quad axel is a jump that requires four and a half rotations midair. Afterward, he said, I was so nervous that I couldn’t really think about anything, and I did most of my jumps with just muscle memory.
That struck me. In fields like emergency care, muscle memory isn’t just impressive—it can be life-saving.
But what is muscle memory, really? It’s when your brain, through repetition, builds pathways that make complex movements automatic, so when pressure hits, your body knows what to do.
Julian, when you hear the phrase ‘muscle memory under pressure,’ what comes to mind from your training and clinical experience?
02:04 Julian: Yeah, I think about those unexpected moments when you’re providing care to a patient. Like if you’re in the middle of abdominal surgery and you accidentally nicked a large artery and then blood starts spewing everywhere and then you have abdominal content in play. What do you do in that moment? How do you prioritize? What’s your first step? What’s your next step? You have a ton of people around you. What instructions do you give them to help you? Right? What meds are you going to give in that moment to stabilize the patient and make sure we can, you know, continue with the goals of the surgery. I think about, you know, in the cardiac arrest, when everyone’s in there and someone’s pumping at the chest, someone is getting all the pads down, preparing to shock the patient and you’re trying to start an IV in that moment and everyone around you is moving, the whole body is vibrating from the chest compressions and you’re trying to put this needle inside so that they can give life-saving meds. How do you get that done within the timely manner so that you can save this guy’s life? Right? That’s what I think about when you say muscle memory under pressure.
Part 2: At the Intersection – Developing Muscle Memory in Healthcare
03:18 Yin: That scene you painted—it’s intense. Was there a moment in training where it all clicked, and you thought, ‘Okay, this is how I’ll act when it’s real’? What kind of practice got you to that point?
03:33 Julian: I think that it’s the way, like we were talking about training. So, how are you, how much do you know about what you’re doing? How much do you know behind the system you’re trying to solve? So in healthcare, we teach clinicians the physiology in how your body works and what is the proper functioning of each body system and what does malfunction look like and how do you fix each malfunction, like, so like cardiac arrest is a very specific malfunction that could go bad really fast. So we develop algorithms for that, to CPR and drug administration and create a team environment where a sequence of events can be done really quickly. So when you combine the physiology training along with the systems that we’ve developed to save lives, you combine that together, that’s how we could, you know, be so successful in saving people’s lives.
04:33 Yin: So it’s conceptual knowledge, and systems like you said. What did your nurse training look like and how did it help you build those automatic, high-stakes skills you’d need under pressure?
04:46 Julian: Yeah, so I got my nursing degree from VCU. It’s a bachelor’s degree. And there’s different kinds of nursing education you can get in America. So I did the bachelor’s degree, which is the four-year version. The first two years were they put side-by-side practical skills and also physiology and science, body science. We teach those both. And then the last two years, you get into more advanced skills. And then, you know, so, forgot to mention the first two years, along with learning how the body works, you also learn how the body breaks down. And then years three and four, you learn about, okay, how do you fix broken bodies, medications, interventions, and then we learn advanced skills in nursing, and, as well as leadership and research, because a lot in medicine is about continually improving as new research emerges, because we’re not just gonna do the same thing all the time if research shows that this other way could be better for the patient.
05:47 Yin: You mentioned the shift from deliberate thought to automatic action. What’s one common challenge educators face when trying to train that kind of muscle memory in clinical settings?
05:59 Julian: Yeah, for sure. I mean, I think there’s a pitfall when you teach systems and automation without a comprehensive foundation of the underlying concept. So, for example, when we found out that CPR is a very important component to save lives and really counter the effects of cardiac arrest, there’s a push in public health to have the general public learn the concepts and skills of CPR. The skill is pretty simple. I mean, you just, you know, teaching people two things to check and then how to do the compressions and breaths. And if those things are present, do this. If things are not present, do that. So give them a simple diagram. Just make sure that you keep pressing on the chest and do it the right way, right? And if you do that until the EMS comes, the chances of survival increases by a certain number. That’s huge.
However, where it goes wrong is, what if the situation that you’re presented with is not textbook? It’s not like what you have learned from those CPR classes, right? So there’s very nuanced situations with the body and it, it could surprise you. In those moments it’s like, do you do this? Do you do that? Or do you just do nothing?
07:20 Yin: That’s a great point—things don’t always follow the script, especially in high-stakes situations. In sports like skating, athletes simulate competition nerves. And in medicine, you’ve got code blues and trauma drills. From your experience, what kind of practice environments actually prepares someone for those unpredictable, high-pressure moments?
07:43 Julian: Yeah, you know, simulations are great and it’s very important because what it trains you to do is to go through the protocol. We need to do A, then B, then C, and D, and E, and you have to do all those in quick succession, and you have to memorize that succession. And there’s a reason why A is before B and there’s B before C. It’s like pilots, before they fly a real plane. You know, recently I read about this, the King and Queen of Thailand flew themselves from their country to visit a neighboring country. The King and Queen were both in the cockpit. The Queen was the first officer. Yeah. And like, I was like, is this the first time? Surely they don’t just fly 737s for fun. No, they don’t. But they’ve been flying in a simulator. They were in a simulator. They practice the checklist, everything that goes into, you know, taking off to landing. They practice all the emergency situations that a 737 pilot needed to learn.
So these simulations are very important. Even in like a cardiac arrest. I remember in nursing school, we were in our fourth year, and this was like 12 years ago, probably 13 or 14 years ago, but we would have med students in there because, know, usually you run codes with the presence of doctors and other professionals in the room. So we invite other like medical students, pharmacy students in the room and then we’re gonna run a code together. We switch roles. So not always is the med student the leader, sometimes the nursing student is the leader, but you get to experience what each role does and you’re given the protocol and what needs to be done. So they just run the protocol and each time the situation is different. They throw you a curve ball and then still you run through the protocol. You do this first, you do that next, and then this is what you do at that point.
But simulations is not all there is to producing a high-performing clinical team because, you know, as I said earlier, if you don’t know the basic and the foundations, it prevents your ability to face unpredictable situations, right? So knowing the concepts between why A has to come before B, and B comes before C. So when you get a curveball and say, okay, what do I do here? Okay, I know the concepts, and this actually needs to come first, and then I do that one. And then so it will help inform you to make better decisions.
10:23 Yin: That’s important—especially in high-stakes moments where no one person sees the whole picture. From your experience, what helps teams build the trust and confidence to speak up when it matters most?
10:38 Julian: Yeah, and also another thing that we learn in healthcare over time is the need for backup and help. I don’t have the word right now for that specific, but basically we check each other. So there was a lot of medical errors that happened like 50 years ago because people were afraid to speak up against doctors. So doctors would make a wrong statement, make a wrong decision, and nurses or therapists or pharmacists would not want to speak up because they that’s the doctor, he knows what they’re doing, I do not want to get yelled at. But that caused a lot of medical errors because doctors are human too. we’re, these critical situations are being managed by experts who are also human. And so we, in those situations, we need each other to check each other’s like, hey, are you sure, just to repeat back, you wanted one milligram of FD and then get that now. Just to confirm that that’s what they want. And then if you realize that there’s, but I just gave one dose like five minutes ago, is that what you want right now? Or I don’t know, like asking questions to verify that that is exactly what we want to do in this situation because you don’t want to assume that they are completely aware about the situation. You want to ask educated questions and check them and say, hey, I just want to make sure that we’re completely on the same page, that we’re doing what’s right for the patient. This drug is contraindicated in this situation and this is what we’re looking at, right? So, right, we’ve learned over time that it’s okay for nurses to ask questions to doctors and vice versa and you know, we can all work together as a team to help our patients.
12:30 Yin: One thing I keep coming back to is the idea of failing safely during training. Athletes call it training ugly—embracing mistakes early and often. How important is that in healthcare? And how do you realistically make space for failure without putting lives at risk?
12:50 Julian: Yeah. So for skill practices, we have dummies and we practice any sort of invasive procedures on dummies first, and you know how to make sure you can inolate properly, make sure you can find the right anatomy when you intubate, or any sort of procedure you practice on dummies first. Once you get good at that, then for certain procedures like IVs, you can practice on each other, and then you practice on patients. And even while when we first hit the floor and take care of patients, you always have preceptors and nursing have nursing preceptors that you work alongside with. Doctors, you start up as a med student and you precept like residents. And then even after you get your degree, you are just like a doctor in training, resident. And then you become a fellow before you actually become an attending physician. So we train, we teach, we demonstrate, and then we observe, and then we audit. So we do frequent audits for critical skills, like patient identification. Like that’s one thing we’ve learned over and over, that if you miss patient identification, that’s opening up rooms for a ton of errors from happening. So we check behind each other to make sure that we are actually talking about the right patient, doing things for the right patient. And we’ve learned over time that not just one patient identifier, you need to use two patient identifiers. So we have the Joint Commission that kind of regulates things that kind of oversees any medical error trends that are happening and then come up with best practices to recommend to hospitals and healthcare practices to implement.
14:32 Yin: You know, nurses have done this so well, it’s rubbed off on me. Sometimes I’ll say, “Don’t you want to double-check I’m the right patient?” even before they do. That says a lot about how deeply this practice has been embedded.
14:48 Julian: Yeah, yeah. And also like over time, I mean, we’re coming to an age where technology has also come to help us. I call it dummy-proof technology. Like you cannot force the, you have to scan the patient’s armband and you have to scan the med. You cannot not do the either one and you do it in the wrong order, then it will not let you give that medication.
Right? You have to be actually negligent. It’s like, I’m going to ignore all these steps and just give you this medication. You’re in deep trouble at that point. But we put all these checks and balances in place so that nurses can make sure they’re doing the right thing. And even with this, I mean, like with all this said, we’ve come a long way, but errors still happen. And so we also come up with quality processes where we do post-error like analysis to determine the cause and how to prevent this in the future. And that continues to inform future healthcare practices and processes.
15:46 Yin: It sounds like you’re also talking about how the system supports learning from mistakes. When an error does happen, how do you help nurses process it so it leads to growth, not just blame?
15:58 Julian: You know, we talked to the situation and the breakdown in the processes. You know, there’s a lot of things that are going on in some of these critical moments, right? How chaotic was the environment where whatever they’re doing was happening? How distracted were they because of the chaos? Were there holes in the process or the system? Was there any breakdown in that? Right? So we know all the things that are going in, like talk about a cheese, there’s, you have to go through, needs to have several holes that line up at the same time before something can go completely straight through the cheese. Like there’s not just one check that wasn’t there, right? Multiple, it’s a combination of factors that led to that error from happening. So just walking through that situation, I mean, there’s also times where it’s just gross negligence, right? In those situations, you know, letting go of the clinician, it would be the… the right thing to do, but oftentimes there needs to be more investigation to find out what were the circumstances that led to the mistake and the error.
17:05 Yin: Many of our listeners design learning experiences—some in healthcare, others in fields like cybersecurity, aviation, or education. Based on your experience, what principles would you share with anyone designing training for high-stakes, high-pressure roles?
17:27 Julian: You know, something that would be very effective is to show your students the final product. Like for people who want to be a surgeon, like show them that a surgeon in the midst of a high stakes critical moment and how that surgeon solve that problem and save the patient’s life and then introduce the curriculum, right? How did the surgeon get here? Not by just learning how to cut and how to suture. That is just the surface. That surgeon knows all these physiological components, knows how fast that artery is delivering blood to other body parts. And that surgeon knows the role of everyone in that room and their capabilities to help because there was delegation in place, there’s equipment, there is reading the vital signs and what the body is telling you, knowing what tools and medications are at your disposal to use in that moment. So showing them the final product of their aspiration, and I feel like that would kind of help them be motivated to learn every single thing, to get to that final product.
18:43 Yin: That reminds me of a book by David Perkins, where he talks about Making Learning Whole, starting with the big picture before breaking things down. In nursing education, do you ever start by showing learners what a real critical situation looks like before teaching them the step-by-step skills?
19:05 Julian: I mean, so it kind of reminds me of the one of the first few scenes of Karate Kid. I was going to look it up before today, but maybe the listeners know about this. When the Karate Kid was first trained, I think one of the first activities he was given was hang up clothes to dry or something like that. Or it was something very mundane to the point that the student was like, this is pointless. I want to learn karate. The trainer had to kind of encourage him and use the hard method just to like, he didn’t explain what’s the purpose of that task, but at the end of the training, everything came together. was like, that’s why you had me do this very boring task. You were training me for discipline. You were training my arm strength. You were training me for endurance. You know, all these skills that came through, but like, I wonder how that training would have been different if… you know, he got an overview of the final product and, you know, kind of know the components that went into that.
Part 3: Mic Drop – Closing Thought20:04 Yin: Food for thought. And clearly, I need to watch The Karate Kid. Before we wrap, we always leave listeners with a Mic Drop moment—a quote or idea to carry with them. This week’s quote is from Archilochus, a Greek poet and warrior:
“We don’t rise to the level of our expectations—we fall to the level of our training.”
When you hear that, what comes to mind from your journey in nursing and healthcare?
20:38 Julian: It’s like that concept, I can do it in my sleep. If there’s a skill that you are trying to master and you can’t say that you can do it in your sleep, there’s still more training for you to do.
20:50 Yin: Thank you so much for sharing your insight and experience with us. And to our listeners, thanks for wandering with us today. Until next time—keep learning at the intersections.
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