Knowledge Under Pressure

On The ITSO Matrix, Premortem, and Humanity

Dan Dworkis, MD PhD
2 min readDec 15, 2022


Photo by National Cancer Institute on Unsplash

Field notes from what we’ve been up to, what we’ve been taking in, and what we are thinking about at The Emergency Mind Project.

If you have ideas or things you’d like to see — or if you want to help and get more involved — I’d love to hear from you:

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The ITSO Matrix to Optimize Systems-Based Medical Education + Patient Care

The ITSO Matrix is a mental model designed to help groups map the existing strategies they use to perform under pressure across multiple scales and plan new priorities. In this article for the International Clinician Educators Network, we explore the ITSO Matrix and apply it to improving patient care and medical education.

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Premortem: Criticality, and Probability

No surprise that I love the premortem technique. I use it frequently and teach it across domains. This quick video by The McChrystal Group gives a great overview but also digs into some of the details of criticality and probability that are often glossed over when talking about pre-mortem exercises.

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Operators are humans. Our ability to make decisions and operate under pressure is not uniform but changes with sleep, hydration, stress etc. What we choose to do when we’re off changes what we can do when we’re on. So, how do we keep track of this? How do we remember in the middle of a crisis to recover ourselves? How do we build in recovery even when we’re struggling at the end of a shift/operation?

Something you want to see? Idea for a future thing to dig into? Hit reply and let me know what you’re thinking.

Keep training, and good luck out there!

— Dan



Dan Dworkis, MD PhD

Emergency Doctor. Applying knowledge under pressure. The Emergency Mind Book: