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observations were coordinated through the 24th Special Op- Data analysis also revealed five social determinants of un-
erations Command Surgeon General and the leadership of conventional resilience that structure and support the right
both detachments. Consent was obtained during individual relationship to performance pressure across the deployment
interview sessions and focus groups. Purposive sampling al- cycle. They are as follows: bonding patterns, impression man-
lowed us to recruit 24 medics to engage in individual inter- agement, medical-martial creativity, grief processing, and fam-
views, which lasted from 4–12 hours across multiple times and ily formations. Each social determinant represents the tactical
settings. This group included four members from each disci- level of unconventional resilience and will be explored in the
pline within SOST (surgeon, emergency medicine physicians, fourth through the eighth articles of this series. Taken together,
anesthesia provider, critical care nurse, surgical technician, these articles help to answer the question, “What makes peo-
and respiratory technician) and focus groups. Field observa- ple resilient?” The final article in this series will explain un-
tions were performed at both SOST detachments as well as conventional resilience within a new infrastructure of holistic
Air Forces Special Operations Command (AFSOC) headquar- and integrated performance that fuses meaningful aspects of
ters to better understand the broader organizational culture of the conventional resilience construct, while also expanding
SOST. Researchers also participated in a SOST field-training, to include a broader understanding of cultural and interper-
intended to approximate combat performance. sonal experiences impacting SOF medic practical performance
across the deployment cycle.
The data analysis process relied on an interdisciplinary team of
subject matter experts, who engaged in a bottom-up method While our interdisciplinary method may be disruptive, engag-
of interpreting the data. This occurred in three phases that ing novel research supports our definition of unconventional
vacillated between focusing on particular pieces of the data resilience and prepares SOF medics to be analytically nimble—
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and broader impressions of the entire dataset. The first phase an agility trait that promotes the ability to rigorously question
began when all research team members wrote an interpretive standard approaches to complex real-world challenges and
summary concerning their thoughts, interpretations, and as- construct new models of problem solving. As such, being an-
sumptions about the research protocol. Rigor was maintained, alytically nimble is foundational to supporting change-agency
in this phase, by meticulously tracking the unfolding inter- because it supports engagement with the complex human di-
pretations of meaning. The second phase involved identifying mension of warfare.
meaningful themes that emerged across the entire dataset after
all data were collected. The analysis team members then held Author Contributions
monthly teleconference meetings to construct an emergent tax- EAJ conceived of this study and wrote the protocol. SLH ob-
onomy of themes contained in the data set. The third phase tained funding and IRB. JD acted as liaison to the Air Force
involved member checking preliminary themes with research Special Operations community in specific the 24 Special Op-
participants and other SOF medics. All feedback was inte- erations Wing and Special Operations Surgical Teams. JD
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grated into the final work product. Rigor was maintained also orchestrated all approvals for field observations. EAJ
throughout the analytic process by meticulously tracking un- recruited participants, collected and analyzed interview, data,
folding interpretations of meaning through writing field notes and drafted the initial taxonomy of themes. EAJ wrote the
after field observations, as well as through interpretive sum- first draft of this paper. SLF contributed substantive changes
maries after each interview or focus group was analyzed. 42 to a second draft. JD served as Air Force Special Operations
Command medical expert during data analysis process. JB and
JW-B provided substantive feedback to second draft. JB served
Preliminary Findings and Future Implications
as a military medical expert in redacting findings. All authors
Our initial research findings resulted in over 3,000 pages of read and approved the final manuscript.
individual interview and focus group data, 200 hours of raw
audio files, and 400 pages of field notes across the team. As Disclosures
stated in the introduction, our goal was to justify how resil- JB, JW-B, JD, and SLH have no financial relationship to this
ience ought to be studied to support the future performance study. EAJ served as the Senior Lead Research Scientist on this
needs of SOF medicine. In the subsequent eight articles of this project and was paid through the following contracting compa-
series, we will use empirical data to detail our bottom-up the- nies: Parsons Corporation, ABSS Solutions, Inc./1st American
oretical architecture in relationship to the levels of warfare Systems and Services, LLC, and Innovative Employee Solutions.
(strategic, operational, and tactical). This new theory views
SOF medic resilience as an adaptive process that involves Funding
moving with adversity instead of standing against it and eval- This research is sponsored by funding (# FU 20-042) from
uates the structures that support SOF medics’ ability to relate the Air Force Research Lab-US Air Force School of Aerospace
to the pressure of practical performance in SOF culture. Ex- Medicine (AFRL-USAFSAM) through the Studies and Analysis
plication of the strategic framework of unconventional resil- Program.
ience will be discussed in the next article. Additionally, data
analysis revealed that resilience is expressed at three levels: or- Disclaimer
ganizational, team, and individual. This operational model of The Public Affairs Office, United States Air Force 60th Medi-
unconventional resilience will be discussed in the third article cal Group at Travis Air Force Base, Fairfield, CA has approved
of this series. When all three levels of resilience are integrated this publication for universal distribution. The AFRL’s Insti-
and harmonized, unconventional resilience is expressed as dy- tutional Review Board approved the study as an exempt pro-
namic freedom of maneuver which facilitates connection to tocol (# FWR20200104) in August 2020. The information,
oneself, others, and community amidst ambiguous situations. content and/or conclusions do not necessarily represent the of-
Together, the next two articles help to answer the question, ficial position or policy of AFRL-USAFSAM, the Department
“What is resilience?” of Defense, or the US Government.

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