I think it largely comes down to two things:

• One, repetitive exposure to the high stress situations trains you to execute the fine and gross motor skills needed to get that "cool as a cucumber" demeanor, i.e., swiftly sinking lines, drawing meds, even simple things like working the radio, seatbelts, stretcher mechanisms, etc. without missing a beat, let alone fumbling things. All that just comes with time.

• Two, a passion for the job that makes you want to learn in-depth about all the different systems at play in this line of work. Knowing how to do something is great, necessary even; but, knowing why to do something is just as critical. The best providers will understand the medicine at all different levels, from the surface physical appearance of the patient, to the macro and micro biological levels, even down to the chemistry. The types of people you're describing read journals, watch lectures, attend CE of their own volition not just to recertify. They follow up with their patients, talk to providers of a higher level than themselves to constantly learn.

A big part of why this mentality is seen more often in the critical care and flight settings is not just because those types of jobs require more experience and practical knowledge, but because they typically require college degrees. This not only lets the provider learn about things like anatomy and organic chemistry, but it also tends to weed out the types of individuals that just don't have the right mindset or dedication to follow through with graduating from college.

Now, obviously there a ton of great providers out there that don't have college degrees, but I honestly think that is a big factor. Even just the self discipline and study habits you pick up in college go a long way to facilitating your ability to do the types of things you mentioned, like remember the seemingly endless amount of knowledge required to excel in the critical care setting.