Why we ask “Why?”

By Loren Deutsch

Recently, a Freakonomics broadcast on NPR, called How to Launch a Behavior-Change Revolution, caught my attention. During the 45-minute episode two professors from the University of Pennsylvania, Angela Duckworth and Katy Milkman, talked about their goal to solve every social problem. Their theory is that human beings are the social problem and because humans repeatedly make decisions that undermine their well-being, they create additional problems (in health, education, and finance). This topic presses into our work at LAS because it touches on questions that we frequently ask our students about their academic difficulties and the obstacles in their way. We start by simply asking, “Why?”

In helping students and residents learn how to learn, we need to understand why the difficulties exist in the first place, and to provide help, we need to understand those difficulties within a personal narrative. We cannot assume or generalize. So, we ask “Why?” in order to listen, and begin to understand. This process helps deepen our awareness about each of our students, and therefore, much of the LAS training curriculum hinges on “Why?” – At LAS, we call this part of the training curriculum, The Intangibles, largely because it comprises a broad set of concepts that are often familiar but not always well understood. At times they can feel intangible.  

Many of our students are medical students and doctors who come to LAS requesting help with learning and achieving, particularly on high stakes exams. These individuals are intelligent, but they are also stuck. When people experience academic difficulty, the tendancy is to default to what is most familiar, whether or not it has ever been effective. As Duckworth and Milkman discussed in the Freakonomics broadcast, human beings repeatedly make decisions that undermine their well-being. In education, that translates into students using study skills that no longer serve them well, or never did in the first place.

Learning and achievement is made even more difficult with the added pressure of time-sensitive deadlines, and a belief that learning better, faster, and more efficiently requires adding something new. With a proliferation of productivity apps and self-help literature, students are quick to bypass a textbook, self-reflection strategy, or review session, in favor of the ever-present learning apps on their smartphone.  While more immediate, productivity apps also require a learning curve and can compound academic difficulties.

In an age when medical students can use search engines to learn about the mechanism of action in a particular drug, it is a harder sell to ask them to take time to learn it within a deeper context, to include the physiology, pathophysiology, and microbiology. It is far quicker to Google a question, and therefore, immediate gratification usually prevails. The downside is that medical students risk memorizing something they do not understand, and can not retain or apply in future situations. This downside sets them up for possible failure.  

Drive theory is based on a premise that humans beings have basic needs such as eating, sleeping, and staying warm, and are motivated to satisfy those needs for survival. When we are tired, we know we must sleep. Sleep solves fatigue.

Another way to consider drive theory is based on a premise that humans have basic needs such as eating, sleeping, and staying warm, but due to restraints or obstacles, they are hindered in satisfying those needs. The motivation for survival has not decreased, it has been obstructed. Duckworth and Milkman might argue that some people do not get enough sleep because they do not practice good sleep hygiene. The short and long-term effects associated with delayed or diminished sleep include fatigue, stress, and long-term health problems. This is not a novel idea but getting people to adjust their sleep patterns is often difficult to do and incentives like less fatigue, lower rates of stress, and decreased long-term health problems do not appear to help either.

In the example of sleep, we are reminded to look beyond incentives for decision making that results in decreased sleep, and instead consider obstacles that get in the way of it. Asking “Why?” helps address the underlying obstacles that are ultimately implicated when we look at changing behavior. If the decision to forego sleep is the problem we need to address the decision making that led to it. This underscores the importance of how we think about academic support. Academic support is typically linked to tutoring, comprehension support, skill building, or test prep support. What if we think about academic support as solving a problem, like Duckworth and Milkman suggest? Would that help us identify something more intangible?

Consider what contributes to academic difficulty. In addition to feelings associated with learning or achieving, and cognitive or neurological problems that might exist, there are deeply engrained habits of mind associated with learning, achieving, and academic difficulty. In that context, asking “Why?” and then providing support for the answers could foster the curiosity needed to cultivate new habits. New habits have the potential to create behavior change and ultimately, solve a problem.

Later this week LAS will post the first of three essays on The Intangibles, starting with a blog post by Rachel Lewin about resilience and burnout.