Why is the most powerful word in education. Asking why is a mark of curiosity, the strongest intrinsic motivating factor. It forces people to find answers and ultimately ask more questions. It drives people to endlessly pursue knowledge. It, along with its cousins what and how, have driven scientists and researchers for centuries. What seeks to identify the element responsible for a given phenomenon. How is asked to better understand the processes that underpin a phenomenon. But why is the question that is asked when people want to utilize critical thinking. Why does not seek simple answers, rather it asks a fundamental characteristic that entrains judgement, reasoning, and logic. Why beckons itself for someone with wisdom, experience and insight to bring reason and logic out of uncertainty.
Children are the epitome of learning and curiosity. Anyone who has known a 5-year-old child with an incessant, unrelenting string of whys’ can attest to this. How does that curiosity transition as children grow into adulthood? The answer is contained within the transition from pedagogy to andragogy. Malcolm Knowles is credited for popularizing the term andragogy which is the term used for adult learning theory. Knowles described several factors that are essential to adult learning that support motivation in learning: The need to know, self-concept of the learner, role of past experiences, readiness to learn, orientation to learning, and motivation (Knowles, Holton, & Swanson, 2011; Severino, Aiello, Cascio, Ficarra, & Messina, 2011).
• Need to know - the principle that adult learners need to know why they are learning something.
• Self-concept of the learner - the need to feel autonomy in the pursuit of knowledge and involvement in their own learning processes.
• Role of past experiences - adult learners need to be able to have prior knowledge activated and know where this new knowledge fits into their schema of old knowledge.
• Readiness to learn - the need to feel the urgency to learn the material.
• Orientation to learning – learners want to know how and where they will apply this new knowledge.
• Motivation - the simple desire to learn.
These are all principles that underline and motivate adult learners. In medicine, we encourage ourselves and others to be lifelong learners. Therefore, we need to foster this curiosity to promote lifelong learning pursuits.
There is a well quoted story detailed the power of why: A father was cooking with his daughter and they were making a pot roast. The father cut off the end of the pot roast and put it in the oven. The inquisitive and observant little girl turned to her father and asked, “Why do you cut of the end of the pot roast?” The father had not contemplated this before and simply stated, “That’s how my mother always did it.” He then in turn called his mother and inquired, “Mom why did you always cut off the end of the pot roast before placing it in the oven.” The grandmother laughed and stated simply, “Oh honey, it was because I never had a pot big enough!”
How many times in medicine - especially in surgery - do we tell our students, “well that’s how I was taught,” or “that’s how it’s done.” There was always an original answer to why things are done the way they are. As students go through training we are so prone to fall into the trap of learning certain ways of doing things as dogma. One never really questions this until a student simply asks, why. I myself chose to train at a different institution for fellowship than residency because I wanted to see a different perspective. When I arrived for fellowship I saw things done a different way and I asked myself why, in residency, we did it differently. I appreciated and understood my residency training on a deeper level because of this. We learn and innovate when we eschew dogma and embrace deeper understanding.
When learners don’t achieve a deeper understanding of a subject, they risk not retaining knowledge. They are unable to transfer to novel contexts and having limited problem solving abilities using this knowledge. Here, they are prone to misconceptions, and are unable to pass on this knowledge in any meaningful way. David Perkins describes this as fragile knowledge. (D. Perkins, 2003; D. N. Perkins, 1992; D. N. Perkins & Salomon, 1988). Understanding the why allows for a deeper understanding instead of these fragile knowledges. More importantly, when you have a deeper understanding of the why, you can in turn train the next generation the reason behind the surgical technique, decision, or process.
I had a teacher in an undergraduate physics class who spent a whole semester teaching us physics principles and bunches of equations. For the final exam, he had four essay questions. The last question had a simple stem and only one data point. The question asked what was the approximate weight of water on earth and gave the radius of the earth. Every learner had been equipped with the basic skills to answer this question but few could answer it correctly. In fact, only 12% of students got it correct. So what was the difference between those that got it right and those that got it wrong? Those that got it correct had a deeper understanding of the why. They didn’t just see a bunch of equations and just know how to plug and play, they knew why you use those equations and what assumptions were entrained in each. When they were presented a novel context they were able to transfer that knowledge, pull out the appropriate equations and realize what assumptions needed to be made to correctly answer the question. Was this high failure rate the professor’s fault or the students’? Should the professor have been more explicit about the why? Should the students have asked the why? My feeling is that as educators, it is ultimately our job to make sure that our trainees have the tools necessary to succeed and move to the next level before they leave our purview.
To conclude, we – as medical educators - should encourage our students to ask why. This is the highest order of understanding. If students understand the why, we increase their likelihood of deep understanding, retention, and transfer to novel contexts. The phrase “because that was how I was taught” promotes rout memory instead of deep understanding. To achieve deep understanding, they need to conceptualize how this information fits, and connects to, their greater knowledge of the subject. Once students have this deeper understanding they will remember it, be able to functionally use it, and pass it on to others. This is our ultimate goal as educators.
How will you promote the why?
Knowles, M. S., Holton, E. F., & Swanson, R. A. (2011). The Adult Learner. The Adult Learner (Vol. 24).
Perkins, D. (2003). Deep and Fragile Knowledge, Smart Schools. WGBH, 2003, 2003.
Perkins, D. N. (1992). Smart Schools : from training memories to educating minds. New York: Free Press.
Perkins, D. N., & Salomon, G. (1988). Teaching for transfer. Educational Leadership, 46, 22–32. Retrieved from http://arxiv.org/abs/0704.1854
Severino, S., Aiello, F., Cascio, M., Ficarra, L., & Messina, R. (2011). Distance education: The role of self-efficacy and locus of control in lifelong learning. Procedia - Social and Behavioral Sciences, 28, 705–717. https://doi.org/10.1016/j.sbspro.2011.11.132
Eric Gantwerker MD, MS, MMSc (MedEd) (Educators ’15, Leaders ’15) is a graduate of the MMSc in Medical Education Program at Harvard Medical School. His expertise is in educational technology, faculty development, motivational theory, and the cognitive psychology of learning. He is currently working clinically in Chicago as a pediatric otolaryngologist as well as serving as the Vice President, Medical Director of a technology company called Level Ex.
You can follow Dr. Gantwerker on Twitter @DrEricGant.