Dig for the Why

The second practical tip for implementing the Core Content Mastery Method is dig for the why. You’ve heard us talk about how we feel the Why Behind the What is a Core Tenet of our pedagogy. So, we want to help you understand how to dig that why out. To illustrate what we mean by this, I’ll give an example…

Acidosis causes hyperkalemia. That’s a fact. There’s nothing wrong with that. Except…when a student sees this fact, this statement…their first response is going to be… (CLICK) … “But, WHY!?” Why does that happen? How does that happen? The student will need a deeper explanation – acidosis is excess positive hydrogen ions, so the body is trying to bring the hydrogen ions out of the bloodstream. But to do that it has to balance the charges by releasing potassium to replace it. See?

So learners need a GOOD foundation in order to be able to understand a topic at the higher levels. I love the way Sal Khan explains it – if you were building a house and you only completed the foundation at about 80% accuracy, then you built the first floor at 80% accuracy…when you start to build the second floor, it’s going to collapse! That’s why we aim for mastery at all levels! So…ways to give that good foundation – give a little A&P review… “acidosis is an excess of positive hydrogen ions in the bloodstream”. Link that to chemistry or pathophysiology – “the body has to balance out those charges in order to move the hydrogen ions out of the blood”. That helps to build a solid foundation to understand WHY acidosis causes hyperkalemia.

Other things you can do – discuss the mechanism of action of meds. Insulin lowers blood glucose – okay but HOW – well it opens the gated channels in the cells that allows glucose to enter and be used. When you’re listing symptoms or medications – be able to explain why that’s a symptom – or why we give that medication. Here’s an example of all of this pulled together. Heart failure means less cardiac output because the heart can’t pump – that decreases perfusion to the kidneys – the kidneys will hold onto fluid because they’re trying to improve their own perfusion – that causes volume overload – that volume can’t get through the heart efficiently, so it backs up into the lungs and into the body. So patients experience shortness of breath because of all the fluid in their lungs – and they’ll gain weight because of all the extra fluid in their body – so we give loop diuretics like furosemide to help the kidneys excrete more water from the loop of henle and decrease that strain on the system.

I know – that seems so simple – but you’d be surprised how many educators would give 1) a definition of heart failure. Then 2) a list of symptoms. Then 3) a list of medications, without ever tying them together or helping students understand WHY or HOW it all works together.

So, put yourself in the shoes of the student. Read back what you wrote – does it make you want to ask “But why?” or “But how?” or even “What does that have to do with anything?” If so – pivot, make the adjustment. Do you look at a symptom and think – hmm…I wonder why that causes that symptom? Look it up! Know that if you aren’t sure – they won’t be sure either. So, think like a student.

Okay, so those are some tips on digging for the why. Remember it’s about giving them what they need so that they can master the content and not feel overwhelmed. Now, go out and be your best self today. And, as always, happy nursing!