ICE Book Review – How to Change: The Science of Getting from Where You Are to Where You Want to BE

By Rob Cooney (@EMEducation)

How to Change: The Science of Getting from Where You Are to Where You Want to BE
By Katy Milkman

Medical educators are no strangers to change. Clinical work involves staying abreast of rapidly expanding volume of “evidence.” Teaching requires us to try to get learners to expand their learning (i.e., change their “minds”). We also know how exceedingly difficult this can be, for ourselves and for others. There’s a lot of advice on how to make changes, but is any if this advice valid?

Dr. Milkman is an engineer turned behavioral scientist. In this book, she sets out to explore and explain what behavioral scientists have learned about making meaningful change. She explains the power of a “blank slate” as the key moment to begin or activate change. Blank slate moments are big life events (i.e., the arrival of a new child, starting residency) that serve as a powerful timepoints to initiate new behaviors or change efforts. Unfortunately, they tend to be rare. The good news is that although people won’t have many blank slate moments in our lives, we can use the “fresh start effect” instead. Fresh starts can be anything from the beginning of the week, to a birthday, to a new job. These moments act as effective stimulators for change because humans tend to view time as a series of events instead of a true continuum. But beware, a fresh start can also derail progress when you’re on a roll (think vacation and weight loss efforts).

The book continues to explore key evidence-supported principles to harness for change. Impulsivity (the tendency to favor instant gratification over long-term rewards) can be tempered by making the unappealing task more fun or rewarding (fun exercise vs “what you should do”) or temptation bundling (exercising while watching your favorite series). Procrastination can be tackled by using “commitment devices.” These can be as simple as a deadline with a consequence or limits on your internet access to pledges displayed publicly.

Overall, How to Change is packed with useful ideas gleaned from the behavioral science literature. As educators, physicians, and humans, we can benefit from understanding the influences of psychology on our behavior and methods to circumvent our default operating state. I highly recommend this book to all CEs.

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