There is a difference between knowing something and being able to explain why you know it. I have become much more aware of that difference through teaching.
Throughout my career, I have taught pathology to medical students and worked with resident physicians. Earlier in my career, I probably thought about medical education mostly from the student’s perspective. The student was there to learn from someone who had more training and experience. Once I began teaching, I realized that the exchange was not quite that simple.
A student can ask a basic question about something I have understood for years, and suddenly I have to put my reasoning into words. I cannot simply say that I recognize what I am seeing because I have encountered it before. I have to explain what I am recognizing, which details matter, what other possibilities I considered, and why I reached a particular conclusion.
Sometimes explaining that process is more difficult than reaching the conclusion itself. Teaching has shown me that it does not only reveal what the student understands. It can also reveal how well I understand something myself.
Experience Can Make Reasoning Feel Automatic
Pathology involves a great deal of pattern recognition. As you gain experience, you naturally build a mental library from the cases you have encountered. Certain findings become familiar, and you become more efficient at recognizing what deserves your attention.
That efficiency is one of the benefits of experience. I would not expect to approach a case after years in medicine in exactly the same way I approached it as a new resident. Training and repetition are supposed to make physicians more capable and more efficient.
However, experience can also make parts of the reasoning process feel almost automatic. I may look at something and immediately recognize why it concerns me, but a medical student looking at the same thing may not understand what caught my attention.
If I am teaching that student, telling them that they will understand after they have more experience is not particularly useful. I need to slow down and explain what I noticed. I need to describe which features are significant, what possibilities those features raise, and why one interpretation may make more sense than another.
Going through that process reminds me how much reasoning can sit underneath a conclusion that initially feels instinctive.
Simple Questions Can Be Surprisingly Difficult
Students sometimes ask questions that appear simple at first. They may ask why a particular finding matters, why I am considering one possibility instead of another, or how my thinking would change if one feature of the case were different.
Those questions can force an experienced physician to examine assumptions that have developed over time.
If I believe something is true, can I clearly explain why I believe it? Am I relying on evidence and experience, or has the finding simply become so familiar that I no longer consciously think about the reasoning behind it? Would I reach the same conclusion if an important part of the case were different?
I do not believe every medical decision needs to become a lengthy academic discussion. Physicians work under practical constraints, and we need to be efficient. Students also need to learn that not every question requires additional testing or an exhaustive search for another explanation.
Part of developing medical judgment is learning which questions deserve more attention. Teaching that distinction can be just as important as teaching the underlying medical facts.
Some Lessons Are Difficult to Learn From a Textbook
I have always placed a great deal of value on reading medical literature. I continue to read journals and new editions of textbooks in breast pathology, and I participate in continuing medical education because medical knowledge continues to change.
At the same time, some of the most important parts of my own education came from other physicians.
Dr. Jonathan Lara and Dr. Ira Bleiweiss were important mentors during my development in breast pathology. Experienced mentors can provide something that is difficult to reproduce in a textbook.
A textbook can describe a disease, explain its characteristics, and provide representative examples. An experienced physician can help you work through the case that does not look exactly like the example in the book.
Those situations raise more complicated questions. What should you do when only part of the expected pattern is present? How much importance should you give to a finding that seems inconsistent with everything else? When should you reconsider your initial impression, and when do you have enough information to be comfortable with a conclusion?
Those are difficult questions to answer through reading alone. Part of learning medicine comes from watching experienced physicians work through them and eventually developing your own judgment.
When I later began teaching medical students and residents, I became more aware of my responsibility to pass some of that process forward.
Teaching Is More Than Providing the Correct Answer
When you already know the answer, it can be tempting to provide it immediately. That may be efficient, but it does not necessarily help someone learn how to reach the answer independently.
When the circumstances allow it, I prefer to understand how the student or resident is approaching the problem. I might ask what they see, what possibilities they are considering, or whether there is anything about the case that does not fit their initial impression.
The purpose is not to make someone guess what I am thinking. The purpose is to help them develop a reasoning process that will remain useful when an experienced physician is no longer standing beside them.
There is an important balance involved. Medicine is not simply an academic exercise when patient care is involved. There are situations when efficiency and clear communication have to take priority. A teaching opportunity should never interfere with the responsibility to handle the work appropriately.
Learning how to teach within those practical limits is part of medical education as well.
Students Can Make Experienced Physicians Think Differently
Medical teaching is often described as knowledge passing from an experienced physician to someone earlier in training. That certainly happens, but I think that description leaves out an important part of the relationship.
Students make teachers think.
Someone who has not seen hundreds of similar cases may ask a question that an experienced physician would not have thought to ask. Most of the time, there is a straightforward answer. Occasionally, however, the question makes you reconsider how you have been thinking about something.
I see value in that.
Experience should give physicians confidence, but I do not believe it should make us resistant to questions. If anything, years in medicine should make us more comfortable examining why we believe what we believe.
Teaching creates regular opportunities to do exactly that.
Explaining What You Know Tests What You Understand
After years in medicine, I have become less interested in thinking about expertise simply as the amount of information someone knows. A strong knowledge base is essential, but knowledge alone does not make someone an expert.
A physician also needs to understand how different pieces of information connect. We need to recognize where uncertainty exists, determine which questions are worth pursuing, and explain the reasoning behind our conclusions.
Teaching tests those abilities in a very direct way.
When a student asks me why I reached a particular conclusion, I have to take reasoning that may have become instinctive and make it understandable to someone else. That process can expose gaps, assumptions, or ideas that deserve another look.
I may begin the conversation as the teacher, but that does not mean I stop learning during it.
That has become one of the things I value most about teaching medicine. You begin by trying to help another person understand something more clearly. In the process, you are reminded to make sure you still understand it clearly yourself.