Neural basis of nonanalytical reasoning expertise during clinical evaluation
Brain and Behavior
Dual-process theory; Expertise; Functional MRI; Medical education; Neural efficiency; Nonanalytical reasoning
© 2015 The Authors. Introduction: Understanding clinical reasoning is essential for patient care and medical education. Dual-processing theory suggests that nonanalytic reasoning is an essential aspect of expertise; however, assessing nonanalytic reasoning is challenging because it is believed to occur on the subconscious level. This assumption makes concurrent verbal protocols less reliable assessment tools. Methods: Functional magnetic resonance imaging was used to explore the neural basis of nonanalytic reasoning in internal medicine interns (novices) and board-certified staff internists (experts) while completing United States Medical Licensing Examination and American Board of Internal Medicine multiple-choice questions. Results: The results demonstrated that novices and experts share a common neural network in addition to nonoverlapping neural resources. However, experts manifested greater neural processing efficiency in regions such as the prefrontal cortex during nonanalytical reasoning. Conclusions: These findings reveal a multinetwork system that supports the dual-process mode of expert clinical reasoning during medical evaluation.
Durning, S., Costanzo, M., Artino, A., Graner, J., van der Vleuten, C., Beckman, T., Wittich, C., Roy, M., Holmboe, E., & Schuwirth, L. (2015). Neural basis of nonanalytical reasoning expertise during clinical evaluation. Brain and Behavior, 5 (3). http://dx.doi.org/10.1002/brb3.309