Neural Areas of Activation During Clinical Reasoning and Decision Making
Abstract
Background: Neural areas of activation involved in clinical reasoning and decision making were assessed using functional magnetic resonance imaging (fMRI) in novice and expert clinicians as they reasoned through and assigned clinical diagnoses to sixteen different clinical cases (eight easy, and eight hard).
Results: During the clinical reasoning phase, novices had increased activation in the left anterior temporal cortex during easy and hard clinical cases, and the prefrontal cortex during hard clinical cases. There were no significant differences in brain activity between groups during clinical decision making for the easy cases. During clinical diagnoses on hard cases, novices had increased left anterior temporal cortex and left ventrolateral prefrontal cortex activation, whereas experts had increased activations in the right parietal cortex and right dorsolateral and ventrolateral prefrontal cortex.
Conclusion: Two modifiers of neural activation during clinical reasoning and clinical diagnoses include clinician level of expertise and task difficulty. Novice clinicians rely more heavily on semantic memory, when reasoning and as well demand more working memory (WM) when reasoning through cases. While both novices and experts demand use of the pre frontal cortex (PFC) during decision making, differences in hemispheric activations could suggest WM and supporting areas of the PFC evolve from use of semantic, factual knowledge that is rule-based guided by basic causal explanations in novices, to processes dedicating more attention to evaluative assessment in experts where comparisons between exemplars with more internal experiences are used.
Description
Keywords
Education, Education--Health, Education, Psychology--Cognitive
Citation
Hruska, P. (2015). Neural Areas of Activation During Clinical Reasoning and Decision Making (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/27078