Durning Steven J, Costanzo Michelle E, Artino Anthony R, Graner John, van der Vleuten Cees, Beckman Thomas J, Wittich Christopher M, Roy Michael J, Holmboe Eric S, Schuwirth Lambert
Department of Medicine, Uniformed Services University of the Health Sciences 4301 Jones Bridge Road, Bethesda, Maryland, 20814.
National Intrepid Center of Excellence, Walter Reed National Military Medical Center 8901 Wisconsin Avenue, Bldg 51, Bethesda, Maryland, 20889.
Brain Behav. 2015 Mar;5(3):e00309. doi: 10.1002/brb3.309. Epub 2015 Jan 29.
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.
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.
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.
These findings reveal a multinetwork system that supports the dual-process mode of expert clinical reasoning during medical evaluation.
理解临床推理对于患者护理和医学教育至关重要。双加工理论表明，非分析性推理是专业技能的一个重要方面；然而，评估非分析性推理具有挑战性，因为它被认为发生在潜意识层面。这一假设使得同时进行的言语报告成为不太可靠的评估工具。
在内科实习医生（新手）和获得委员会认证的内科住院医生（专家）完成美国医学执照考试和美国内科医学委员会的多项选择题时，使用功能磁共振成像来探索非分析性推理的神经基础。
结果表明，新手和专家除了有不重叠的神经资源外，还共享一个共同的神经网络。然而，在非分析性推理过程中，专家在前额叶皮层等区域表现出更高的神经处理效率。
这些发现揭示了一个多网络系统，该系统在医学评估过程中支持专家临床推理的双加工模式。
