Neural areas of activation during feedback processing of clinical decision making

Abstract

Studies in neural areas of activation during clinical reasoning and decision-making play a critical role in improving medical education; however, the effect of feedback processing in clinical decision-making is poorly understood. In particular, differences in feedback processing in novice and expert clinicians during clinical decision-making. To understand this difference, we presented feedback (correct/incorrect diagnosis) to novice and expert clinicians after diagnosing simple or complex (easy, hard) cases while functional magnetic resonance imaging (fMRI) data were collected. Sixteen clinical cases (in the field of gastroenterology) were presented in the form of multiple-choice questions during an fMRI scanning session, followed by corrective feedback. As hypothesized, providing feedback for clinical diagnosis evoked multiple neural activations in some cortical regions, including the cingulate cortex, temporal cortex, striatum, orbitofrontal, and occipital cortexes in novice and expert groups. Interestingly, our findings indicate that positive feedback evoked more significant neural activation (in areas like the temporal cortex, cingulate cortex, and striatum) in novice clinicians than experts, which suggests that the novice group relies more on motivation, reward processing, and working memory than experts. Our neuroimaging results also showed a considerable activation of the left orbitofrontal cortex in feedback processing (both positive and negative) for both groups. This area plays an active role in learning and decision-making. In sum, the results here show that feedback processing in clinicians is impacted by expertise – there are some common neural regions related to learning and decision- making. Still, there were unique activations in novices tied to motivation, reward processing, and working memory, presumably driven by their lack of experience.