A neural marker of medical visual expertise: implications for training

The spacing effect in remote information-integration category learning

The present experiments examined whether the temporal distribution of procedural category learning experiences would impact learning outcomes. Participants completed the remote category learning experiments on a smartphone in one of two learning conditions: massed or distributed. Consistent with expectations, distributed learners in both experiments reached higher accuracy levels than massed learners. In Experiment 1 the effect disappeared after accounting for reaction time differences, suggesting that it was driven by attentional mechanisms. In Experiment 2, the spacing advantage was only present for previously studied items during a post-learning test, suggesting a role of consolidation. In both experiments, it seems likely that temporal spacing helped participants discover the optimal information-integration categorization strategy. These results suggest that adult category learning is facilitated by temporal spacing. Future work may further explore the effects of temporal and contextual distinctiveness of learning experiences on category learning outcomes.

Pathologists aren't pigeons: exploring the neural basis of visual recognition and perceptual expertise in pathology

Visual (perceptual) reasoning is a critical skill in many medical specialties, including pathology, diagnostic imaging, and dermatology. However, in an ever-compressed medical curriculum, learning and practicing this skill can be challenging. Previous studies (including work with pigeons) have suggested that using reward-feedback-based activities, novices can gain expert levels of visual diagnostic accuracy in shortened training times. But is this level of diagnostic accuracy a result of image recognition (categorization) or is it the acquisition of diagnostic expertise? To answer this, the authors measured electroencephalographic data (EEG) and two components of the human event-related brain potential (reward positivity and N170) to explore the nature of visual expertise in a novice-expert study in pathology visual diagnosis. It was found that the amplitude of the reward positivity decreased with learning in novices (suggesting a decrease in reliance on feedback, as in other studies). However, this signal remained significantly different from the experts whose reward positivity signal did not change over the course of the experiment. There were no changes in the amplitude of the N170 (a reported neural marker of visual expertise) in novices over time. Novice N170 signals remained statistically and significantly lower in amplitude compared to experts throughout task performance. These data suggest that, while novices gained the ability to recognize (categorize) pathologies through reinforcement learning as quantified by the change in reward positivity, increased accuracy, and decreased time for responses, there was little change in the neural marker associated with visual expertise (N170). This is consistent with the multi-dimensional and complex nature of visual expertise and provides insight into future training programs for novices to bridge the expertise gap.

Use of neuroimaging to measure neurocognitive engagement in health professions education: a scoping review

PURPOSE

To map the current literature on functional neuroimaging use in medical education research as a novel measurement modality for neurocognitive engagement, learning, and expertise development.

METHOD

We searched PubMed, Embase, Cochrane, ERIC, and Web of Science, and hand-searched reference lists of relevant articles on April 4, 2019, and updated the search on July 7, 2020. Two authors screened the abstracts and then full-text articles for eligibility based on inclusion criteria. The data were then charted, synthesized, and analyzed descriptively.

RESULTS

Sixty-seven articles published between 2007 and 2020 were included in this scoping review. These studies used three main neuroimaging modalities: functional magnetic resonance imaging, functional near-infrared spectroscopy, and electroencephalography. Most of the publications (90%, n = 60) were from the last 10 years (2011-2020). Although these studies were conducted in 16 countries, 68.7% (n = 46) were from three countries: the USA (n = 21), UK (n = 15), and Canada (n = 10). These studies were mainly non-experimental (74.6%, n = 50). Most used neuroimaging techniques to examine psychomotor skill development (57%, n = 38), but several investigated neurocognitive correlates of clinical reasoning skills (22%, n = 15).

CONCLUSION

This scoping review maps the available literature on functional neuroimaging use in medical education. Despite the heterogeneity in research questions, study designs, and outcome measures, we identified a few common themes. Included studies are encouraging of the potential for neuroimaging to complement commonly used measures in education research and may help validate/challenge established theoretical assumptions and provide insight into training methods. This review highlighted several areas for further research. The use of these emerging technologies appears ripe for developing precision education, establishing viable study protocols for realistic operational settings, examining team dynamics, and exploring applications for real-time monitoring/intervention during critical clinical tasks.

Learning to diagnose X-rays: a neuroscientific study of practice-related activation changes in the prefrontal cortex

OBJECTIVES

Medical expertise manifests itself by the ability of a physician to rapidly diagnose patients. How this expertise develops from a neural-activation perspective is not well understood. The objective of the present study was to investigate practice-related activation changes in the prefrontal cortex (PFC) as medical students learn to diagnose chest X-rays.

METHODS

The experimental paradigm consisted of a learning and a test phase. During the learning phase, 26 medical students were trained to diagnose four out of eight chest X-rays. These four cases were presented repeatedly and corrective feedback was provided. During the test phase, all eight cases were presented together with near- and far-transfer cases to examine whether participants' diagnostic learning went beyond simple rote recognition of the trained X-rays. During both phases, participants' PFC was scanned using functional near-infrared spectroscopy. Response time and diagnostic accuracy were recorded as behavioural indicators. One-way repeated measures ANOVA were conducted to analyse the data.

RESULTS

Results revealed that participants' diagnostic accuracy significantly increased during the learning phase (F=6.72, p<0.01), whereas their response time significantly decreased (F=16.69, p<0.001). Learning to diagnose chest X-rays was associated with a significant decrease in PFC activity (F=33.21, p<0.001) in the left dorsolateral prefrontal cortex, the orbitofrontal area, the frontopolar area and the frontal eye field. Further, the results of the test phase indicated that participants' diagnostic accuracy was significantly higher for the four trained cases, second highest for the near-transfer, third highest for the far-transfer cases and lowest for the untrained cases (F=167.20, p<0.001) and response time was lowest for the trained cases, second lowest for the near-transfer, third lowest for the far-transfer cases and highest for the untrained cases (F=9.72, p<0.001). In addition, PFC activity was lowest for the trained and near-transfer cases, followed by the far-transfer cases and highest for the untrained cases (F=282.38, p<0.001).

CONCLUSIONS

The results suggest that learning to diagnose X-rays is associated with a significant decrease in PFC activity. In terms of dual-process theory, these findings support the notion that students initially rely more on slow analytical system-2 reasoning. As expertise develops, system-2 reasoning transitions into faster and automatic system-1 reasoning.

Visual experience modulates whole-brain connectivity dynamics: A resting-state fMRI study using the model of radiologists

Visual expertise refers to proficiency in visual recognition. It is attributed to accumulated visual experience in a specific domain and manifests in widespread neural activities that extend well beyond the visual cortex to multiple high‐level brain areas. An extensive body of studies has centered on the neural mechanisms underlying a distinctive domain of visual expertise, while few studies elucidated how visual experience modulates resting‐state whole‐brain connectivity dynamics. The current study bridged this gap by modeling the subtle alterations in interregional spontaneous connectivity patterns with a group of superior radiological interns. Functional connectivity analysis was based on functional brain segmentation, which was derived from a data‐driven clustering approach to discriminate subtle changes in connectivity dynamics. Our results showed there was radiographic visual experience accompanied with integration within brain circuits supporting visual processing and decision making, integration across brain circuits supporting high‐order functions, and segregation between high‐order and low‐order brain functions. Also, most of these alterations were significantly correlated with individual nodule identification performance. Our results implied that visual expertise is a controlled, interactive process that develops from reciprocal interactions between the visual system and multiple top‐down factors, including semantic knowledge, top‐down attentional control, and task relevance, which may enhance participants' local brain functional integration to promote their acquisition of specific visual information and modulate the activity of some regions for lower‐order visual feature processing to filter out nonrelevant visual details. The current findings may provide new ideas for understanding the central mechanism underlying the formation of visual expertise.

An expert advantage in detecting unfamiliar visual signals in noise

Diagnostic radiologists are experts in discriminating and classifying medical images for clinically significant anomalies. Does their perceptual expertise confer an advantage in unfamiliar visual tasks? Here, this issue was investigated by comparing the performance of 10 radiologists and 2 groups of novices on the ability to detect novel visual signals: band-limited textures in noise. Observers performed a yes/no detection task in which texture spatial frequency and external noise levels were varied. The task was performed on two consecutive days. Contrast thresholds and response bias were measured. Contrast thresholds of radiologists were superior to the control groups in all stimulus conditions on both days. Performance improved by an equivalent amount for all groups across days. Response bias differed consistently across stimulus conditions and days but not across groups. The difference in thresholds between the radiologists and control groups suggests that experience in diagnostic medical imaging produces perceptual skills that that transfer beyond the trained domain.

Neurobiology of Schemas and Schema-Mediated Memory

Schemas are superordinate knowledge structures that reflect abstracted commonalities across multiple experiences, exerting powerful influences over how events are perceived, interpreted, and remembered. Activated schema templates modulate early perceptual processing, as they get populated with specific informational instances (schema instantiation). Instantiated schemas, in turn, can enhance or distort mnemonic processing from the outset (at encoding), impact offline memory transformation and accelerate neocortical integration. Recent studies demonstrate distinctive neurobiological processes underlying schema-related learning. Interactions between the ventromedial prefrontal cortex (vmPFC), hippocampus, angular gyrus (AG), and unimodal associative cortices support context-relevant schema instantiation and schema mnemonic effects. The vmPFC and hippocampus may compete (as suggested by some models) or synchronize (as suggested by others) to optimize schema-related learning depending on the specific operationalization of schema memory. This highlights the need for more precise definitions of memory schemas.

The potential of neuroscience for health sciences education: towards convergence of evidence and resisting seductive allure

Since emergence of the field 'Educational Neuroscience' (EN) in the late nineties of the previous century, a debate has emerged about the potential this field holds to influence teaching and learning in the classroom. By now, most agree that the original claims promising direct translations to teaching and learning were too strong. I argue here that research questions in (health professions) education require multi-methodological approaches, including neuroscience, while carefully weighing what (combination of) approaches are most suitable given a research question. Only through a multi-methodological approach will convergence of evidence emerge, which is so desperately needed for improving teaching and learning in the classroom. However, both researchers and teachers should become aware of the so-called 'seductive allure' of EN; that is, the demonstrable physical location and apparent objectivity of the measurements can be interpreted as yielding more powerful evidence and warranting stronger conclusions than, e.g., behavioral experiments, where in fact oftentimes the reverse is the case. I conclude that our tendency as researchers to commit ourselves to one methodological approach and to addressing educational research questions from a single methodological perspective is limiting progress in educational science and in translation to education.