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首页> 外文期刊>Advances in health sciences education: theory and practice >Working memory, reasoning, and expertise in medicine-insights into their relationship using functional neuroimaging
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Working memory, reasoning, and expertise in medicine-insights into their relationship using functional neuroimaging

机译：工作记忆，推理和医学方面的专业知识-使用功能性神经影像学了解他们之间的关系

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Clinical reasoning is dependent upon working memory (WM). More precisely, during the clinical reasoning process stored information within long-term memory is brought into WM to facilitate the internal deliberation that affords a clinician the ability to reason through a case. In the present study, we examined the relationship between clinical reasoning and WM while participants read clinical cases with functional magnetic resonance imaging (fMRI). More specifically, we examined the impact of clinical case difficulty (easy, hard) and clinician level of expertise (2nd year medical students, senior gastroenterologists) on neural activity within regions of cortex associated with WM (i.e., the prefrontal cortex) during the reasoning process. fMRI was used to scan ten second-year medical students and ten practicing gastroenterologists while they reasoned through sixteen clinical cases [eight straight forward (easy) and eight complex (hard)] during a single 1-h scanning session. Within-group analyses contrasted the easy and hard cases which were then subsequently utilized for a between-group analysis to examine effects of expertise (novice > expert, expert > novice). Reading clinical cases evoked multiple neural activations in occipital, prefrontal, parietal, and temporal cortical regions in both groups. Importantly, increased activation in the prefrontal cortex in novices for both easy and hard clinical cases suggests novices utilize WM more so than experts during clinical reasoning. We found that clinician level of expertise elicited differential activation of regions of the human prefrontal cortex associated with WM during clinical reasoning. This suggests there is an important relationship between clinical reasoning and human WM. As such, we suggest future models of clinical reasoning take into account that the use of WM is not consistent throughout all clinical reasoning tasks, and that memory structure may be utilized differently based on level of expertise.
机译：临床推理取决于工作记忆（WM）。更准确地说，在临床推理过程中，将长期记忆中存储的信息带入WM，以促进内部审议，从而使临床医生能够通过案例进行推理。在本研究中，我们研究了参与者通过功能性磁共振成像（fMRI）阅读临床病例时的临床推理与WM之间的关系。更具体地说，我们在推理过程中研究了临床病例难易程度（易，难）和临床医生的专业知识水平（2年制医学生，高级胃肠病医师）对与WM相关的皮层（即前额叶皮层）内神经活动的影响。处理。 fMRI被用于扫描十名二年级医学生和十名执业肠胃病学家，同时他们在一个1小时的扫描过程中对16例临床病例进行了推理[8个简单（简单）和8个复杂（困难）]。组内分析对比了简单案例和困难案例，随后将其用于组间分析以检查专业知识的影响（新手>专家，专家>新手）。阅读临床病例在两组的枕骨，额叶前，顶叶和颞皮质区域引起多种神经激活。重要的是，对于容易和困难的临床病例，新手在前额叶皮层中的激活都增加，这表明在临床推理过程中，新手比专家更充分地利用WM。我们发现临床专家水平在临床推理过程中引起与WM相关的人类前额叶皮层区域的差异激活。这表明临床推理与人类WM之间存在重要关系。因此，我们建议在未来的临床推理模型中考虑到WM的使用在所有临床推理任务中均不一致，并且记忆结构可能会因专业水平而有所不同。

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