The brain on expert medical performance: a systematic review and activation likelihood estimation functional magentic resonance imaging meta-analysis

Abstract

Healthcare systems require the efficient development of expert performance. Several studies have explored the cognitive foundations of medical expert performance, especially in radiology. Studying at the brain level could provide further insight into specific mechanisms mediating medical expert performance. Researchers have recently begun to systematically employ neuroimaging in this field. Most studies focus on specific specializations rather than identifying shared neural substrates across disciplines. This systematic review and activation likelihood estimation (ALE) meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A total of 297 studies examining neural correlates were identified by comparing expert and novice medical performance. After screening, 22 studies were included in the final analysis. For studies reporting three-dimensional coordinates, ALE meta-analysis revealed consistent involvement of the medial frontal lobe, including the superior frontal gyrus, dorsomedial and ventromedial prefrontal cortex, and inferior frontal and fusiform gyri. Radiology-specific analyses highlighted activation in the ventromedial prefrontal cortex, the left pre-supplementary motor area (pre-SMA), along with the fusiform and opercular inferior frontal gyri. Internal medicine-based studies highlighted involvement of the SMA, inferior frontal gyrus, and dorsomedial prefrontal cortex. Our results revealed involvement, at different levels, of the medial frontal cortex, including the SMA and superior and inferior frontal gyri, which is part of the network relevant for inhibitory control and decision-making. The development of decision-making during the diagnostic process is relevant for the training of future professionals.

Keywords: Medical expert performance; SMA; fMRI; learning; radiology.

Figure 1:

Flowchart of the selection process.

Figure 2:

Forest and funnel plots of the demographic and behavioral results reported in the included studies.

Figure 3:

(a) Pooled ALE meta-analysis maps. ALE map of the resulting clusters for studies on medical expertise. Maps are superimposed on a 2 × 2 × 2 mm MNI template according to neurological convention. The colored bar denotes the corresponding ALE value ranges indicated on the maps (P < 0.0005). (b) Radiology results. ALE maps of the resulting clusters for studies on radiological expertise. The map is superimposed on a 2 × 2 × 2 mm MNI template according to neurological convention. The colored bar denotes the corresponding ALE value ranges indicated on the maps (P < 0.0005). (c) Internal medicine results. ALE maps of the resulting clusters for studies on internal medicine expertise. The map is superimposed on a 2 × 2 × 2 mm MNI template according to neurological convention. The colored bar denotes the corresponding ALE value ranges indicated on the maps (P < 0.0005). Abbreviations: SMA = somatomotor area; SOG = superior occipital gyrus; IFG = inferior frontal gyrus; vmPFC = ventromedial prefrontal cortex; dmPFC = dorsomedial prefrontal cortex.

Figure 4:

(a) ALE meta-analysis maps for task-based and resting-state studies. ALE map of the resulting clusters for the task-based studies. Maps are superimposed on a 2 × 2 × 2 mm MNI template according to neurological convention. The colored bar denotes the corresponding ALE value ranges indicated on the maps (P < 0.0005). (b) Resting-state studies. ALE maps of the resulting clusters for resting-state studies. The map is superimposed on a 2 × 2 × 2 mm MNI template according to neurological convention. The colored bar denotes the corresponding ALE value ranges indicated on the maps (P < 0.0005).