title: Neural basis of nonanalytical reasoning expertise during clinical evaluation.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  These findings reveal a multinetwork system that supports the dual-process mode of expert clinical reasoning during medical evaluation.
authors: Department of Medicine, Uniformed Services University of the Health Sciences 4301 Jones Bridge Road, Bethesda, Maryland, 20814.
authors: Steven J
authors: SJ
authors: Durning
authors: Department of Medicine, Uniformed Services University of the Health Sciences 4301 Jones Bridge Road, Bethesda, Maryland, 20814.
authors: Michelle E
authors: ME
authors: Costanzo
authors: Department of Medicine, Uniformed Services University of the Health Sciences 4301 Jones Bridge Road, Bethesda, Maryland, 20814.
authors: Anthony R
authors: AR
authors: Artino
authors: National Intrepid Center of Excellence, Walter Reed National Military Medical Center 8901 Wisconsin Avenue, Bldg 51, Bethesda, Maryland, 20889.
authors: John
authors: J
authors: Graner
authors: Department of Educational Development and Research, Maastricht University 6200 MD, Maastricht, The Netherlands.
authors: Cees
authors: C
authors: van der Vleuten
authors: Mayo Clinic, Division of General Internal Medicine, Department of Internal Medicine, College of Medicine Rochester, Minnesota, 55905.
authors: Thomas J
authors: TJ
authors: Beckman
authors: Mayo Clinic, Division of General Internal Medicine, Department of Internal Medicine, College of Medicine Rochester, Minnesota, 55905.
authors: Christopher M
authors: CM
authors: Wittich
authors: Department of Medicine, Uniformed Services University of the Health Sciences 4301 Jones Bridge Road, Bethesda, Maryland, 20814.
authors: Michael J
authors: MJ
authors: Roy
authors: American Board of Internal Medicine 510 Walnut Street, Suite 1700, Philadelphia, Pennsylvania, 19106-3699, USA.
authors: Eric S
authors: ES
authors: Holmboe
authors: Flinders University, School of Medicine GPO Box 2100, Adelaide, 5001, South Australia, Australia.
authors: Lambert
authors: L
authors: Schuwirth
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003657:Decision Making; D004501:Education, Medical; D006801:Humans; D007388:Internal Medicine / Q000193:education / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009415:Nerve Net / Q000502:physiology*; D005791:Patient Care; D010820:Physicians / Q000523:psychology / Q000592:standards; D017397:Prefrontal Cortex / Q000502:physiology*; D011340:Problem Solving; D011582:Psychological Theory; D013337:Students, Medical / Q000523:psychology*; D013850:Thinking
keywords: Dual-process theory; expertise; functional MRI; medical education; neural efficiency; nonanalytical reasoning