Abstract
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.
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References
Anderson, S. J., Hecker, K. G., Krigolson, O. E., & Jamniczky, H. A. (2018). A reinforcement-based learning paradigm increases anatomical learning and retention-a neuroeducation study. Frontiers Human Neuroscience, 12, 38. https://doi.org/10.3389/fnhum.2018.00038
Anderson, S. J., Jamniczky, H. A., Krigolson, O. E., Coderre, S. P., & Hecker, K. G. (2019). Quantifying two-dimensional and three-dimensional stereoscopic learning in anatomy using electroencephalography. Nature Partner Journal: Science of Learning, 4, 10. https://doi.org/10.1038/s41539-019-0050-4
Bilalic, M., Grottenthaler, T., Nagele, T., & Lindig, T. (2016). The faces in radiological images: Fusiform face area supports radiological expertise. Cerebral Cortex, 26(3), 1004–1014.
Brainard, D. H. (1997). The psychophysics toolbox. Spatial Vision, 10(4), 433–436.
Ciechanski, P., Kirton, A., Wilson, B., Williams, C. C., Anderson, S. J., Cheng, A., Lopushinsky, S., & Hecker, K. G. (2019). Electroencephalography correlates of transcranial direct-current stimulation enhanced surgical skill learning: A replication and extension study. Brain Research. https://doi.org/10.1016/j.brainres.2019.146445
Crewther, B. T., Shetty, K., Jarchi, D., Selvadurai, S., Cook, C. J., Leff, D. R., Darzi, A., & Yang, G. Z. (2016). Skill acquisition and stress adaptations following laparoscopic surgery training and detraining in novice surgeons. Surgical Endoscopy, 30(7), 2961–2968.
David Thompson Foundation (2021). Noah’s Arkive: Davis-Thompson Foundation. Retrieved November 30, 2021, from: https://davisthompsonfoundation.org/noahs-arkive/
Durning, S. J., Costanzo, M. E., Artino, A. R., Graner, J., van der Vleuten, C., Beckman, T. J., Wittich, C. M., Roy, M. J., Holmboe, E. S., & Schuwirth, L. (2015). Neural basis of nonanlytical reasoning expertise during clinical evaluation. Brain and Behavior, 5(3), e00309.
Ericsson, K. A., & Harwell, K. W. (2019). Deliberate practice and proposed limits on the effects of practice on the acquisition of expert performance: Why the original definition matters and recommendations for future research. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2019.02396
Gao, Y., Cavuoto, L., Dutta, A., Kruger, U., Yan, P., Nemani, A., Norfleet, J. E., Makled, B. A., Silvestri, J., Schwaitzberg, S., Intes, X., & De, S. (2021). Decreasing the surgical errors by neurostimulation of primary motor cortex and the associated brain activation via Neuroimaging. Frontiers in Neuroscience, 15, 651192. https://doi.org/10.3389/fnins.2021.651192
Hruska, P., Hecker, K. G., Coderre, S., McLaughlin, K., Cortese, F., Doig, C., Beran, T., Wright, B., & Krigolson, O. (2016b). Hemispheric differences in novices and experts during decision making. Advances in Health Sciences Education. https://doi.org/10.1007/s10459-015-9648-3
Hruska, P., Krigolson, O., Coderre, S., McLaughlin, K., Cortese, F., Doig, C., Beran, T., Wright, B., & Hecker, K. G. (2016a). Working memory, reasoning, and expertise in medicine–insights into their relationship using functional neuroimaging. Advances in Health Sciences Education. https://doi.org/10.1007/s10459-015-9649-2
Jensen, G., Resnik, L., & Haddad, A. (2008) Expertise and clinical reasoning. In Higgs J, Jones M, Loftus S, Christensen N (Eds.), Clinical Reasoning in the Health Professions (3rd ed.) Philadelphia, PA: Butterworth Heinemann Elsevier.
King, J.M. (2021) Dr. John M. Kings’ Necropsy Show and Tell: Cornell College of Veterinary Medicine. Retrived December 1, 2021, from https://secure.vet.cornell.edu/nst/nst.asp.
Krigolson, O. E., Hassall, C. D., & Handy, T. C. (2013). How we learn to make decisions: Rapid propagation of reinforcement learning prediction errors in humans. Journal of Cognitve Neuroscience, 26(3), 635–644.
Krigolson, O. E., Pierce, L. J., Holroyd, C. B., & Tanaka, J. W. (2009). Learning to become an expert: Reinforcement learning and the acquisition of perceptual expertise. Journal of Cognitve Neuroscience, 21(9), 1834–1841.
Levenson, R. M., Krupinski, E. A., Navarro, V. M., & Wasserman, E. A. (2015). Pigeons (Columba livia) as Trainable Observers of Pathology and Radiology Breast Cancer Images. PLoS ONE, 10(11), e0141357.
Luck, S. J. (2014). An Introduction to the Event-related Potential Technique (2nd ed.). MITPress.
Marrs, K. A., & Novak, G. (2004). Just-in-time teaching in biology: Creating an active learner classroom using the internet. Cell Biology Education, 3(1), 49–61.
Novak, G. (2011). Just-in-time teaching. New Directions for Teaching and Learning., 128, 63–73.
Pelli, D. G. (1997). The videotoolbox software for visual psychophysics: Transforming numbers into movies. Spatial Vision, 10(4), 437–442.
Pusic, M., Pecaric, M., & Boutis, K. (2011). How much practice is enough? Using learning curves to assess the deliberate practice of radiograph interpretation. Academic Medicine, 86(6), 731–736.
Rockarts, J., Brewer-Deluce, D., Shali, A., Mohialdin, V., & Wainman, B. (2020). National survey on Canadian undergraduate medical programs: The decline of the anatomical sciences in Canadian medical education. Anatomical Sciences Education, 13(3), 381–389.
Rourke, L., Cruikshank, L. C., Shapke, L., & Singhal, A. (2016). A neural marker of medical visual expertise: Implications for training. Advances in Health Sciences Education, 21(5), 953–966.
Scott, L. S. (2011). Face perception and perceptual expertise in adult and developmental populations. Oxford Handbook of Face Perception., 28, 195–213.
Scott, L. S., Tanaka, J. W., Sheinberg, D. L., & Curran, T. (2006). A reevaluation of the electrophysiological correlates of expert object processing. Journal of Cognitve Neuroscience, 18(9), 1453–1465.
Scott, L. S., Tanaka, J. W., Sheinberg, D. L., & Curran, T. (2008). The role of category learning in the acquisition and retention of perceptual expertise: A behavioral and neurophysiological study. Brain Research, 1210, 204–215.
Tanaka, J. W., & Curran, T. (2001). A neural basis for expert object recognition. Psycholological Science, 12(1), 43–47.
Thompson, J. J., Blair, M. R., & Henrey, A. J. (2014). Over the hill at 24: persistent age-related cognitive-motor decline in reaction times in an ecologically valid video game task begins in early adulthood. PLoS ONE, 9(4), e94215. https://doi.org/10.1371/journal.pone.0094215
Toy, S., Ozsoy, S., Shafiei, S., Antonenko, P., & Schwengel, D. (2023). Using electroencephalography to explore neurocognitive correlates of procedural proficiency: A pilot study to compare experts and novices during simulated endotracheal intubation. Brain and Cognition, 165, 105938. https://doi.org/10.1016/j.bandc.2022.105938
Warren, A. L., & Donnon, T. (2013). Optimizing biomedical science learning in a veterinary curriculum: A review. Journal of Veterinary Medical Education, 40(3), 210–222.
Williams, C. C., Hecker, K. G., Paget, M. K., Coderre, S. P., Burak, K. W., Wright, B., et al. (2017). The application of reward learning in the real world: Changes in the reward positivity amplitude reflect learning in a medical education context. International Journal of Psychophysiology. https://doi.org/10.1016/j.ijpsycho.2017.10.010
Acknowledgements
The authors would like to thank Dr. Martin Pusic and the editors for their thoughtful comments on this manuscript. This work was funded by KGH’s Canada Foundation for Innovation infrastructure grant.
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A.W., S.A. and K.G.H. wrote the manuscript text, S.A. analyzed the neural data and prepared the figures, K.G. H. analyzed the behavioral data. All authors assisted with experimental design and all reviewed the manuscript.
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K.G.H. is also the Chief Assessment Officer for the International Council for Veterinary Medicine.
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Anderson, S.J., Warren, A.L., Abdullayeva, N. et al. Pathologists aren’t pigeons: exploring the neural basis of visual recognition and perceptual expertise in pathology. Adv in Health Sci Educ 28, 1579–1592 (2023). https://doi.org/10.1007/s10459-023-10232-z
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DOI: https://doi.org/10.1007/s10459-023-10232-z