Neural basis of nonanalytical reasoning expertise during clinical evaluation

S.J. Durning, Michelle Costanzo, Anthony Artino, John Graner, Cees van der Vleuten, Thomas Beckman, Christopher Wittich, Michael Roy, Eric Holmboe, Lambertus Schuwirth

    Research output: Contribution to journalArticlepeer-review

    10 Citations (Scopus)


    Introduction: 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.

    Original languageEnglish
    Pages (from-to)10
    Number of pages10
    JournalBrain and Behavior
    Issue number3
    Publication statusPublished - 1 Mar 2015


    • Dual-process theory
    • Expertise
    • Functional MRI
    • Medical education
    • Neural efficiency
    • Nonanalytical reasoning


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