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Clinical decision-making augmented by simulation training: neural correlates demonstrated by functional imaging: a

S S H Goon¹, E A Stamatakis, R M Adapa

¹University Division of Anaesthesia, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.

British Journal of Anaesthesia

|September 26, 2013

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Simulation training may reduce stress responses during clinical decision-making compared to online training. This neuroimaging study found distinct brain activation patterns, suggesting simulation benefits for medical students.

Area of Science:

Neuroscience
Medical Education
Cognitive Science

Background:

Understanding the neuroanatomical basis of clinical decision-making is crucial.
Investigating differences between online and simulation training can reveal simulation's benefits.

Purpose of the Study:

To explore neural correlates of clinical decision-making.
To determine if simulation versus online training impacts these neural correlates.

Main Methods:

Pilot prospective parallel group cohort study with 12 third-year medical students.
Randomization into simulation-based or online-based anaphylaxis training groups.
Functional magnetic resonance imaging (fMRI) during clinical and non-clinical question answering, alongside physiological and performance measures.

Keywords:

computer simulation; magnetic resonance imaging, functional; stress, psychological

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Main Results:

Significant activation in the ventral anterior cingulate cortex and medial prefrontal cortex when comparing clinical to non-clinical questions.
These areas activated in the online group for training-related questions, but not in the simulation group.
The simulation group showed a trend towards faster and more accurate MCQ performance, though not statistically significant.

Conclusions:

Observed brain activation may indicate heightened stress responses to clinical questions, particularly in the online training group.
Simulation training appears to attenuate neural responses associated with stress during clinical decision-making.
Findings suggest simulation training may offer a neurobiological advantage in preparing medical students for clinical scenarios.