The brain on expert medical performance: a systematic review and activation likelihood estimation functional magentic...

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.