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Updated: Jan 14, 2026

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Expertise Related Changes in Resting-State Functional Connectivity Patterns Following a Clinical Reasoning and

Filomeno Cortese1,2, Pamela Hruska3, Kevin J McLaughlin4

  • 1Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Brain and Behavior
|January 13, 2026
PubMed
Summary
This summary is machine-generated.

Expert gastroenterologists maintain active brain networks post-task, unlike novices who revert to self-referential thought. This shows distinct neural mechanisms supporting diagnostic expertise development.

Keywords:
clinical reasoningexpertisefunctional magnetic resonance imagingresting‐stateunivariate and multivariate analyses

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Area of Science:

  • Neuroscience
  • Cognitive Science
  • Medical Education

Background:

  • Diagnostic expertise in medicine is crucial for effective patient care.
  • Understanding the neural underpinnings of clinical decision-making can inform training strategies.
  • Expertise is thought to involve distinct cognitive and neural processes compared to novice performance.

Purpose of the Study:

  • To investigate the behavioral and neural correlates of clinical decision-making in expert gastroenterologists versus novice medical students.
  • To determine how diagnostic expertise is reflected in brain activity before and after a decision-making task.
  • To identify differences in brain connectivity associated with expertise.

Main Methods:

  • Participants completed a clinical decision-making task with behavioral measures (accuracy, response time).
  • Resting-state fMRI was acquired immediately before and after the task.
  • Seed-based connectivity and partial least squares (PLS) analyses focused on the frontopolar prefrontal cortex (FPPFC) network.

Main Results:

  • Experts demonstrated superior accuracy and speed, particularly on easier cases, indicating enhanced cognitive efficiency.
  • Post-task, experts showed increased FPPFC connectivity with the paracingulate gyrus (executive control network), while novices connected with the posterior cingulate cortex (default mode network).
  • PLS analysis revealed experts engaged executive/attentional networks post-task, whereas novices activated default mode network regions.

Conclusions:

  • Clinical expertise is linked to sustained engagement of goal-directed neural networks post-task, suggesting ongoing cognitive evaluation.
  • Novices tend to disengage from the task and revert to internally directed thought processes.
  • Distinct neural mechanisms underlie the development and maintenance of diagnostic expertise.