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"Contemplating the next maneuver": functional neuroimaging reveals intraoperative decision-making strategies
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Title: | "Contemplating the next maneuver": functional neuroimaging reveals intraoperative decision-making strategies |
Authors: | Leff, DR Yongue, G Vlaev, I Orihuela-Espina, F James, D Taylor, MJ Athanasiou, T Dolan, R Yang, GZ Darzi, A |
Item Type: | Journal Article |
Abstract: | OBJECTIVE: To investigate differences in the quality, confidence, and consistency of intraoperative surgical decision making (DM) and using functional neuroimaging expose decision systems that operators use. SUMMARY BACKGROUND DATA: Novices are hypothesized to use conscious analysis (effortful DM) leading to activation across the dorsolateral prefrontal cortex, whereas experts are expected to use unconscious automation (habitual DM) in which decisions are recognition-primed and prefrontal cortex independent. METHODS: A total of 22 subjects (10 medical student novices, 7 residents, and 5 attendings) reviewed simulated laparoscopic cholecystectomy videos, determined the next safest operative maneuver upon video termination (10 s), and reported decision confidence. Video paradigms either declared ("primed") or withheld ("unprimed") the next operative maneuver. Simultaneously, changes in cortical oxygenated hemoglobin and deoxygenated hemoglobin inferring prefrontal activation were recorded using Optical Topography. Decision confidence, consistency (primed vs unprimed), and quality (script concordance) were assessed. RESULTS: Attendings and residents were significantly more certain (P < 0.001), and decision quality was superior (script concordance: attendings = 90%, residents = 78.3%, and novices = 53.3%). Decision consistency was significantly superior in experts (P < 0.001) and residents (P < 0.05) than novices (P = 0.183). During unprimed DM, novices showed significant activation of the dorsolateral prefrontal cortex, whereas this activation pattern was not observed among residents and attendings. During primed DM, significant activation was not observed in any group. CONCLUSIONS: Expert DM is characterized by improved quality, consistency, and confidence. The findings imply attendings use a habitual decision system, whereas novices use an effortful approach under uncertainty. In the presence of operative cues (primes), novices disengage the prefrontal cortex and seem to accept the observed operative decision as correct. |
Issue Date: | 1-Feb-2017 |
Date of Acceptance: | 1-Feb-2017 |
URI: | http://hdl.handle.net/10044/1/29057 |
DOI: | 10.1097/SLA.0000000000001651 |
ISSN: | 1528-1140 |
Publisher: | Lippincott, Williams & Wilkins |
Start Page: | 320 |
End Page: | 330 |
Journal / Book Title: | Annals of Surgery |
Volume: | 265 |
Issue: | 2 |
Replaces: | 10044/1/45337 http://hdl.handle.net/10044/1/45337 |
Copyright Statement: | © 2016 Wolters Kluwer Health, Inc. All rights reserved. |
Sponsor/Funder: | The Academy of Medical Sciences National Institute for Health Research Engineering & Physical Science Research Council (EPSRC) Engineering & Physical Science Research Council (EPSRC) National Institute of Health Research |
Funder's Grant Number: | Dan Leff Starter Grant NF-SI-0510-10186 EP/N027132/1 EP/J021199/1 |
Keywords: | Science & Technology Life Sciences & Biomedicine Surgery brain decision making functional near-infrared spectroscopy prefrontal simulation surgery training BILE-DUCT INJURIES LAPAROSCOPIC CHOLECYSTECTOMY OPERATING-ROOM SURGEONS BRAIN UNCERTAINTY PERFORMANCE ACTIVATION CORTEX RISK Adult Cholecystectomy, Laparoscopic Decision Making Female Functional Neuroimaging Humans Intraoperative Period Male Middle Aged Prefrontal Cortex Students, Medical Surgeons Video Recording Prefrontal Cortex Humans Cholecystectomy, Laparoscopic Intraoperative Period Decision Making Students, Medical Video Recording Adult Middle Aged Female Male Functional Neuroimaging Surgeons Surgery 11 Medical and Health Sciences |
Publication Status: | Published |
Conference Place: | United States |
Appears in Collections: | Department of Surgery and Cancer Institute of Global Health Innovation Faculty of Engineering |