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Neural correlates of effective learning in experienced medical decision-makers.

Downar, J; Bhatt, M; Montague, PR; (2011) Neural correlates of effective learning in experienced medical decision-makers. PLoS One , 6 (11) , Article e27768. 10.1371/journal.pone.0027768. Green open access

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Abstract

Accurate associative learning is often hindered by confirmation bias and success-chasing, which together can conspire to produce or solidify false beliefs in the decision-maker. We performed functional magnetic resonance imaging in 35 experienced physicians, while they learned to choose between two treatments in a series of virtual patient encounters. We estimated a learning model for each subject based on their observed behavior and this model divided clearly into high performers and low performers. The high performers showed small, but equal learning rates for both successes (positive outcomes) and failures (no response to the drug). In contrast, low performers showed very large and asymmetric learning rates, learning significantly more from successes than failures; a tendency that led to sub-optimal treatment choices. Consistently with these behavioral findings, high performers showed larger, more sustained BOLD responses to failed vs. successful outcomes in the dorsolateral prefrontal cortex and inferior parietal lobule while low performers displayed the opposite response profile. Furthermore, participants' learning asymmetry correlated with anticipatory activation in the nucleus accumbens at trial onset, well before outcome presentation. Subjects with anticipatory activation in the nucleus accumbens showed more success-chasing during learning. These results suggest that high performers' brains achieve better outcomes by attending to informative failures during training, rather than chasing the reward value of successes. The differential brain activations between high and low performers could potentially be developed into biomarkers to identify efficient learners on novel decision tasks, in medical or other contexts.

Type: Article
Title: Neural correlates of effective learning in experienced medical decision-makers.
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1371/journal.pone.0027768
Publisher version: http://dx.doi.org/10.1371/journal.pone.0027768
Language: English
Additional information: © 2011 Downar et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This research was funded by the following grants: National Institutes of Health grant # 1 RC4 AG039067, National Institutes of Health grant # R01 DA11723-02, National Institutes of Health grant # 2R01 MH085496-05A2 The Kane Foundation Fellowship. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.
Keywords: Behavior, Brain Mapping, Decision Making, Female, Humans, Learning, Magnetic Resonance Imaging, Male, Middle Aged, Models, Neurological, Neostriatum, Nervous System Physiological Phenomena, Physicians, Task Performance and Analysis, Treatment Failure
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
URI: https://discovery.ucl.ac.uk/id/eprint/1378410
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