Even a little sleepiness influences neural activation and clinical reasoning in novices

Jennifer Cleland; Laura J. Gates; Gordon D. Waiter; Vincent B. Ho; Lambert Schuwirth; Steven Durning

doi:10.1002/hsr2.406

Even a little sleepiness influences neural activation and clinical reasoning in novices

Jennifer Cleland^*, Laura J. Gates, Gordon D. Waiter, Vincent B. Ho, Lambert Schuwirth, Steven Durning

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background and aims
Sleepiness influences alertness and cognitive functioning and impacts many aspects of medical care, including clinical reasoning. However, dual processing theory suggests that sleepiness will impact clinical reasoning differently in different individual, depending on their level of experience with the given condition. Our aim, therefore, was to examine the association between clinical reasoning, neuroanatomical activation, and sleepiness in senior medical students.

Methods
Our methodology replicated an earlier study but with novices rather than board-certified physicians. Eighteen final-year medical students answered validated multiple-choice questions (MCQs) during an fMRI scan. Each MCQ was projected in three phases: reading, answering, and reflection (modified think aloud). Echo-planar imaging (EPI) scans gave a time series that reflected blood oxygenation level dependent (BOLD) signal in each location (voxel) within the brain. Sleep data were collected via self-report (Epworth Sleepiness Scale) and actigraphy. These data were correlated with answer accuracy using Pearson correlation.

Results
Analysis revealed an increased BOLD signal in the right dorsomedial prefrontal cortex (P
Conclusion
Our findings that novices use System 2 thinking for clinical reasoning and even a little (perceived) sleepiness influences their clinical reasoning ability to suggest that the parameters for safe working may be different for novices (eg, junior doctors) and experienced physicians.

Original language	English
Article number	e406
Number of pages	9
Journal	Health Science Reports
Volume	4
Issue number	4
Early online date	3 Nov 2021
DOIs	https://doi.org/10.1002/hsr2.406
Publication status	Published - 1 Dec 2021

Bibliographical note

Acknowledgements:
We thank the students who took part in this project, and the Institute of Education for Medical and Dental Sciences, University of Aberdeen, for supporting this project. We thank the American College of Physicians for the questions used in this study. We thank Professor Susan Jamieson, University of Glasgow, for her support at the stage of seeking funding for this work.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Keywords

clinical reasoning
fMRI
medical students
sleepiness

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Cite this

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abstract = "Background and aimsSleepiness influences alertness and cognitive functioning and impacts many aspects of medical care, including clinical reasoning. However, dual processing theory suggests that sleepiness will impact clinical reasoning differently in different individual, depending on their level of experience with the given condition. Our aim, therefore, was to examine the association between clinical reasoning, neuroanatomical activation, and sleepiness in senior medical students.MethodsOur methodology replicated an earlier study but with novices rather than board-certified physicians. Eighteen final-year medical students answered validated multiple-choice questions (MCQs) during an fMRI scan. Each MCQ was projected in three phases: reading, answering, and reflection (modified think aloud). Echo-planar imaging (EPI) scans gave a time series that reflected blood oxygenation level dependent (BOLD) signal in each location (voxel) within the brain. Sleep data were collected via self-report (Epworth Sleepiness Scale) and actigraphy. These data were correlated with answer accuracy using Pearson correlation.ResultsAnalysis revealed an increased BOLD signal in the right dorsomedial prefrontal cortex (P ConclusionOur findings that novices use System 2 thinking for clinical reasoning and even a little (perceived) sleepiness influences their clinical reasoning ability to suggest that the parameters for safe working may be different for novices (eg, junior doctors) and experienced physicians.",

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note = "Acknowledgements: We thank the students who took part in this project, and the Institute of Education for Medical and Dental Sciences, University of Aberdeen, for supporting this project. We thank the American College of Physicians for the questions used in this study. We thank Professor Susan Jamieson, University of Glasgow, for her support at the stage of seeking funding for this work.",

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N2 - Background and aimsSleepiness influences alertness and cognitive functioning and impacts many aspects of medical care, including clinical reasoning. However, dual processing theory suggests that sleepiness will impact clinical reasoning differently in different individual, depending on their level of experience with the given condition. Our aim, therefore, was to examine the association between clinical reasoning, neuroanatomical activation, and sleepiness in senior medical students.MethodsOur methodology replicated an earlier study but with novices rather than board-certified physicians. Eighteen final-year medical students answered validated multiple-choice questions (MCQs) during an fMRI scan. Each MCQ was projected in three phases: reading, answering, and reflection (modified think aloud). Echo-planar imaging (EPI) scans gave a time series that reflected blood oxygenation level dependent (BOLD) signal in each location (voxel) within the brain. Sleep data were collected via self-report (Epworth Sleepiness Scale) and actigraphy. These data were correlated with answer accuracy using Pearson correlation.ResultsAnalysis revealed an increased BOLD signal in the right dorsomedial prefrontal cortex (P ConclusionOur findings that novices use System 2 thinking for clinical reasoning and even a little (perceived) sleepiness influences their clinical reasoning ability to suggest that the parameters for safe working may be different for novices (eg, junior doctors) and experienced physicians.

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Even a little sleepiness influences neural activation and clinical reasoning in novices

Abstract

Bibliographical note

Data Availability Statement

Keywords

Access to Document

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Aberdeen Biomedical Imaging Centre

Cite this

Even a little sleepiness influences neural activation and clinical reasoning in novices

Abstract

Bibliographical note

Data Availability Statement

Keywords

Access to Document

Other files and links

Fingerprint

Equipment

Aberdeen Biomedical Imaging Centre

Cite this