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Title: Even a little sleepiness influences neural activation and clinical reasoning in novices
Authors: Cleland, Jennifer
Gates, Laura J.
Waiter, Gordon D.
Ho, Vincent B.
Schuwirth, Lambert
Durning, Steven
Keywords: Science::Medicine
Issue Date: 2021
Source: Cleland, J., Gates, L. J., Waiter, G. D., Ho, V. B., Schuwirth, L. & Durning, S. (2021). Even a little sleepiness influences neural activation and clinical reasoning in novices. Health Science Reports, 4(4), e406-.
Journal: Health Science Reports 
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 <.05) during reflection (Phase 3) associated with increased self-reported sleepiness (ESS) immediately before scanning. Covariate analysis also revealed that increased BOLD signal in the right supramarginal gyrus (P <.05) when reflecting (Phase 3) was associated with increased correct answer response time. Both patterns indicate effortful analytic (System 2) reasoning. 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.
ISSN: 2398-8835
DOI: 10.1002/hsr2.406
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Rights: © 2021 The Authors. Health Science Reports published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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