Brain imaging, behavior research reveals physicians learn more by paying attention to failure
When seeking a physician, you should look for one with experience. Right? Maybe not. Research on physicians' decision-making processes has revealed that those who pay attention to failures as well as successes become more adept at selecting the correct treatment.
"We found that all the physicians in the study included irrelevant criteria in their decisions," said Read Montague, Ph.D., director of the Human Neuroimaging Laboratory at the Virginia Tech Carilion Research Institute, who led the study. "Notably, however, the most experienced doctors were the poorest learners."
The research is published in the Nov. 23 issue of PLoS One, the Public Library of Science open-access journal, in the article, "Neural correlates of effective learning in experienced medical decision-makers," by Jonathan Downar, M.D., Ph.D., assistant professor of psychiatry at the University of Toronto and Toronto Western Hospital; Meghana Bhatt, Ph.D., assistant research professor at Beckman Research Institute, the City of Hope Hospital, Duarte, Calif.; and Montague, who is also a professor of physics in the College of Science at Virginia Tech.
The doctors were instructed to select between two treatments for a series of simulated patients in an emergency room setting. "First they had a chance to learn by experience which of two medications worked better in a series of 64 simulated heart-attack patients, based on a simplified history with just six factors," said Bhatt.
Unknown to the test subjects, of the six factors, only one was actually relevant to the decision: diabetes status. One medication had a 75 percent success rate in patients with diabetes, but only a 25 percent success rate in patients without diabetes. The other had the opposite profile. The physicians had 10 seconds to select a treatment. Then they were briefly presented with an outcome of "SUCCESS: (heart attack) aborted" or "FAILURE: No response."
"After the training, we tested the physicians to see how often they were able to pick the better drug in a second series of 64 simulated patients," said Bhatt. "When we looked at their performance, the doctors separated into two distinct groups. One group learned very effectively from experience, and chose the better drug more than 75 percent of the time. The other group was terrible; they chose the better drug only at coin-flipping levels of accuracy, or half the time, and they also came up with inaccurate systems for deciding how to prescribe the medications, based on factors that didn't matter at all."
In fact, all the doctors reported including at least one of the five irrelevant factors, such as age or previous heart attack, in their decision process.
"The brain imaging showed us a clear difference in the mental processes of the two groups," said Montague. "The high performers activated their frontal lobes when things didn't go as expected and the treatments failed." Such activity showed that the doctors learned from their failures, he said. These physicians gradually improved their performance.
In contrast, the low performers activated their frontal lobes when things did go as expected, said Bhatt. "In other words, they succumbed to 'confirmation bias,' ignoring failures and learning only from the successful cases. Each success confirmed what the low performers falsely thought they already knew about which treatment was better." The researchers termed this counterproductive learning pattern "success-chasing."
"The problem with remembering successes and ignoring failures is that it doesn't leave us any way to abandon our faulty ideas. Instead, the ideas gain strength from each chance success, until they evolve into something like a superstition," said Downar.
The fMRI showed that a portion of the brain called the nucleus accumbens "showed significant anticipatory activation well before the outcome of the trial was revealed, and this anticipatory activation was significantly greater prior to successful outcomes," Montague said. "Based on the outcome of the training phase, we were actually able to predict results in the testing phase for each low-performing subject's final set of spurious treatment rules."
The authors state in the article that the formation of spurious beliefs is universal, such as an athlete's belief in a lucky hat. "But the good news is that physicians can probably be trained to think more like the high performers," said Downar. "I tell my students to remember three things: First, when you're trying to work out a diagnosis, remember to also ask the questions that would prove your hunches wrong. Second, when you think you have the answer, think again and go through the possible alternatives. Third, if the treatment isn't going as expected, don't just brush it off ask yourself what you could have missed."
"These findings underscore the dangers of disregarding past failures when making high-stakes decisions," said Montague. "'Success-chasing' not only can lead doctors to make flawed decisions in diagnosing and treating patients, but it can also distort the thinking of other high-stakes decision-makers, such as military and political strategists, stock market investors, and venture capitalists."
More information: Downar J, Bhatt M, Montague PR (2011) Neural Correlates of Effective Learning in Experienced Medical Decision-Makers. PLoS ONE 6(11): e27768.doi:10.1371/journal.pone.0027768 . dx.plos.org/10.137… pone.0027768
Provided by Virginia Tech
- Functional MRI shows how mindfulness meditation changes decision-making process Apr 20, 2011 | not rated yet | 0
- Dopamine release in human brain tracked at microsecond timescale reveals decision-making Oct 28, 2011 | not rated yet | 0
- Researchers develop tool that saves time, eliminates mistakes in diabetes care Nov 18, 2011 | not rated yet | 0
- Improving anxiety treatment through the help of brain imaging: A potential future treatment strategy May 08, 2008 | not rated yet | 0
- Numerous factors weighed when patients cannot make their own decisions Mar 22, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
(AP)—A woman who lost both hands, her left leg and right foot after contracting a flesh-eating disease has been fitted with prosthetic hands.
Other 3 hours ago | not rated yet | 0
(AP)—Medical marijuana use in Illinois is now in Gov. Pat Quinn's hands after the state Senate approved legislation.
Other 14 hours ago | 5 / 5 (1) | 0
A Nigerian court on Friday sentenced two officials from a pharmaceutical company to seven years in prison over the sale of an adulterated teething drug which killed 84 babies in 2008.
Other 15 hours ago | not rated yet | 0
(HealthDay)—Many Americans feel that keeping out-of-pocket health care costs is more important than staying with the same primary care physician.
Other 16 hours ago | not rated yet | 0
(AP)—China is phasing out its reliance on executed prisoners for donated organs, but an architect of the country's transplant system said Friday that ingrained cultural attitudes are impeding the rise of ...
Other 19 hours ago | not rated yet | 0
Big names in medicine are set to give an upbeat assessment of the war on AIDS on Tuesday, 30 years after French researchers identified the virus that causes the disease.
2 hours ago | not rated yet | 0
The neural machinery underlying our olfactory sense continues to be an enigma for neuroscience. A recent review in Neuron seeks to expand traditional ideas about how neurons in the olfactory bulb might encode information about ...
14 hours ago | not rated yet | 0 |
(Medical Xpress)—What if the quality of your work depends more on your focus on the piano keys or canvas or laptop than your musical or painting or computing skills? If target users can be convinced, they ...
15 hours ago | 3.7 / 5 (3) | 0 |
For combat veterans suffering from post-traumatic stress disorder, 'fear circuitry' in the brain never rests
Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or ...
3 hours ago | not rated yet | 0 |
In 2008 researchers from the University of Southern Denmark showed that the drug thioridazine, which has previously been used to treat schizophrenia, is also a powerful weapon against antibiotic-resistant bacteria such as ...
12 hours ago | 3.7 / 5 (3) | 0 |
(Medical Xpress)—Working with lab mice models of multiple sclerosis (MS), UC Davis scientists have detected a novel molecular target for the design of drugs that could be safer and more effective than current FDA-approved ...
12 hours ago | 5 / 5 (2) | 0 |