Expertise Related Changes in Resting-State Functional Connectivity Patterns Following a Clinical Reasoning and Decision-Making Task.

PURPOSE: This study investigated the behavioral and resting-state neural correlates of clinical decision-making among expert gastroenterologists and novice medical students, aiming to understand how diagnostic expertise is reflected in either pre-task and/or post-task brain activity. METHOD: Participants completed a clinical decision-making task while behavioral measures (accuracy and response time) were recorded. Resting-state fMRI data were acquired immediately before and following the task. Group differences in brain connectivity were analyzed using seed-based connectivity and multivariate partial least squares (PLS) analyses, focusing on the frontopolar prefrontal cortex (FPPFC) and its associated networks. FINDING: Experts outperformed novices in diagnostic accuracy and speed, especially on "easy" cases, suggesting enhanced cognitive efficiency. Experts also showed more pronounced response time variation with task difficulty, potentially reflecting strategic modulation. Resting-state fMRI revealed that experts had increased post-task connectivity between the FPPFC and the paracingulate gyrus (PaCG), a brain area associated with the executive control network. Novices, by contrast, showed stronger FPPFC connectivity with the posterior cingulate cortex (PCC), part of the default mode network (DMN), indicating a return to internally directed cognition. PLS analyses further revealed that experts engaged executive and attentional network regions post-task, while novices primarily activated DMN regions. Notably, for the expert group only, increased brain activity in attention-related regions was associated with gastroenterologists who had slower, deliberate responses on easy cases. CONCLUSION: Clinical expertise is associated with sustained engagement of goal-directed neural networks after task completion, potentially reflecting ongoing cognitive evaluation or preparation. In contrast, novices appear to disengage more readily, reverting to self-referential thought. These findings highlight distinct neural mechanisms that may support the development of diagnostic expertise.