A Multidisciplinary Study on Brain-based Experience-knowledge Model for Experts Decision making

Abstract

With social development, societies have changed to knowledge-centered societies requiring highly specialized knowledge, and the importance of the role of experts has increased. Especially, the expertise of clinical experts is very important since it improves the quality of medical services provided to patients and promotes the overall national health. Therefore, this study analyzed the characteristics of the decision-making process employed by clinical experts and confirmed experts' EEG characteristics by measuring their cerebral activity during clinical decision making. In other words, this study developed a model of experts' experiential knowledge in decision making in order to improve clinical experts' decision-making process. Experts' EEG characteristics, which influence complex clinical decision making processes, were analyzed, and a brain-based learning strategy to improve experts' clinical decision making was proposed based on this. <br/> In this study, experts were defined as those who have been continuously working in clinical dentistry for 10 years or more and can effectively solve problems in clinical decision making. This study was performed in the following two projects in order to develop a brain-based model of experts' experiential knowledge: (1) The first study is a qualitative study of clinical decision making in a clinical scenario. (2) The second study is an analysis of differences in cortical activity of experts and novices through EEG. <br/> In the 1st study, this study was analyzed a process of clinical decision making in experts and novices: First, in order to investigate experts' and novices' basic characteristics, preliminary surveys were conducted with questionnaires assessing their decision making type and preference for left and right brains. After investigating the basic characteristics based on preliminary type analyses, a commonly encountered patient case was developed with the help of dentists, and all participants were asked to proceed with clinical treatment of the case, in order to confirm the differences in the characteristics of the experts and novices in clinical decision making. The differences between the two groups were analyzed through thematic analysis performed via video analysis and the think-aloud method. This study found that the experts preferred using both brains (used right and left brains) and made reasonable decisions. Moreover, when their clinical decision making processes were observed in a real-life clinical situation comprising three main steps, the experts started categorizing the patient's chief complaints through their existing knowledge while being open to various possibilities at the 'identify patient's goal' stage. They also started collecting their information based on the evidence given by the patient, established possible hypotheses, and asked questions and proceeded with tests that were consistent with the hypotheses. However, the novices proceeded with questions and tests according to pre-determined protocols. Second, at the 'analysis of information' step, the experts established their hypotheses after oral examination & radiograph reading and selectively performed tests based on them. On the contrary, the novices proceeded with their clinical decision making by confirming facts according to the pre-learned test protocols. Third, at the diagnosis step, the experts carefully confirmed their diagnosis but proceeded quickly once they have made a diagnosis. The experts also stayed open to other possibilities at this step as well. In contrast, the novices rolled out one diagnosis at a time from the diagnosis procedure and steps they knew until they made their diagnosis. Therefore, 'confirmation of the patient's chief complaints', 'oral examination', and 'radiography reading' steps, which showed the most prominent differences in the experts' and novices' decision making, were set as the major steps of dental experts' clinical decision making. <br/> In the 2nd study, the three major steps established through the experiment conducted under an environment simulating the actual clinical environment were developed further into tasks to measure brain waves in the experts and novices. 'Confirmation of the patient's chief complaints', 'oral examination', and 'radiography reading' steps were developed into six tasks, and the experts' and novices' cortical activities were measured through a 32-channel EEG. The data measured during the six tasks were pre-processed to statistically analyze the differences between the groups. As a result, the two groups did not differ in the background signals measured in a relaxed state with the eyes closed and during the first task (confirmation of the patient's chief complaints), the novices had higher activities in the left frontal lobe, occipital lobe, and parietal lobe than the experts at the steps where oral examination & radiography reading. After EEG measurement, the accuracy of the participants' diagnoses made to investigate their clinical decision making was analyzed in order to measure the difficulty of each task. In task 6 (oral examination data), which was difficult and had the lowest accuracy of diagnoses made by the experts, the brain activities in both groups were higher than in other tasks