Cognitive Neuroscience Foundations of Surgical and Procedural Expertise: Focus on Theory

This chapter describes the cognitive processes and associated neuroscientific manifestations of expertise in surgery and other specialties where procedural acumen encompasses a component of expertise, and considers the processes by which health professions’ educators may leverage this knowledge to support the development of expertise in procedural domains. Three primary dimensions of procedural performance are considered, including perceptual expertise (the ability to accurately recognize and differentiate patterns from perceptual inputs), cognitive expertise (the ability to accurately interpret, differentiate, and render decisions in complex environments), and psychomotor expertise (the ability to anticipate and execute accurate motor responses). The foundational elements of expertise are embedded in long-term memory, and the development of expertise requires significant investment by individuals to rigorously engage in the content domain for significant periods of time. Once acquired, expertise appears to be effortless; however, neuroscience confirms that experts’ brains are highly stimulated; they are simply stimulated in different areas than novices, because they have developed different strategies for working within their expertise domain. Importantly, expertise in one domain does not transfer to another domain, primarily because of the very neuroscientific mechanisms by which expertise is developed. If domain patterns alter (e.g., open surgical procedures become laparoscopic procedures), expertise may need to be reacquired to accommodate the changes in the performance domain.