On the journey to measure cognitive expertise: What can functional imaging tell us?

Background: Experience level correlates with motor cortex and supplementary motor area activation during laparoscopy. Whether brain activation patterns correlate with cognitive surgical task expertise is unknown. We compared the functional neuroimaging responses during simulated operative dictation—a cognitive surgical task—by experience level. Study Design: Junior (postgraduate years 1-3) and senior (postgraduate years 4-5) residents and attendings were recruited over 1 year. After a baseline rest period, participants were asked to dictate a simulated operative note for an open inguinal hernia repair with mesh. Functional near-infrared spectroscopy data were recorded from the prefrontal, sensorimotor, and occipital brain areas. The hemodynamic response based on changes in oxyhemoglobin and deoxyhemoglobin concentrations during the task relative to the pre-task baseline for each participant were calculated. Group-level differences in oxyhemoglobin were evaluated using a general linear model. Results: Thirty participants, 10 from each of the 3 experience levels, were recruited. In the left prefrontal cortex, senior activation (–182) was stronger than both junior (14) and attending (27) activation (P < .001). In the left premotor cortex, senior activation (–147) was stronger than both junior (–52) and attending (15) activation (P = .008). In the left parietal cortex, senior activation (–255) was stronger than both junior (–41) and attending (12) activation (P < .001). Conclusion: Functional neuroimaging responses during the cognitive task of simulated operative dictation differ by skill level. This study represents the first brain imaging analysis of cognitive function connecting mental imagery, brain activation, and a cognitive surgical task linked to previously performed motor tasks. Functional neuroimaging may act as a nonbiased assessment tool of cognitive skill.