Separating the Noise from the Signal

This chapter synthesizes evidence from cognitive psychology and neuroscience to explain the journey from novice to expert in clinical decision-making. Inspired by the lived experience of a medical student, we explain how sensory processing and cognitive processing (i.e., emotions, attention, perception, and memory) interact to drive learning and clinical competence. We provide a neuroscientific explanation for the emotions described by the novice in their personal narrative. The emotions experienced by the medical student are a direct result of inexperience or, as we will outline, a lack of sufficient prior examples in memory. The familiarity of our environment, or lack thereof, influences what we attend to. If most things in our environment feel unfamiliar, we experience a deep sense of doubt and uncertainty as we cannot be sure what to look at or where the next piece of vital information will come from. Fortunately, with appropriate guided learning, mechanisms that support neural plasticity refine our perceptual and attentional capacity to meet the demands of new environments. Once we understand a complex environment, we become more efficient at acquiring knowledge and skills. We also recruit our prior experiences to make informed predictions – the critical element of effective medical decision making. Developing the capacity to interpret information and make decisions in a complex environment creates a sense of confidence more effectively and efficiently. Yet, as the medical student points out, this confidence might prevent the search for more details. We propose a set of effective education strategies targeting both the novice’s lack of experience and the expert’s narrowed lens.