Medical education and distrust modulate the response of insular-cingulate network and ventral striatum in pain diagnosis

Elife. 2021 Apr 27:10:e63272. doi: 10.7554/eLife.63272.

Abstract

Healthcare providers often underestimate patients' pain, sometimes even when aware of their reports. This could be the effect of experience reducing sensitivity to others pain, or distrust toward patients' self-evaluations. Across multiple experiments (375 participants), we tested whether senior medical students differed from younger colleagues and lay controls in the way they assess people's pain and take into consideration their feedback. We found that medical training affected the sensitivity to pain faces, an effect shown by the lower ratings and highlighted by a decrease in neural response of the insula and cingulate cortex. Instead, distrust toward the expressions' authenticity affected the processing of feedbacks, by decreasing activity in the ventral striatum whenever patients' self-reports matched participants' evaluations, and by promoting strong reliance on the opinion of other doctors. Overall, our study underscores the multiple processes which might influence the evaluation of others' pain at the early stages of medical career.

Keywords: distrust; human; medical education; neuroscience; pain disgnosis; pain facial expression.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Education, Medical
  • Feedback
  • Female
  • Gyrus Cinguli / diagnostic imaging
  • Gyrus Cinguli / physiology*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Neuroimaging
  • Pain / diagnosis*
  • Pain / psychology
  • Pain Measurement / methods
  • Pain Measurement / psychology
  • Students, Medical / psychology*
  • Trust* / psychology
  • Ventral Striatum / diagnostic imaging
  • Ventral Striatum / physiology*
  • Young Adult

Grants and funding

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.