The performance of doctors. i: professionalism and self regulation in a changing world

Performance errors in conflict tasks often result from inappropriate action impulses, and are thought to signal the need for increased control over the motor system. However, errors may also result from lapses in sustained attention, which may require different monitoring and adaptation mechanisms. Distinguishing between the mechanisms of adaptation is important as both error types may occur intermixed. To this end, we measured EEG of healthy human subjects while they performed three variants of the Simon task in which errors were more likely to occur due to attentional lapses, failures of motor control, or both. Behavioral results showed that subjects exhibited less conflict effects and less impulsive errors in sustained attention compared with the other Simon conditions. Time-frequency analyses of EEG data showed that the sustained attention Simon condition, compared with the motor control Simon condition, was characterized by: (1) less error-related MFC theta (4–8 Hz) power and an absence of error-related MFC–DLPFC theta phase synchronization; (2) stronger error-related suppression of parieto-occipital alpha (8–12 Hz) power and stronger parieto-occipital–frontal alpha synchronization. A control experiment, using SART (the Sustained Attention to Response Test), confirmed that adaptation after attentional lapses involved posterior alpha power suppression, in addition to inter-regional frontal theta activity. Together, these results suggest that at least two cortical mechanisms exist for performance monitoring, and that different tasks and task-settings can recruit these mechanisms in a different way. Post-error brain dynamics thus consist of heterogeneous activity from multiple neurocognitive processes.