Background The use of eye tracking in the simulated setting can help improve our understanding of what sources of information clinicians are using as they deliver routine patient care. The aim of this simulation study was to observe the differences, if any, between the eye tracking patterns of leaders who performed best in a simulated postpartum hemorrhage (PPH) high-fidelity scenario, in comparison with those who performed worst. Methods Forty anesthesia trainees from the University of Catania Medical School were divided into eight teams, to enact four times the same scenario of a patient with postpartum hemorrhage following vaginal delivery. Trainees who were assigned the leader’s role wore the eye tracking glasses during the scenario, and their behavioral skills were evaluated by two observers, who reviewed the video recordings of the scenarios using a standardized checklist. The leader’s eye tracking metrics, extracted from 27 selected areas of interest (AOI), were recorded by a Tobii Pro Glasses 50 Hz wearable wireless eye tracker. Team performance was evaluated using a PPH checklist. After completion of the study, the leaders were divided into two groups, based on the scores they had received (High-Performance Leader group, HPL, and Low-Performance Leader group, LPL). Results In the HPL group, the duration and number of fixations were greater, and the distribution of gaze was uniformly distributed among the various members of the team as compared with the LPL group (with the exception of the participant who performed the role of the obstetrician). The HPL group also looked both at the patient’s face and established eye contact with their team members more often and for longer (P < .05). The team performance (PPH checklist) score was greater in the HPL group (P < .001). The LPL group had more and/or longer fixations of technical areas of interest (P < .05). Conclusions Our findings suggest that the leaders who perform the best distribute their gaze across all members of their team and establish direct eye contact. They also look longer at the patient’s face and dwell less on areas that are more relevant to technical skills. In addition, the teams led by these best performing leaders fulfilled their clinical task better. The information provided by the eye behaviors of “better-performing physicians” may lay the foundation for the future development of both the assessment process and the educational tools used in simulation. Trial Registration Clinical.Trial.Gov ID n. NCT04395963.
IntroductionEvidence for self-assessment in medicine is controversial with participants under-rating or overestimating their performance. It is also unclear whether this under or overestimation changes during the process of repeated simulation experience. In this study, the authors analyzed the evolution of the behavioral skills of anesthesia trainees during four consecutive standardized postpartum hemorrhages (PPH) high-fidelity simulation scenarios. They compared the self-assessment made by the leader himself and the assessment made by his teammates individually with the assessment made by two expert observers. MethodsThe authors enrolled forty anesthesia trainee volunteers and divided them into eight teams of five participants each. Each team enacted the same scenario of a patient with atonic PPH following vaginal delivery four times so that all the trainees, except the one assigned the leader's role, could rotate through the roles of anesthesia trainee, obstetrician, midwife, and nurse. The participants themselves and two expert observers, using standardized checklists and questionnaires, carried out an evaluation of the technical (diagnosis and treatment of atonic PPH) and behavioral (leadership, communication, situational awareness, and overall appraisal) skills evidenced in the scenarios. ResultsThe authors noted a progressive improvement in the behavioral scores given to the leader by the examiners, his team, and himself, from the first to the fourth scenario. The scores given by the participants and by the leader himself were greater than those given by the independent observers in the first two scenarios but these differences were no longer significant during the last two scenarios.
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