An observational study using eye tracking to assess resident and senior anesthetists’ situation awareness and visual perception in postpartum hemorrhage high fidelity simulation

Abstract

Background The postpartum hemorrhage (PPH) is the leading cause of maternal mortality in the world. Human factors and especially situation awareness has primarily responsibility to explain suboptimal cares. Based on eye tracking and behavior analysis in high fidelity simulation of PPH management, the goal of this study is to identify perceptual and cognitive key parameters of the expertise. Methods Two groups of fifteen anesthetists (residents and experienced anesthetists) watched the beginning of a severe simulated PPH management. During this first experimental phase, situation awareness was assessed using SAGAT (Situation Awareness Global Assessment Technique) questionnaire and visual behavior was analyzed with eye tracking. In the continuity of the video sequence, they have to step in the PPH situation and to provide care to the simulated patient. Performance of cares was evaluated and self-assessed as well as cognitive load. Results No statistical difference between the residents and experienced anesthetists was observed on performance of simulated PPH management. The mean expected practice score was 76.9 ± 13.9%). Assessment of situation awareness (65 ± 7%), cognitive load (74.4 ± 11.3%) and theoretical knowledge of PPH (52.4 ± 3.5%) were also not statistically different between the two groups. Only results of self-assessed performance (respectively 66.1 ± 16.6 and 47.0 ± 20.8 for experts and residents) and eye-tracking data revealed that experts tended to get accurate evaluation of their performance and to monitor more the blood loss of the patient. Experts have in average 8.28% more fixating points than Novices and gazed the blood loss region longer (865 ms ± 439 vs. 717 ms ± 362). Conclusions This study pointed out the limits of classical assessment of performance, and human factors based on questionnaires to identify expertise in simulated PPH care. A neuroscientific approach with new technology like eye tracking could provide new objective and more sensitive insights on human factors in simulated medical emergency situations.

Anesthesia personnel’s visual attention regarding patient monitoring in simulated routine and critical incidents. An eye-tracking study.

“…Analyzing the areas of interest on the patient monitor, we found that the vital sign blood pressure received the most visual attention in both non-critical and critical scenarios. This is consistent with a recent study [11]. However, we expected the respiratory vital signs such as oxygen saturation, tidal volume, and respiratory rate to receive more visual attention.…”

“…Mobile eye-tracking devices have become established tools for gaining insights into cognitive processes such as visual attention, workload, con dence, and physician awareness [6][7][8]. Previous studies investigated the healthcare providers' visual attention regarding patient monitoring systems [8][9][10][11]. They found that during real anesthesia cases, healthcare professionals spent about 5% of their time observing the patient monitor [10].…”

“…They found that during real anesthesia cases, healthcare professionals spent about 5% of their time observing the patient monitor [10]. The blood pressure and heart rate seemed to be the most frequently viewed vital signs during simulated anesthesia scenarios [11]. However, it is still highly debated whether emergencies or different levels of experience among healthcare providers change the visual attention span [10][11][12][13][14].…”

Eye tracking metrics and leader’s behavioral performance during a post-partum hemorrhage high-fidelity simulated scenario

“…Eye tracking has also been reported as being an aid during the post scenario debriefing [21,22]. In one study [23], the performance and human factors in high-fidelity simulation of postpartum hemorrhage were analyzed by the visual behavior analysis using a standardized fixed eye tracking protocol, during viewing of a simulated video. In this study, the authors concluded suggesting a "neuroscientific approach with new technology like eye tracking to provide a new objective and more sensitive insights on human factors in simulated medical emergency situations".…”

Anesthesia personnel’s visual attention regarding patient monitoring in simulated non-critical and critical situations, an eye-tracking study

“…They found that during real anesthesia cases, healthcare professionals spent about 5% of their time observing the patient monitor [ 8 ]. The blood pressure and heart rate seemed to be the most frequently viewed vital signs during simulated anesthesia scenarios [ 13 ], and in critical situations, anesthesiologists tend to direct more visual attention toward the patient monitor [ 14 ]. However, whether different levels of experience among healthcare providers play a role in the distribution of visual attention on the patient monitor is not yet clear [ 8 , 13 , 15 , 16 ].…”