Eye-tracking analysis of skilled performance in clinical extracorporeal circulation

Abstract

The manipulation of extracorporeal circulation (ECC), which is performed by perfusionists during cardiovascular surgery, is a highly sophisticated cognitive process based on visual information obtained from information sources such as ECC indicators, surgeons, an operating field, a scrub nurse, surgical instruments, displays, patients, among others. An eye-tracking approach is expected to be a powerful means of automatic and rapid analysis. This paper presents the results of a pilot study in which an eye-tracking approach was applied to the analysis of ECC operation tasks conducted during real clinical cardiovascular surgery in the operating room. Eye-tracking data on four perfusionists were recorded while they were manipulating the ECC during a series of cardiovascular surgeries. The experience of the perfusionists ranged from 2 to 26+ years. Based on the data obtained, fixation-by-fixation cataloging of eye-tracking data in which each fixation was transcribed in timeline style was performed for each perfusionist. Gaze allocation tendencies during the surgeries for all four perfusionists were determined through a comparative analysis. It was noted that an expert engineer dispersed his attention more widely than did intermediate and novice perfusionists. Taking the results of the data analysis into consideration, we discuss the implications of well-skilled perfusionists' performance during the manipulation of ECC, as well as the principles that guide how eye-tracking data obtained in real surgery should be processed. This is the first study on the application of an eye-tracking approach to the analysis of ECC operation tasks to be reported in the Japanese literature.

Validating Eye Tracking as an Objective Assessment Tool in Simulation

“…Only a few participants wrote comments, and they were not formally analyzed but included, ''having the glasses on did not change how I would have taken care of the patient,'' ''a little tight, however, they felt just like normal sunglasses,'' ''there could be more padding around the eyes,'' and ''once the simulation started, I was more concerned about the patient.'' The wearability reported by the participants is congruent with other studies actually done in the clinical setting (Koh et al, 2011;Tomizawa, Aoki, Suzuki, Matayoshi, & Yozu, 2012). Importantly, the technology has advanced tremendously since this study was completed with great improvements in comfort and wearability.…”

“…The ETG provided data that differentiated groups by substantial fixation differences in AOIs satisfying Aim 2. As in other studies (Koh et al, 2011;Matsumoto et al, 2011;Tomizawa et al, 2012), the scan path images and ETG data revealed a marked difference between how novices and experts are able to process data in a busy environment. While novices spent a significant amount of time looking at data that was not relevant to the ''patient's'' immediate problem (i.e., focusing on the heart rate of a dyspneic patient), the expert seemed to know what was important and was able to acquire the pertinent information much faster.…”

“…While a larger sample size is desirable, ETG studies generally include smaller sample sizes due to the video analysis required for data retrieval. Sample sizes in other studies range from as low as four (Tomizawa et al, 2012) to twenty four (Matsumoto et al, 2011). While the sample size of this project was large compared with most other ETG studies, further research with larger sample sizes is needed to further establish validity and reliability of ETG as an evaluative tool in a clinical simulation assessment.…”

Optimal eye movement strategies: a comparison of neurosurgeons gaze patterns when using a surgical microscope

“…Regarding live surgeries, Atkins et al [3] and Tomizawa et al [37] studied expertise behavioural differences in the operating room (OR). Tomizawa et al reported that expert perfusionists tend to disperse their attention more widely than novices.…”

Eye-Tracking in the Study of Visual Expertise: Methodology and Approaches in Medicine

“…In a study of operating room technicians utilizing circulation machines, eye-tracking revealed that expert technicians visually fixated upon a larger number of critical sources of information during the operative procedure as compared to novices (Y. Tomizawa et al, 2012). With knowledge of these differences, it may be possible to incorporate eye-tracking as a component of self-assessment in early medical practice.…”