<p>Novice and Expert Anesthesiologists’ Eye-Tracking Metrics During Simulated Epidural Block: A Preliminary, Brief Observational Report</p>

Abstract

Introduction: Eye tracking is the process of measuring an individual's eye movements to register their attentional behavior by using a device called an eye-tracker. Studies conducted using eye-tracking techniques have demonstrated a number of differences in eye movement parameters and patterns between experts and novices. The aim of this preliminary study was to evaluate if there are any differences in eye-tracking metrics between novice and expert anesthesiologists during the performance of an epidural block using an epidural simulator. Methods: Seven experts and seven novices who gave their consent to this preliminary study were asked to perform an epidural technique using an epidural simulator while wearing a pair of Tobii Pro glasses. Number of fixations, fixation duration, heat maps and scan-paths were examined by Tobii Pro Lab Software. Duration of the procedure was also recorded. Results: The observation of the attentional heat map and gaze plot showed different gaze dispersion between experts and novices. The mean total duration of fixations during needle insertion and advancement and catheter introduction was lower in experts than trainees (respectively, 0.18 vs 3.56 sec; P<0.05 and 0.73 vs 2.48 sec; P<0.05). The mean fixation count was greater in experts vs trainees (5 vs 2; P<0.05). The mean duration of the epidural procedure was 104.16 (41) (trainees) vs 65.3 (32.6) seconds (experts) (P<0.05). Expert anesthesiologists spent more time fixating a more specific target location (eg, the point of the epidural needle rather than the syringe's barrel) whilst novices split their attention between tracking their tools and the target location. Discussion: Eye tracking may have interesting implications for the creation of assessment programs, which distinguish skill level through the use of gaze behavior, and may be a promising tool for monitoring training progress towards the development of expertise.

Comparing the Visual Perception According to the Performance Using the Eye-Tracking Technology in High-Fidelity Simulation Settings

“…Results showed that experts watched the tools for a shorter time and the ball for a longer time than novices did [ 22 ]. The eye-tracking technology allowed the distinctions in visual perception of the experts and novices [ 23 , 24 , 25 , 26 ]. Typically, novice clinicians tend to unnecessarily activate data-collection approach to validate their hypothesis before arriving at a final diagnosis while experts make appropriate assumptions more quickly based on past similar experiences and accurately perceive more precisely the relative importance of information such as case progression, vital signs, and symptoms [ 27 ].…”

Translational simulation: from description to action

“…Observer tools (see Table 2 for examples) may be based on conceptual frameworks, evidence-based principles, validated assessment tools, and/or process-orientated events. Direct observation can be supplemented by remote observation and recording using video communication platforms, advanced monitoring modalities such as motion tracking [ 5 ] and eye movement tracking [ 40 ], and post-event data collection. Data analysis.…”

“…Team Emergency Assessment Measure (TEAM) [ 38 ] Time-to-event, e.g. time to CT scan for trauma patients [ 8 ] Safe design goals observer tool [ 39 ] Ethnographic observation [ 6 ] Monitoring Video and/or audio recording and streaming Motion tracking [ 5 ] Eye movement tracking [ 40 ] Other ergonomic assessment tools (e.g. heart rate monitoring, strain measurements) [ 41 ] Learning conversations Debrief approaches Rapid cycle deliberate practice [ 42 ] (can be modified to improve processes as well as individual performance) Systems-focused Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework [ 43 ] SAFEE debriefing tool [ 44 ] (based on evidence-based design principles) Pluralist walkthrough [ 41 ] with iterative discussions ‘Brainstorm’ sessions [ 45 , 46 ] (e.g.…”

“…Tabletop simulations followed by simulations within mock-ups of the space confirm other previously identified latent safety threats [ 51 ]. The process follows the Agency for Healthcare Research and Quality (AHRQ) evidence-based safe design principles [ 40 ], and data from observations and debriefings are documented on the Simulation-based Quality Improvement Observation Tool (SQIOT) [ 14 ] by both observers and simulation facilitators. Data from the SQIOTs are collated, risk rated, and reported on a Healthcare Failure Modes Effects Analysis (HFMEA) summary report [ 15 , 39 ].…”

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

“…Overall eye tracking methodology has contributed significantly to training assessment and has been used in simulation practices in the attempt to better understand insights into how data are collected and acted on during high-load cognitive processes [4][5][6][7][8].…”