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

Abstract

Introduction: We used eye-tracking technology to explore the visual perception of clinicians during a high-fidelity simulation scenario. We hypothesized that physicians who were able to successfully manage a critical situation would have a different visual focus compared to those who failed.

Methods: A convenience sample of 18 first-year emergency medicine residents were enrolled voluntarily to participate in a high-fidelity scenario involving a patient in shock with a 3rd degree atrioventricular block. Their performance was rated as pass or fail and depended on the proper use of the pacing unit. Participants were wearing pre-calibrated eye-tracking glasses throughout the 9-min scenario and infrared (IR) markers installed in the simulator were used to define various Areas of Interest (AOI). Total View Duration (TVD) and Time to First Fixation (TFF) by the participants were recorded for each AOI and the results were used to produce heat maps.

Results: Twelve residents succeeded while six failed the scenario. The TVD for the AOI containing the pacing unit was significantly shorter (median [quartile]) for those who succeeded compared to the ones who failed (42 [31-52] sec vs. 70 [61-90] sec, p = 0.0097). The TFF for the AOI containing the ECG and vital signs monitor was also shorter for the participants who succeeded than for those who failed (22 [6-28] sec vs. 30 [27-77] sec, p = 0.0182).

Discussion: There seemed to be a connection between the gaze pattern of residents in a high-fidelity bradycardia simulation and their performance. The participants who succeeded looked at the monitor earlier (diagnosis). They also spent less time fixating the pacing unit, using it promptly to address the bradycardia. This study suggests that eye-tracking technology could be used to explore how visual perception, a key information-gathering element, is tied to decision-making and clinical performance.

Keywords: eye-tracking; medical education; performance.

Figure 1

Infrared markers (red oval) framing three different Areas of interest (AOI): (A) Head of the patient, (B) Monitor, (C) Defibrillator/pacing unit.

Figure 2

The data showed that residents who succeeded had a significantly shorter median [IQR] TVD at the pacing unit than the ones who failed (42 [31–52] sec vs. 70 [61–90] sec, p = 0.0097). The residents who succeeded also had a shorter median [IQR] TFF at the monitor compared with those who failed (28 [6–48] sec vs. 30 [25–77] sec, p = 0.5532). The boxplots show the median and IQR.

Figure 3

A heat map showing that the pacing unit exhibits fewer fixations (green colored) for the residents who succeeded than for those who failed (red-colored) A: Defibrillator/Pacing Unit B: Infrared markers.