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Lee M, Desy J, Tonelli AC, Walsh MH, Ma IWY. The association of attentional foci and image interpretation accuracy in novices interpreting lung ultrasound images: an eye-tracking study. Ultrasound J 2023; 15:36. [PMID: 37697149 PMCID: PMC10495286 DOI: 10.1186/s13089-023-00333-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/02/2023] [Indexed: 09/13/2023] Open
Abstract
It is unclear, where learners focus their attention when interpreting point-of-care ultrasound (POCUS) images. This study seeks to determine the relationship between attentional foci metrics with lung ultrasound (LUS) interpretation accuracy in novice medical learners. A convenience sample of 14 medical residents with minimal LUS training viewed 8 LUS cineloops, with their eye-tracking patterns recorded. Areas of interest (AOI) for each cineloop were mapped independently by two experts, and externally validated by a third expert. Primary outcome of interest was image interpretation accuracy, presented as a percentage. Eye tracking captured 10 of 14 participants (71%) who completed the study. Participants spent a mean total of 8 min 44 s ± standard deviation (SD) 3 min 8 s on the cineloops, with 1 min 14 s ± SD 34 s spent fixated in the AOI. Mean accuracy score was 54.0% ± SD 16.8%. In regression analyses, fixation duration within AOI was positively associated with accuracy [beta-coefficients 28.9 standardized error (SE) 6.42, P = 0.002). Total time spent viewing the videos was also significantly associated with accuracy (beta-coefficient 5.08, SE 0.59, P < 0.0001). For each additional minute spent fixating within the AOI, accuracy scores increased by 28.9%. For each additional minute spent viewing the video, accuracy scores increased only by 5.1%. Interpretation accuracy is strongly associated with time spent fixating within the AOI. Image interpretation training should consider targeting AOIs.
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Affiliation(s)
- Matthew Lee
- Division of General Internal Medicine, Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Janeve Desy
- Division of General Internal Medicine, Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Ana Claudia Tonelli
- UNISINOS University, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael H Walsh
- Division of General Internal Medicine, Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Irene W Y Ma
- Division of General Internal Medicine, Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
- W21C, University of Calgary, Calgary, AB, Canada.
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Karmakar A, Khan MJ, Abdul-Rahman MEF, Shahid U. The Advances and Utility of Artificial Intelligence and Robotics in Regional Anesthesia: An Overview of Recent Developments. Cureus 2023; 15:e44306. [PMID: 37779803 PMCID: PMC10535025 DOI: 10.7759/cureus.44306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
The integration of artificial intelligence (AI) and robotics in regional anesthesia has brought about transformative changes in acute pain management for surgical procedures. This review explores the evolving landscape of AI and robotics applications in regional anesthesia, outlining their potential benefits, challenges, and ethical considerations. AI-driven pain assessment, real-time guidance for needle placement during nerve blocks, and predictive modeling solutions for nerve blocks have the potential to enhance procedural precision and improve patient outcomes. Robotic technology aids in accurate needle insertion, reducing complications and improving pain relief. This review also highlights the ethical and safety considerations surrounding AI implementation, emphasizing data security and professional training. While challenges such as costs and regulatory hurdles exist, ongoing research and clinical trials demonstrate the practical utility of these technologies. In conclusion, AI and robotics have the potential to reshape regional anesthesia practice, ultimately improving patient care and procedural accuracy in pain management.
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Affiliation(s)
- Arunabha Karmakar
- Anesthesiology and Critical Care, Hamad Medical Corporation, Doha, QAT
| | | | | | - Umair Shahid
- Anesthesiology and Critical Care, Hamad Medical Corporation, Doha, QAT
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Hafner C, Scharner V, Hermann M, Metelka P, Hurch B, Klaus DA, Schaubmayr W, Wagner M, Gleiss A, Willschke H, Hamp T. Eye-tracking during simulation-based echocardiography: a feasibility study. BMC MEDICAL EDUCATION 2023; 23:490. [PMID: 37393288 DOI: 10.1186/s12909-023-04458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION Due to the technical progress point-of-care ultrasound (POCUS) is increasingly used in critical care medicine. However, optimal training strategies and support for novices have not been thoroughly researched so far. Eye-tracking, which offers insights into the gaze behavior of experts may be a useful tool for better understanding. The aim of this study was to investigate the technical feasibility and usability of eye-tracking during echocardiography as well as to analyze differences of gaze patterns between experts and non-experts. METHODS Nine experts in echocardiography and six non-experts were equipped with eye-tracking glasses (Tobii, Stockholm, Sweden), while performing six medical cases on a simulator. For each view case specific areas of interests (AOI) were defined by the first three experts depending on the underlying pathology. Technical feasibility, participants' subjective experience on the usability of the eye-tracking glasses as well as the differences of relative dwell time (focus) inside the areas of interest (AOI) between six experts and six non-experts were evaluated. RESULTS Technical feasibility of eye-tracking during echocardiography was achieved with an accordance of 96% between the visual area orally described by participants and the area marked by the glasses. Experts had longer relative dwell time in the case specific AOI (50.6% versus 38.4%, p = 0.072) and performed ultrasound examinations faster (138 s versus 227 s, p = 0.068). Furthermore, experts fixated earlier in the AOI (5 s versus 10 s, p = 0.033). CONCLUSION This feasibility study demonstrates that eye-tracking can be used to analyze experts and non-experts gaze patterns during POCUS. Although, in this study the experts had a longer fixation time in the defined AOIs compared to non-experts, further studies are needed to investigate if eye-tracking could improve teaching of POCUS.
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Affiliation(s)
- Christina Hafner
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Vincenz Scharner
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Martina Hermann
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Philipp Metelka
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Benedikt Hurch
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Daniel Alexander Klaus
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Wolfgang Schaubmayr
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Wagner
- Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Harald Willschke
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Thomas Hamp
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
- Emergency Medical Service Vienna, Radetzkystraße 1, 1030, Vienna, Austria.
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Chan AHY, Lee WF, Van Gerven PWM, Chenkin J. Assessment of changes in gaze patterns during training in point-of-care ultrasound. BMC MEDICAL EDUCATION 2022; 22:658. [PMID: 36056331 PMCID: PMC9440555 DOI: 10.1186/s12909-022-03680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a core skill in emergency medicine (EM), however, there is a lack of objective competency measures. Eye-tracking technology is a potentially useful assessment tool, as gaze patterns can reliably discriminate between experts and novices across medical specialties. We aim to determine if gaze metrics change in an independent and predictable manner during ultrasound training. METHODS A convenience sample of first-year residents from a single academic emergency department was recruited. Participants interpreted 16 ultrasound videos of the focused assessment with sonography for trauma (FAST) scan while their gaze patterns were recorded using a commercially available eye-tracking device. The intervention group then completed an introductory ultrasound course whereas the control group received no additional education. The gaze assessment was subsequently repeated. The primary outcome was total gaze duration on the area of interest (AOI). Secondary outcomes included time to fixation, mean duration of first fixation and mean number of fixations on the AOI. RESULTS 10 EM residents in the intervention group and 10 non-EM residents in the control group completed the study. After training, there was an 8.8 s increase in the total gaze time on the AOI in the intervention group compared to a 4.0 s decrease in the control group (p = .03). EM residents were also 3.8 s quicker to fixate on the AOI whereas the control group became 2.5 s slower (p = .04). There were no significant interactions on the number of fixations (0.43 vs. 0.18, p = .65) or duration of first fixation on the AOI (0.02 s vs. 0.06 s, p = .63). CONCLUSIONS There are significant and quantifiable changes in gaze metrics, which occur with incremental learning after an ultrasound course. Further research is needed to validate the serial use of eye-tracking technology in following a learner's progress toward competency in point-of-care ultrasound image interpretation.
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Affiliation(s)
- Alice H Y Chan
- Department of Emergency Medicine, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, AG245, Toronto, ON, M4N 3M5, Canada.
| | - Wei Feng Lee
- Department of Emergency Medicine, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, AG245, Toronto, ON, M4N 3M5, Canada
- Department of Emergency Medicine, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, Singapore, 609606
| | - Pascal W M Van Gerven
- Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jordan Chenkin
- Department of Emergency Medicine, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, AG245, Toronto, ON, M4N 3M5, Canada
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McLeod G, McKendrick M, Tafili T, Obregon M, Neary R, Mustafa A, Raju P, Kean D, McKendrick G, McKendrick T. Patterns of Skills Acquisition in Anesthesiologists During Simulated Interscalene Block Training on a Soft Embalmed Thiel Cadaver: Cohort Study. JMIR MEDICAL EDUCATION 2022; 8:e32840. [PMID: 35543314 PMCID: PMC9412904 DOI: 10.2196/32840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/19/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The demand for regional anesthesia for major surgery has increased considerably, but only a small number of anesthesiologists can provide such care. Simulations may improve clinical performance. However, opportunities to rehearse procedures are limited, and the clinical educational outcomes prescribed by the Royal College of Anesthesiologists training curriculum 2021 are difficult to attain. Educational paradigms, such as mastery learning and dedicated practice, are increasingly being used to teach technical skills to enhance skills acquisition. Moreover, high-fidelity, resilient cadaver simulators are now available: the soft embalmed Thiel cadaver shows physical characteristics and functional alignment similar to those of patients. Tissue elasticity allows tissues to expand and relax, fluid to drain away, and hundreds of repeated injections to be tolerated without causing damage. Learning curves and their intra- and interindividual dynamics have not hitherto been measured on the Thiel cadaver simulator using the mastery learning and dedicated practice educational paradigm coupled with validated, quantitative metrics, such as checklists, eye tracking metrics, and self-rating scores. OBJECTIVE Our primary objective was to measure the learning slopes of the scanning and needling phases of an interscalene block conducted repeatedly on a soft embalmed Thiel cadaver over a 3-hour period of training. METHODS A total of 30 anesthesiologists, with a wide range of experience, conducted up to 60 ultrasound-guided interscalene blocks over 3 hours on the left side of 2 soft embalmed Thiel cadavers. The duration of the scanning and needling phases was defined as the time taken to perform all the steps correctly. The primary outcome was the best-fit linear slope of the log-log transformed time to complete each phase. Our secondary objectives were to measure preprocedural psychometrics, describe deviations from the learning slope, correlate scanning and needling phase data, characterize skills according to clinical grade, measure learning curves using objective eye gaze tracking and subjective self-rating measures, and use cluster analysis to categorize performance irrespective of grade. RESULTS The median (IQR; range) log-log learning slopes were -0.47 (-0.62 to -0.32; -0.96 to 0.30) and -0.23 (-0.34 to -0.19; -0.71 to 0.27) during the scanning and needling phases, respectively. Locally Weighted Scatterplot Smoother curves showed wide variability in within-participant performance. The learning slopes of the scanning and needling phases correlated: ρ=0.55 (0.23-0.76), P<.001, and ρ=-0.72 (-0.46 to -0.87), P<.001, respectively. Eye gaze fixation count and glance count during the scanning and needling phases best reflected block duration. Using clustering techniques, fixation count and glance were used to identify 4 distinct patterns of learning behavior. CONCLUSIONS We quantified learning slopes by log-log transformation of the time taken to complete the scanning and needling phases of interscalene blocks and identified intraindividual and interindividual patterns of variability.
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Affiliation(s)
- Graeme McLeod
- Ninewells Hospital, Dundee, United Kingdom
- University of Dundee, Dundee, United Kingdom
| | - Mel McKendrick
- Optomize Ltd, Glasgow, United Kingdom
- Heriot-Watt University, Edinburgh, United Kingdom
| | | | | | - Ruth Neary
- Raigmore Hospital, Inverness, United Kingdom
| | | | - Pavan Raju
- Ninewells Hospital, Dundee, United Kingdom
| | | | | | - Tuesday McKendrick
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
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Eye Tracking Use in Surgical Research: A Systematic Review. J Surg Res 2022; 279:774-787. [PMID: 35944332 DOI: 10.1016/j.jss.2022.05.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/18/2022] [Accepted: 05/22/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Eye tracking (ET) is a popular tool to study what factors affect the visual behaviour of surgical team members. To our knowledge, there have been no reviews to date that evaluate the broad use of ET in surgical research. This review aims to identify and assess the quality of this evidence, to synthesize how ET can be used to inform surgical practice, and to provide recommendations to improve future ET surgical studies. METHODS In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature review was conducted. An electronic search was performed in MEDLINE, Cochrane Central, Embase, and Web of Science databases up to September 2020. Included studies used ET to measure the visual behaviour of members of the surgical team during surgery or surgical tasks. The included studies were assessed by two independent reviewers. RESULTS A total of 7614 studies were identified, and 111 were included for data extraction. Eleven applications were identified; the four most common were skill assessment (41%), visual attention assessment (22%), workload measurement (17%), and skills training (10%). A summary was provided of the various ways ET could be used to inform surgical practice, and three areas were identified for the improvement of future ET studies in surgery. CONCLUSIONS This review provided a comprehensive summary of the various applications of ET in surgery and how ET could be used to inform surgical practice, including how to use ET to improve surgical education. The information provided in this review can also aid in the design and conduct of future ET surgical studies.
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Teng C, Lee LH, Lander J, Drukker L, Papageorghiou AT, Noble AJ. Skill Characterisation of Sonographer Gaze Patterns during Second Trimester Clinical Fetal Ultrasounds using Time Curves. PROCEEDINGS. EYE TRACKING RESEARCH & APPLICATIONS SYMPOSIUM 2022; 2022:30. [PMID: 36812105 PMCID: PMC7614191 DOI: 10.1145/3517031.3529637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We present a method for skill characterisation of sonographer gaze patterns while performing routine second trimester fetal anatomy ultrasound scans. The position and scale of fetal anatomical planes during each scan differ because of fetal position, movements and sonographer skill. A standardised reference is required to compare recorded eye-tracking data for skill characterisation. We propose using an affine transformer network to localise the anatomy circumference in video frames, for normalisation of eye-tracking data. We use an event-based data visualisation, time curves, to characterise sonographer scanning patterns. We chose brain and heart anatomical planes because they vary in levels of gaze complexity. Our results show that when sonographers search for the same anatomical plane, even though the landmarks visited are similar, their time curves display different visual patterns. Brain planes also, on average, have more events or landmarks occurring than the heart, which highlights anatomy-specific differences in searching approaches.
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Affiliation(s)
- Clare Teng
- Institute of Biomedical Engineering, University of Oxford Oxford, United Kingdom
| | - Lok Hin Lee
- Institute of Biomedical Engineering, University of Oxford Oxford, United Kingdom
| | - Jayne Lander
- Nuffield Department of Women’s and Reproductive Health, University of Oxford Oxford, United Kingdom
| | - Lior Drukker
- Nuffield Department of Women’s and Reproductive Health, University of Oxford Oxford, United Kingdom Women’s Ultrasound, Department of Obstetrics and Gynecology, Beilinson Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel Aviv, Israel
| | - Aris T. Papageorghiou
- Nuffield Department of Women’s and Reproductive Health, University of Oxford Oxford, United Kingdom
| | - Alison J. Noble
- Institute of Biomedical Engineering, University of Oxford Oxford, United Kingdom
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Teng C, Sharma H, Drukker L, Papageorghiou AT, Noble JA. Visualising Spatio-Temporal Gaze Characteristics for Exploratory Data Analysis in Clinical Fetal Ultrasound Scans. PROCEEDINGS. EYE TRACKING RESEARCH & APPLICATIONS SYMPOSIUM 2022; 2022:31. [PMID: 36649381 PMCID: PMC7614061 DOI: 10.1145/3517031.3529635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Visualising patterns in clinicians' eye movements while interpreting fetal ultrasound imaging videos is challenging. Across and within videos, there are differences in size an d position of Areas-of-Interest (AOIs) due to fetal position, movement and sonographer skill. Currently, AOIs are manually labelled or identified using eye-tracker manufacturer specifications which are not study specific. We propose using unsupervised clustering to identify meaningful AOIs and bi-contour plots to visualise spatio-temporal gaze characteristics. We use Hierarchical Density-Based Spatial Clustering of Applications with Noise (HDBSCAN) to identify the AOIs, and use their corresponding images to capture granular changes within each AOI. Then we visualise transitions within and between AOIs as read by the sonographer. We compare our method to a standardised eye-tracking manufacturer algorithm. Our method captures granular changes in gaze characteristics which are otherwise not shown. Our method is suitable for exploratory data analysis of eye-tracking data involving multiple participants and AOIs.
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Affiliation(s)
- Clare Teng
- University of Oxford, Institute of Biomedical Engineering, United Kingdom
| | - Harshita Sharma
- University of Oxford, Institute of Biomedical Engineering, United Kingdom
| | - Lior Drukker
- University of Oxford, Nuffield Department of Women's and Reproductive Health, United Kingdom and Tel-Aviv University, Women's Ultrasound, Department of Obstetrics and Gynecology, Beilinson Medical Center, Sackler Faculty of Medicine, Israel
| | - Aris T Papageorghiou
- University of Oxford, Nuffield Department of Women's and Reproductive Health, United Kingdom
| | - J. Alison Noble
- University of Oxford, Institute of Biomedical Engineering, United Kingdom
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Marín-Conesa E, Sánchez-Ferrer F, Grima-Murcia MD, Sánchez-Ferrer ML. The Application of a System of Eye Tracking in Laparoscopic Surgery: A New Didactic Tool to Visual Instructions. Front Surg 2021; 8:643611. [PMID: 34179065 PMCID: PMC8219847 DOI: 10.3389/fsurg.2021.643611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/29/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Laparoscopic surgery is an increasingly used technique, but it requires a high degree of learning, and communication between the operating room crew is considerably difficult. The use of eye tracking has been proposed as a didactic and evaluation tool in several settings, including in laparoscopy in simulators. Objectives: This study aimed to evaluate the usefulness of the use of eye tracking systems (Tobii glasses 2) in laparoscopic surgery as a didactic and assessment tool to improve communication in the operating room and improve patients' security. Methodology: An anonymous survey was sent to the students and medical teachers of a faculty of medicine and practicing doctors and residents. The message contained an explanation about the use of the Tobii glasses, a link to watch the video showing its use in a laparoscopic surgery, and the survey to complete after watching the video. Results: The survey was answered by 113 participants (51.3% medical students, 27.4% medical teachers, 18.6% practicing doctors, and 2.7% medicine residents). Eighty-three percent agreed with the usefulness of the “Tobii glasses” in the operating room for improving communication between the main surgeon and the assistant, for learning complex surgery techniques, for obtaining didactic videos, and for indicating anatomical structures. The item scored worst was the price of the glasses. Conclusions: It is possible to record and project expert gaze patterns in the operating room in real time using the Tobii glasses. This device allows improving communication among the surgical crew and the learning of residents and also improving the security of surgical patients.
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Affiliation(s)
- Ester Marín-Conesa
- Department of Neurology, 'Reina Sofía' University Hospital of Murcia, Murcia, Spain
| | - Francisco Sánchez-Ferrer
- Department of Pediatrics, "San Juan" University Hospital, Miguel Hernandez University, Alicante, Spain
| | | | - María Luisa Sánchez-Ferrer
- Department of Obstetrics and Gynecology of the University Hospital "Virgen de la Arrixaca", Institute for Biomedical Research of Murcia, IMIB-Arrixaca, University of Murcia, Murcia, Spain
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Lee WF, Chenkin J. Exploring Eye-tracking Technology as an Assessment Tool for Point-of-care Ultrasound Training. AEM EDUCATION AND TRAINING 2021; 5:e10508. [PMID: 33898911 PMCID: PMC8052995 DOI: 10.1002/aet2.10508] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/21/2020] [Accepted: 07/10/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Eye-tracking technology has emerged as a potentially useful learner assessment tool in several medical specialties. In the fields of general surgery and anesthesiology, it has been shown to reliably differentiate between different levels of expertise in procedural skills. In the field of radiology, it has been shown to be a valid assessment tool for diagnostic test interpretation. Current methods of competency assessment in point-of-care ultrasound (POCUS) remain a challenge, because they require significant direct observation time by an instructor. The purpose of this study was to determine if eye-tracking technology can accurately distinguish between novice and experts in the interpretation of POCUS clips, specifically of the focused assessment using sonography in trauma (FAST) scan. METHODS A convenience sample of medical students, residents, and emergency physicians from a single academic emergency department were invited to participate. Participants included both novices and experts in POCUS. Each participant completed a baseline questionnaire and viewed 16 video clips of a FAST ultrasound examination while their gaze patterns were recorded by a commercially available eye-tracking device. The primary outcome was total gaze time on the area of interest (AOI). Secondary outcomes included total time to fixation, mean number of fixations, and mean duration of first fixation on the AOI. RESULTS Fifteen novices and 15 experts completed this study. For total gaze time on the AOI, experts fixated their gaze significantly longer than novices (75.8 ± 16.2 seconds vs. 56.6 ± 12.8 seconds, p = 0.001). Similarly, experts were significantly faster to fixate on the AOI and had a higher fixation count on the AOI (8.5 ± 4.0 seconds vs. 15.1 ± 6.8 seconds, p = 0.003; and 170 ± 30 vs. 143 ± 28 seconds, p = 0.016). There were no differences on the mean duration of first fixation on the AOI (0.42 ± 0.12 seconds vs. 0.39 ± 0.09 seconds, p = 0.467). CONCLUSION Eye-tracking technology shows the potential to differentiate between experts and novices by their gaze patterns on video clips of FAST examinations. The total gaze time on the AOI may be a useful metric to help in the assessment of competency in POCUS image interpretation. In addition, the evaluation of gaze patterns may help educators identify causes of interpretation errors. Future studies are needed to further validate these metrics in a larger cohort.
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Affiliation(s)
- Wei Feng Lee
- Emergency DepartmentSunnybrook Health Sciences CentreTorontoOntarioCanada
- Emergency DepartmentNg Teng Fong General HospitalSingapore
| | - Jordan Chenkin
- Emergency DepartmentSunnybrook Health Sciences CentreTorontoOntarioCanada
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Morgan J, Wooldridge AR, Composto A, Mitchell A, Ramadhani WA, Roychowdhury J, Hanson K, Vazquez-Melendez E, Kendhari H, Shaikh N, Riech T, Mischler M, Krzyzaniak S, Barton G, Formella KT, Abbott ZR, Farmer JN, Ebert-Allen R, Croland T. Evaluating the Efficacy of a Mobile, Augmented Reality Pediatric Code Cart Education Application. ACTA ACUST UNITED AC 2021. [DOI: 10.1177/1071181320641247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pediatric codes are rare events that require fast intervention from medical professionals to resuscitate a child. A pediatric code cart contains all medications and equipment immediately needed to complete a pediatric resuscitation, but not all health care professionals (HCPs) know what is located on the cart and where. A mobile, augmented reality (AR) application was created to improve this knowledge. Ten participants performed a timed search on the cart while wearing Tobii Pro eye tracking glasses before and after exposure to the application. Also, a survey to assess participants’ confidence using the code cart was administered before and after exposure to the application; the post survey also contained usability and satisfaction scales. The results showed that performance and confidence improved after using the application, and that the application usability is acceptable. Our findings suggest the application is useful for improving knowledge and efficiency while working with a pediatric code cart.
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Affiliation(s)
- John Morgan
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana- Champaign, USA
| | - Abigail R. Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana- Champaign, USA
| | - Anthony Composto
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana- Champaign, USA
| | - Ashley Mitchell
- Department of Bioengineering, University of Illinois at Urbana-Champaign, USA
| | - Widya A. Ramadhani
- Illinois School of Architecture, University of Illinois at Urbana-Champaign, USA
| | | | - Keith Hanson
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, USA
| | | | - Harleena Kendhari
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, USA
| | - Nadia Shaikh
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, USA
| | - Teresa Riech
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, USA
- Department of Emergency Medicine, University of Illinois College of Medicine at Peoria, USA
| | - Matthew Mischler
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, USA
- Department of Emergency Medicine, University of Illinois College of Medicine at Peoria, USA
| | | | | | | | | | | | | | - Trina Croland
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, USA
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McKendrick M, Yang S, McLeod GA. The use of artificial intelligence and robotics in regional anaesthesia. Anaesthesia 2021; 76 Suppl 1:171-181. [PMID: 33426667 DOI: 10.1111/anae.15274] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022]
Abstract
The current fourth industrial revolution is a distinct technological era characterised by the blurring of physics, computing and biology. The driver of change is data, powered by artificial intelligence. The UK National Health Service Topol Report embraced this digital revolution and emphasised the importance of artificial intelligence to the health service. Application of artificial intelligence within regional anaesthesia, however, remains limited. An example of the use of a convoluted neural network applied to visual detection of nerves on ultrasound images is described. New technologies that may impact on regional anaesthesia include robotics and artificial sensing. Robotics in anaesthesia falls into three categories. The first, used commonly, is pharmaceutical, typified by target-controlled anaesthesia using electroencephalography within a feedback loop. Other types include mechanical robots that provide precision and dexterity better than humans, and cognitive robots that act as decision support systems. It is likely that the latter technology will expand considerably over the next decades and provide an autopilot for anaesthesia. Technical robotics will focus on the development of accurate sensors for training that incorporate visual and motion metrics. These will be incorporated into augmented reality and visual reality environments that will provide training at home or the office on life-like simulators. Real-time feedback will be offered that stimulates and rewards performance. In discussing the scope, applications, limitations and barriers to adoption of these technologies, we aimed to stimulate discussion towards a framework for the optimal application of current and emerging technologies in regional anaesthesia.
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Affiliation(s)
- M McKendrick
- Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh, UK.,Optomize Ltd, Glasgow, UK
| | - S Yang
- James Watt School of Engineering, University of Glasgow, Glasgow, UK
| | - G A McLeod
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK.,University of Dundee, UK
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Ramlogan RR, Chuan A, Mariano ER. Contemporary training methods in regional anaesthesia: fundamentals and innovations. Anaesthesia 2021; 76 Suppl 1:53-64. [PMID: 33426656 DOI: 10.1111/anae.15244] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 12/26/2022]
Abstract
Over the past two decades, regional anaesthesia and medical education as a whole have undergone a renaissance. Significant changes in our teaching methods and clinical practice have been influenced by improvements in our theoretical understanding as well as by technological innovations. More recently, there has been a focus on using foundational education principles to teach regional anaesthesia, and the evidence on how to best teach and assess trainees is growing. This narrative review will discuss fundamentals and innovations in regional anaesthesia training. We present the fundamentals in regional anaesthesia training, specifically the current state of simulation-based education, deliberate practice and curriculum design based on competency-based progression. Moving into the future, we present the latest innovations in web-based learning, emerging technologies for teaching and assessment and new developments in alternate reality learning systems.
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Affiliation(s)
- R R Ramlogan
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - A Chuan
- Department of Anaesthesia, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - E R Mariano
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.,Anesthesiology and Peri-operative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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14
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Bell CR, Szulewski A, Walker M, McKaigney C, Ross G, Rang L, Newbigging J, Kendall J. Differences in Gaze Fixation Location and Duration Between Resident and Fellowship Sonographers Interpreting a Focused Assessment With Sonography in Trauma. AEM EDUCATION AND TRAINING 2021; 5:28-36. [PMID: 33521488 PMCID: PMC7821074 DOI: 10.1002/aet2.10439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/22/2020] [Accepted: 02/07/2020] [Indexed: 05/30/2023]
Abstract
OBJECTIVES We quantified the gaze fixation duration of resident and fellowship sonographers interpreting a prerecorded focused assessment with sonography in trauma (FAST). We hypothesized that all sonographers would fixate on each relevant anatomic relationship but that the duration of fixation would differ. METHODS We conducted a cross-sectional study collecting and analyzing the gaze fixations of a convenience sample of current resident and fellowship sonographers. All sonographers viewed a standardized FAST video, and their gaze fixations were recorded using a Tobii X3-120 eye-tracking bar. Gaze fixations over nine anatomic regions of interest (ROIs) were identified. These were assessed for normality and analyzed using the Wilcoxon rank sum test at an alpha of 0.05 and Bonferroni correction p value of <0.0034. The chi-square test and Pearson's correlation were performed to assess statistical association. RESULTS The gaze fixation recordings of 24 resident and eight fellowship sonographers were suitable for analysis. Fourteen of the 24 resident sonographers viewed all ROIs in the FAST, whereas all eight fellowship sonographers viewed each of the nine relevant ROIs. Five ROIs were identified over which at least one resident sonographer did not have a gaze fixation. No statistically significant difference was identified between groups. Resident sonographers gaze fixated over the left upper quadrant (LUQ) splenorenal interface for a median (interquartile range) of 10.64 (9.73-11.60) seconds. The fellowship group viewed the same ROI for 8.43 (6.64-8.95) seconds (p < 0.003). All participants viewed this ROI. No other ROIs had a statistical difference. CONCLUSION Five ROIs were identified that were not visually interrogated by all resident sonographers. Only 14 of 24 resident sonographers visually interrogated every area in the FAST, whereas all fellowship sonographers interrogated every ROI. A statistically significant difference was found in gaze fixation duration between resident and fellowship sonographers in one ROI. Further study is required for gaze fixation assessment to become a tool for the interpretation component of point-of-care ultrasound.
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Affiliation(s)
- Colin R. Bell
- Department of Emergency MedicineKingston Health Sciences CentreKingstonOntario
- Queen’s University School of MedicineKingstonOntario
| | - Adam Szulewski
- Department of Emergency MedicineKingston Health Sciences CentreKingstonOntario
- Queen’s University School of MedicineKingstonOntario
| | - Melanie Walker
- Department of Emergency MedicineKingston Health Sciences CentreKingstonOntario
| | - Conor McKaigney
- Department of Emergency MedicineSouth Health, Alberta Health Services and Cumming School of Medicine at the University of CalgaryCalgaryAlbertaCanada
| | - Graeme Ross
- Department of Emergency MedicineKingston Health Sciences CentreKingstonOntario
- Queen’s University School of MedicineKingstonOntario
| | - Louise Rang
- Department of Emergency MedicineKingston Health Sciences CentreKingstonOntario
- Queen’s University School of MedicineKingstonOntario
| | - Joseph Newbigging
- Department of Emergency MedicineKingston Health Sciences CentreKingstonOntario
- Queen’s University School of MedicineKingstonOntario
| | - John Kendall
- Department of Emergency MedicineDenver Health Medical Center and University of Colorado Medical SchoolDenverCO
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GlassesViewer: Open-source software for viewing and analyzing data from the Tobii Pro Glasses 2 eye tracker. Behav Res Methods 2020; 52:1244-1253. [PMID: 31898293 PMCID: PMC7280338 DOI: 10.3758/s13428-019-01314-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We present GlassesViewer, open-source software for viewing and analyzing eye-tracking data of the Tobii Pro Glasses 2 head-mounted eye tracker as well as the scene and eye videos and other data streams (pupil size, gyroscope, accelerometer, and TTL input) that this headset can record. The software provides the following functionality written in MATLAB: (1) a graphical interface for navigating the study- and recording structure produced by the Tobii Glasses 2; (2) functionality to unpack, parse, and synchronize the various data and video streams comprising a Glasses 2 recording; and (3) a graphical interface for viewing the Glasses 2's gaze direction, pupil size, gyroscope and accelerometer time-series data, along with the recorded scene and eye camera videos. In this latter interface, segments of data can furthermore be labeled through user-provided event classification algorithms or by means of manual annotation. Lastly, the toolbox provides integration with the GazeCode tool by Benjamins et al. (2018), enabling a completely open-source workflow for analyzing Tobii Pro Glasses 2 recordings.
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16
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Grima-Murcia MD, Sanchez-Ferrer F, Ramos-Rincón JM, Fernández E. Use of Eye-Tracking Technology by Medical Students Taking the Objective Structured Clinical Examination: Descriptive Study. J Med Internet Res 2020; 22:e17719. [PMID: 32821060 PMCID: PMC7500558 DOI: 10.2196/17719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/02/2020] [Accepted: 05/13/2020] [Indexed: 01/18/2023] Open
Abstract
Background The objective structured clinical examination (OSCE) is a test used throughout Spain to evaluate the clinical competencies, decision making, problem solving, and other skills of sixth-year medical students. Objective The main goal of this study is to explore the possible applications and utility of portable eye-tracking systems in the setting of the OSCE, particularly questions associated with attention and engagement. Methods We used a portable Tobii Glasses 2 eye tracker, which allows real-time monitoring of where the students were looking and records the voice and ambient sounds. We then performed a qualitative and a quantitative analysis of the fields of vision and gaze points attracting attention as well as the visual itinerary. Results Eye-tracking technology was used in the OSCE with no major issues. This portable system was of the greatest value in the patient simulators and mannequin stations, where interaction with the simulated patient or areas of interest in the mannequin can be quantified. This technology proved useful to better identify the areas of interest in the medical images provided. Conclusions Portable eye trackers offer the opportunity to improve the objective evaluation of candidates and the self-evaluation of the stations used as well as medical simulations by examiners. We suggest that this technology has enough resolution to identify where a student is looking at and could be useful for developing new approaches for evaluating specific aspects of clinical competencies.
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Loth S, Cote AC, Shaafi Kabiri N, Bhangu JS, Zumwalt A, Moss M, Thomas K. Improving Triage Accuracy in First Responders: Measurement of Short Structured Protocols to Improve Identification of Salient Triage Features. WORLD MEDICAL & HEALTH POLICY 2019. [DOI: 10.1002/wmh3.306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Katz T, Weinberg DD, Fishman CE, Nadkarni V, Tremoulet P, te Pas AB, Sarcevic A, Foglia EE. Visual attention on a respiratory function monitor during simulated neonatal resuscitation: an eye-tracking study. Arch Dis Child Fetal Neonatal Ed 2019; 104:F259-F264. [PMID: 29903721 PMCID: PMC6294702 DOI: 10.1136/archdischild-2017-314449] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE A respiratory function monitor (RFM) may improve positive pressure ventilation (PPV) technique, but many providers do not use RFM data appropriately during delivery room resuscitation. We sought to use eye-tracking technology to identify RFM parameters that neonatal providers view most commonly during simulated PPV. DESIGN Mixed methods study. Neonatal providers performed RFM-guided PPV on a neonatal manikin while wearing eye-tracking glasses to quantify visual attention on displayed RFM parameters (ie, exhaled tidal volume, flow, leak). Participants subsequently provided qualitative feedback on the eye-tracking glasses. SETTING Level 3 academic neonatal intensive care unit. PARTICIPANTS Twenty neonatal resuscitation providers. MAIN OUTCOME MEASURES Visual attention: overall gaze sample percentage; total gaze duration, visit count and average visit duration for each displayed RFM parameter. Qualitative feedback: willingness to wear eye-tracking glasses during clinical resuscitation. RESULTS Twenty providers participated in this study. The mean gaze sample captured wa s 93% (SD 4%). Exhaled tidal volume waveform was the RFM parameter with the highest total gaze duration (median 23%, IQR 13-51%), highest visit count (median 5.17 per 10 s, IQR 2.82-6.16) and longest visit duration (median 0.48 s, IQR 0.38-0.81 s). All participants were willing to wear the glasses during clinical resuscitation. CONCLUSION Wearable eye-tracking technology is feasible to identify gaze fixation on the RFM display and is well accepted by providers. Neonatal providers look at exhaled tidal volume more than any other RFM parameter. Future applications of eye-tracking technology include use during clinical resuscitation.
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Affiliation(s)
- Trixie Katz
- University of Amsterdam, Amsterdam, The Netherlands
| | - Danielle D. Weinberg
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | | | - Vinay Nadkarni
- The University of Pennsylvania, Philadelphia, USA,Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Patrice Tremoulet
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, USA,Department of Psychology, Rowan University, Glassboro, USA
| | - Arjan B te Pas
- Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Elizabeth E. Foglia
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, USA,The University of Pennsylvania, Philadelphia, USA
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Hanhan J, King R, Harrison TK, Kou A, Howard SK, Borg LK, Shum C, Udani AD, Mariano ER. A Pilot Project Using Eye-Tracking Technology to Design a Standardised Anaesthesia Workspace. Turk J Anaesthesiol Reanim 2018; 46:411-415. [PMID: 30505602 DOI: 10.5152/tjar.2018.67934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Maximising safe handoff procedures ensures patient safety. Anaesthesiology practices have primarily focused on developing better communication tools. However, these tools tend to ignore the physical layout of the anaesthesia workspace itself. Standardising the anaesthesia workspace has the potential to improve patient safety. The design process should incorporate end user feedback and objective data. Methods This pilot project aims to design a standardised anaesthesia workspace using eye-tracking technology at a single university-affiliated Veterans Affairs hospital. Twelve practising anaesthesiologists observed a series of images representing five clinical scenarios. Each of these had a question prompting them to look for certain items commonly found in the anaesthesia workspace. Using eye-tracking technology, the gaze data of participants were recorded. These data were used to generate heat maps of the specific areas of interest in the workspace that received the most fixation counts. Results The laryngoscope and propofol had the highest percentages of gaze fixations on the left-hand side of the workstation, in closest proximity to the anaesthesiologist. Atropine, although the highest percentage of gaze fixations (33%) placed it on the right-hand side of the workstation, also had 25% of gaze fixations centred over the anaesthesia cart. Conclusion Gaze fixation analyses showed that anaesthesiologists identified locations for the laryngoscope and propofol within easy reach and emergency medications further away. Because eye tracking can provide objective data to influence the design process, it may be useful when developing standardised anaesthesia workspace templates for individual practices.
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Affiliation(s)
- Jaber Hanhan
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Roderick King
- Stanford University School of Medicine, Stanford, CA, USA
| | - T Kyle Harrison
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alex Kou
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Steven K Howard
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Lindsay K Borg
- Department of Anaesthesiology, Kaiser Permanente Northwest, Portland, OR, USA
| | - Cynthia Shum
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ankeet D Udani
- Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Edward R Mariano
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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20
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Wagner M, Hauser K, Cardona F, Schmölzer GM, Berger A, Olischar M, Werther T. Implementation and Evaluation of Training for Ultrasound-Guided Vascular Access to Small Vessels Using a Low-Cost Cadaver Model. Pediatr Crit Care Med 2018; 19:e611-e617. [PMID: 30234738 DOI: 10.1097/pcc.0000000000001721] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Critically ill neonatal and pediatric patients often require central vascular access. Real-time ultrasound guidance for central venous catheterization is beneficial. Because the diameter of central veins is much smaller in neonates than in adults, extensive training is needed to master the visualization and catheterization of central veins in neonates. This study assessed the learning effect of a standardized simulation-based teaching program on ultrasound-guided cannulation in a low-cost cadaver tissue model. DESIGN This simulation-based prospective study assessed physician competence in the ultrasound-guided central venous catheterization procedure. Analyses were conducted before and after the teaching course. SETTING Pediatric simulation center at a tertiary care center. SUBJECTS Staff physicians from the Neonatal ICU and PICUs at the Medical University of Vienna. INTERVENTIONS Two latex tubes, with internal diameters of 2 and 4 mm, were inserted in parallel into cadaver tissue to mimic vessels and create a model for central venous catheterization. MEASUREMENTS AND MAIN RESULTS Under ultrasound guidance, each participant attempted to puncture and insert a guide-wire into each of the latex tubes using in-plane and out-of-plane techniques, both before and after the teaching course. The training program was assessed using a questionnaire and a performance checklist. Thirty-nine physicians participated in this study. The rates of failure of guide-wire insertion into 2-mm tubes were significantly lower after than before the teaching course, using both in-plane (p = 0.001) and out-of-plane (p = 0.004) techniques. Teaching, however, did not significantly reduce the insertion failure rate into 4-mm tubes, either in-plane (p = 0.148) or out-of-plane (p = 0.069). The numbers of successful cannulations on the first attempt increased after the teaching in all methods (p = 0.001). CONCLUSIONS Implementation of a skills training program for ultrasound-guided central venous catheterization in a cadaver tissue model was feasible and cost- and time-effective. The number of attempts until successful cannulation of small vessels (2-mm tube) was significantly lower after than before the standardized teaching program.
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Affiliation(s)
- Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria.,Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Kirstin Hauser
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Francesco Cardona
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Monika Olischar
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Tobias Werther
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
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Kim E. Potential of eye tracking technology for assessment of performance and medical education in the field of anesthesia. Korean J Anesthesiol 2018; 71:253-254. [PMID: 30071712 PMCID: PMC6078873 DOI: 10.4097/kja.d.18.00177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Eunsoo Kim
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
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22
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King R, Hanhan J, Harrison TK, Kou A, Howard SK, Borg LK, Shum C, Udani AD, Mariano ER. Using eye tracking technology to compare the effectiveness of malignant hyperthermia cognitive aid design. Korean J Anesthesiol 2018; 71:317-322. [PMID: 29760370 PMCID: PMC6078877 DOI: 10.4097/kja.d.18.00016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/17/2018] [Indexed: 11/11/2022] Open
Abstract
Background Malignant hyperthermia is a rare but potentially fatal complication of anesthesia, and several different cognitive aids designed to facilitate a timely and accurate response to this crisis currently exist. Eye tracking technology can measure voluntary and involuntary eye movements, gaze fixation within an area of interest, and speed of visual response and has been used to a limited extent in anesthesiology. Methods With eye tracking technology, we compared the accessibility of five malignant hyperthermia cognitive aids by collecting gaze data from twelve volunteer participants. Recordings were reviewed and annotated to measure the time required for participants to locate objects on the cognitive aid to provide an answer; cumulative time to answer was the primary outcome. Results For the primary outcome, there were differences detected between cumulative time to answer survival curves (P < 0.001). Participants demonstrated the shortest cumulative time to answer when viewing the Society for Pediatric Anesthesia (SPA) cognitive aid compared to four other publicly available cognitive aids for malignant hyperthermia, and this outcome was not influenced by the anesthesiologists’ years of experience. Conclusions This is the first study to utilize eye tracking technology in a comparative evaluation of cognitive aid design, and our experience suggests that there may be additional applications of eye tracking technology in healthcare and medical education. Potentially advantageous design features of the SPA cognitive aid include a single page, linear layout, and simple typescript with minimal use of single color blocking.
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Affiliation(s)
- Roderick King
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jaber Hanhan
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alex Kou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Steven K Howard
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Lindsay K Borg
- Department of Anesthesiology, Northwest Permanente, Portland, OR, USA
| | - Cynthia Shum
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ankeet D Udani
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Abstract
PURPOSE OF REVIEW Ultrasound-guided regional anesthesia is a challenging, complex skill and requires competence in teaching. The aim of this study was to review current literature on identification of education and learning of ultrasound-guided regional anesthesia and to summarize recent findings on teaching concepts. RECENT FINDINGS Several teaching programs have been described and implemented into daily routine. Factors relevant to current practice are the knowledge of sonoanatomy, the acquisition of manual skills, the teaching ability, and the feedback given to the trainee. Simulation is a rapidly growing field and is supported by the development of phantoms. Needle visualization is one of the core competencies that is necessary for successful ultrasound-guided procedures and could be supported by technical developments in the future to improve teaching concepts. SUMMARY Although a lot of key questions cannot be answered by the latest study results, some interesting findings were able to improve existing education programs. These results should be tailored to the individual need of a trainee, and the effects of improved training programs on patient safety and quality of care have to be investigated. The see one, do one, teach one approach is obsolete and should be abandoned.
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Borg LK, Harrison TK, Kou A, Mariano ER, Udani AD, Kim TE, Shum C, Howard SK. Preliminary Experience Using Eye-Tracking Technology to Differentiate Novice and Expert Image Interpretation for Ultrasound-Guided Regional Anesthesia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:329-336. [PMID: 28777464 DOI: 10.1002/jum.14334] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Objective measures are needed to guide the novice's pathway to expertise. Within and outside medicine, eye tracking has been used for both training and assessment. We designed this study to test the hypothesis that eye tracking may differentiate novices from experts in static image interpretation for ultrasound (US)-guided regional anesthesia. METHODS We recruited novice anesthesiology residents and regional anesthesiology experts. Participants wore eye-tracking glasses, were shown 5 sonograms of US-guided regional anesthesia, and were asked a series of anatomy-based questions related to each image while their eye movements were recorded. The answer to each question was a location on the sonogram, defined as the area of interest (AOI). The primary outcome was the total gaze time in the AOI (seconds). Secondary outcomes were the total gaze time outside the AOI (seconds), total time to answer (seconds), and time to first fixation on the AOI (seconds). RESULTS Five novices and 5 experts completed the study. Although the gaze time (mean ± SD) in the AOI was not different between groups (7 ± 4 seconds for novices and 7 ± 3 seconds for experts; P = .150), the gaze time outside the AOI was greater for novices (75 ± 18 versus 44 ± 4 seconds for experts; P = .005). The total time to answer and total time to first fixation in the AOI were both shorter for experts. CONCLUSIONS Experts in US-guided regional anesthesia take less time to identify sonoanatomy and spend less unfocused time away from a target compared to novices. Eye tracking is a potentially useful tool to differentiate novices from experts in the domain of US image interpretation.
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Affiliation(s)
- Lindsay K Borg
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Alex Kou
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Ankeet D Udani
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - T Edward Kim
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Cynthia Shum
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Steven K Howard
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
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