1
|
Miller DT, Michael S, Bell C, Brevik CH, Kaplan B, Svoboda E, Kendall J. Physical and biophysical markers of assessment in medical training: A scoping review of the literature. MEDICAL TEACHER 2024:1-9. [PMID: 38688520 DOI: 10.1080/0142159x.2024.2345269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Assessment in medical education has changed over time to measure the evolving skills required of current medical practice. Physical and biophysical markers of assessment attempt to use technology to gain insight into medical trainees' knowledge, skills, and attitudes. The authors conducted a scoping review to map the literature on the use of physical and biophysical markers of assessment in medical training. MATERIALS AND METHODS The authors searched seven databases on 1 August 2022, for publications that utilized physical or biophysical markers in the assessment of medical trainees (medical students, residents, fellows, and synonymous terms used in other countries). Physical or biophysical markers included: heart rate and heart rate variability, visual tracking and attention, pupillometry, hand motion analysis, skin conductivity, salivary cortisol, functional magnetic resonance imaging (fMRI), and functional near-infrared spectroscopy (fNIRS). The authors mapped the relevant literature using Bloom's taxonomy of knowledge, skills, and attitudes and extracted additional data including study design, study environment, and novice vs. expert differentiation from February to June 2023. RESULTS Of 6,069 unique articles, 443 met inclusion criteria. The majority of studies assessed trainees using heart rate variability (n = 160, 36%) followed by visual attention (n = 143, 32%), hand motion analysis (n = 67, 15%), salivary cortisol (n = 67, 15%), fMRI (n = 29, 7%), skin conductivity (n = 26, 6%), fNIRs (n = 19, 4%), and pupillometry (n = 16, 4%). The majority of studies (n = 167, 38%) analyzed non-technical skills, followed by studies that analyzed technical skills (n = 155, 35%), knowledge (n = 114, 26%), and attitudinal skills (n = 61, 14%). 169 studies (38%) attempted to use physical or biophysical markers to differentiate between novice and expert. CONCLUSION This review provides a comprehensive description of the current use of physical and biophysical markers in medical education training, including the current technology and skills assessed. Additionally, while physical and biophysical markers have the potential to augment current assessment in medical education, there remains significant gaps in research surrounding reliability, validity, cost, practicality, and educational impact of implementing these markers of assessment.
Collapse
Affiliation(s)
- Danielle T Miller
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah Michael
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Colin Bell
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Cody H Brevik
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Bonnie Kaplan
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ellie Svoboda
- Education Informationist, Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John Kendall
- Department of Emergency Medicine, Stanford School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Wachs JP, Kirkpatrick AW, Tisherman SA. Procedural Telementoring in Rural, Underdeveloped, and Austere Settings: Origins, Present Challenges, and Future Perspectives. Annu Rev Biomed Eng 2021; 23:115-139. [PMID: 33770455 DOI: 10.1146/annurev-bioeng-083120-023315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Telemedicine is perhaps the most rapidly growing area in health care. Approximately 15 million Americans receive medical assistance remotely every year. Yet rural communities face significant challenges in securing subspecialist care. In the United States, 25% of the population resides in rural areas, where less than 15% of physicians work. Current surgery residency programs do not adequately prepare surgeons for rural practice. Telementoring, wherein a remote expert guides a less experienced caregiver, has been proposed to address this challenge. Nonetheless, existing mentoring technologies are not widely available to rural communities, due to a lack of infrastructure and mentor availability. For this reason, some clinicians prefer simpler and more reliable technologies. This article presents past and current telementoring systems, with a focus on rural settings, and proposes aset of requirements for such systems. We conclude with a perspective on the future of telementoring systems and the integration of artificial intelligence within those systems.
Collapse
Affiliation(s)
- Juan P Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana 47907, USA;
| | - Andrew W Kirkpatrick
- Departments of Critical Care Medicine, Surgery, and Medicine; Snyder Institute for Chronic Diseases; and the Trauma Program, University of Calgary and Alberta Health Services, Calgary, Alberta T2N 2T9, Canada.,Tele-Mentored Ultrasound Supported Medical Interaction (TMUSMI) Research Group, Foothills Medical Centre, Calgary, Alberta T2N 2T9, Canada
| | - Samuel A Tisherman
- Department of Surgery and the Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| |
Collapse
|
4
|
Moon Y, Lee WJ, Shin SH, Kim JH, Lee JY, Oh SY, Lim HW. Positional Change of the Eyeball During Eye Movements: Evidence of Translatory Movement. Front Neurol 2020; 11:556441. [PMID: 33041994 PMCID: PMC7527524 DOI: 10.3389/fneur.2020.556441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose: To investigate the positional change of the eyeball induced by horizontal and vertical gazing to deduce translatory movement, using three-dimensional (3D) magnetic resonance imaging (MRI). Methods: In this prospective observational study participants underwent orbital MRI during central, right, left, up, and down gazing. MRI scans were processed using self-developed software; this software enabled 3D MR image reconstruction and the superimposition of reconstructed image sets between different gazes. After acquiring the coordinates of the eyeball centroid in each gaze, the changes in centroid coordinates from central gaze to the other gazes were estimated, and correlations with associated factors were evaluated. Results: The mean distance of centroid movement was 0.69 ± 0.27 mm in abduction, 0.68 ± 0.27 mm in adduction, 0.43 ± 0.23 mm in elevation, and 0.44 ± 0.19 mm in depression. The mean angle of centroid movement in horizontal gaze, measured in terms of the movement of the left eye centroid in the axial plane, was 228.7° in abduction and −4.2° in adduction. In vertical gaze, the mean angle of centroid movement was −96.8° in elevation and 101.8° in depression. Axial length and ocular volume were negatively correlated with the distance of centroid movement in horizontal gaze. Conclusions: The position of the eyeball moved in the same direction as the gaze during horizontal gaze, but in the opposite direction during vertical gaze. For accurate eye movement analyses, such as the measurement of the deviation angle in strabismus, translation should be considered in addition to rotation.
Collapse
Affiliation(s)
- Yeji Moon
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Won June Lee
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Seung Hak Shin
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Ji Hong Kim
- Department of Ophthalmology, Armed Forces Capital Hospital, Seongnam, South Korea
| | - Ji Young Lee
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Han Woong Lim
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
| |
Collapse
|