How Experts Adapt Their Gaze Behavior When Modeling a Task to Novices

Brain computed tomography reading of stroke patients by resident doctors from different medical specialities: An eye-tracking study

BACKGROUND

Using the eye-tracking technique, our work aimed to examine whether difference in clinical background may affect the training outcome of resident doctors' interpretation skills and reading behaviour related to brain computed tomography (CT).

METHODS

Twelve resident doctors in the neurology, radiology, and emergency departments were recruited. Each participant had to read CT images of the brain for two cases. We evaluated each participant's accuracy of lesion identification. We also used the eye-tracking technique to assess reading behaviour. We recorded dwell times, fixation counts, run counts, and first-run dwell times of target lesions to evaluate visual attention. Transition entropy was applied to assess the temporal relations and spatial dynamics of systematic image reading.

RESULTS

The eye-tracking results showed that the image reading sequence examined by transition entropy was comparable among resident doctors from different medical specialties (p = 0.82). However, the dwell time of the target lesions was shorter for the resident doctors from the neurology department (4828.63 ms, p = 0.01) than for those from the resident doctors from the radiology (6275.88 ms) and emergency (5305.00 ms) departments. The eye-tracking results in individual areas of interest only showed differences in the eye-tracking performance of the first-run dwell time (p = 0.05) in the anterior cerebral falx.

DISCUSSION

Our findings demonstrate that resident doctors from different medical specialties may achieve similar imaging reading patterns for brain CT. This may mitigate queries regarding the influence of different backgrounds on training outcomes.

Visualizing a Task Performer’s Gaze to Foster Observers’ Performance and Learning—a Systematic Literature Review on Eye Movement Modeling Examples

Eye movement modeling examples (EMMEs) are instructional videos (e.g., tutorials) that visualize another person’s gaze location while they demonstrate how to perform a task. This systematic literature review provides a detailed overview of studies on the effects of EMME to foster observers’ performance and learning and highlights their differences in EMME designs. Through a broad, systematic search on four relevant databases, we identified 72 EMME studies (78 experiments). First, we created an overview of the different study backgrounds. Studies most often taught tasks from the domains of sports/physical education, medicine, aviation, and STEM areas and had different rationales for displaying EMME. Next, we outlined how studies differed in terms of participant characteristics, task types, and the design of the EMME materials, which makes it hard to infer how these differences affect performance and learning. Third, we concluded that the vast majority of the experiments showed at least some positive effects of EMME during learning, on tests directly after learning, and tests after a delay. Finally, our results provide a first indication of which EMME characteristics may positively influence learning. Future research should start to more systematically examine the effects of specific EMME design choices for specific participant populations and task types.

Eye tracking: empirical foundations for a minimal reporting guideline

In this paper, we present a review of how the various aspects of any study using an eye tracker (such as the instrument, methodology, environment, participant, etc.) affect the quality of the recorded eye-tracking data and the obtained eye-movement and gaze measures. We take this review to represent the empirical foundation for reporting guidelines of any study involving an eye tracker. We compare this empirical foundation to five existing reporting guidelines and to a database of 207 published eye-tracking studies. We find that reporting guidelines vary substantially and do not match with actual reporting practices. We end by deriving a minimal, flexible reporting guideline based on empirical research (Section "An empirically based minimal reporting guideline").

A Platform for Tracking Surgeon and Observer Gaze as a Surrogate for Attention in Ophthalmic Surgery

Purpose

To develop and validate a platform that can extract eye gaze metrics from surgeons observing cataract and vitreoretinal procedures and to enable post hoc data analysis to assess potential discrepancies in eye movement behavior according to surgeon experience.

Design

Experimental, prospective, single-center study.

Participants

Eleven ophthalmic surgeons observing deidentified vitreoretinal and cataract surgical procedures performed at a single university-based medical center.

Methods

An open-source platform was developed to extract gaze coordinates and metrics from ophthalmic surgeons via a computer vision algorithm in conjunction with a neural network to track and segment instruments and tissues, identifying areas of attention in the visual field of study subjects. Eleven surgeons provided validation data by watching videos of 6 heterogeneous vitreoretinal and cataract surgical phases.

Main Outcome Measures

Accuracy and distance traveled by the eye gaze of participants and overlap of the participants' eye gaze with instruments and tissues while observing surgical procedures.

Results

The platform demonstrated repeatability of > 94% when acquiring the eye gaze behavior of subjects. Attending ophthalmic surgeons and clinical fellows exhibited a lower overall cartesian distance traveled in comparison to resident physicians in ophthalmology (P < 0.02). Ophthalmology residents and clinical fellows exhibited more fixations to the display area where surgical device parameters were superimposed than attending surgeons (P < 0.05). There was a trend toward gaze overlap with the instrument tooltip location among resident physicians in comparison to attending surgeons and fellows (41.42% vs. 34.8%, P > 0.2). The number and duration of fixations did not vary substantially among groups (P > 0.3).

Conclusions

The platform proved effective in extracting gaze metrics of ophthalmic surgeons. These preliminary data suggest that surgeon gaze behavior differs according to experience.

Oral presentation assessment and image reading behaviour on brain computed tomography reading in novice clinical learners: an eye-tracking study

BACKGROUND

To study whether oral presentation (OP) assessment could reflect the novice learners' interpretation skills and reading behaviour on brain computed tomography (CT) reading.

METHODS

Eighty fifth-year medical students were recruited, received a 2-hour interactive workshop on how to read brain CT, and were assigned to read two brain CT images before and after instruction. We evaluated their image reading behaviour in terms of overall OP post-test rating, the lesion identification, and competency in systematic image reading after instruction. Students' reading behaviour in searching for the target lesions were recorded by the eye-tracking technique and were used to validate the accuracy of lesion reports. Statistical analyses, including lag sequential analysis (LSA), linear mixed models, and transition entropy (TE) were conducted to reveal temporal relations and spatial complexity of systematic image reading from the eye movement perspective.

RESULTS

The overall OP ratings [pre-test vs. post-test: 0 vs. 1 in case 1, 0 vs. 1 in case 2, p < 0.001] improved after instruction. Both the scores of systematic OP ratings [0 vs.1 in both cases, p < 0.001] and eye-tracking studies (Case 1: 3.42 ± 0.62 and 3.67 ± 0.37 in TE, p = 0.001; Case 2: 3.42 ± 0.76 and 3.75 ± 0.37 in TE, p = 0.002) showed that the image reading behaviour changed before and after instruction. The results of linear mixed models suggested a significant interaction between instruction and area of interests for case 1 (p < 0.001) and case 2 (p = 0.004). Visual attention to the target lesions in the case 1 assessed by dwell time were 506.50 ± 509.06 and 374.38 ± 464.68 milliseconds before and after instruction (p = 0.02). However, the dwell times in the case 2, the fixation counts and the frequencies of accurate lesion diagnoses in both cases did not change after instruction.

CONCLUSION

Our results showed OP performance may change concurrently with the medical students' reading behaviour on brain CT after a structured instruction.

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

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.