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Vergara-Escudero E, Gherciuc A, Buyck D, Eid A, Arango S, Richardson S, Perry TE. Initial Experience of Using First-Person Wearable Video Recording Technology During Central Venous Catheter Placement in the Cardiac Operating Room. J Cardiothorac Vasc Anesth 2024; 38:1409-1416. [PMID: 38503625 DOI: 10.1053/j.jvca.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The aim of this study was to use wearable video-recording technology to measure precisely the timing of discrete events during perioperative central venous catheter (CVC) placements. DESIGN A single-center, observational, exploratory study on the use of wearable video-recording technology during intraoperative CVC placement. SETTING The study was conducted at a University Hospital. PARTICIPANTS Clinical anesthesia residents, cardiothoracic anesthesia fellows, and attending anesthesiologists participated in this study. INTERVENTIONS Participants were asked to use eye-tracking glasses prior to the placement of a CVC in the cardiac operating rooms. No other instruction was given to the participants. MEASUREMENTS AND MAIN RESULTS The authors measured the total time to complete the CVC placement, phase-specific time, and specific times of interest. They compared these times across 3 training levels and tested differences with analysis of variance. The authors' findings indicated significant differences in total CVC placement time when the procedure included a pulmonary artery catheter insertion (1,170 ± 364, 923 ± 272, and 596 ± 226 seconds; F2,63 = 12.71, p < 0.0001). Additionally, they found differences in interval times and times of interest. The authors observed a reduction of variability with increasing experience during the CVC placement phase. CONCLUSIONS In this observational study, the study authors describe their experience using first-person wearable video-recording technology to precisely measure the timing of discrete events during CVC placement by anesthesia residents and anesthesiologists. Future work will leverage the eye-tracking capabilities of the existing hardware to identify areas of inefficiency to develop actionable targets for interventions that could improve trainee performance and patient safety.
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Affiliation(s)
- Enrique Vergara-Escudero
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, University of Minnesota, Minneapolis, MN.
| | | | | | - Aya Eid
- University of Minnesota Medical School, Minneapolis, MN
| | - Susana Arango
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, University of Minnesota, Minneapolis, MN
| | - Stephen Richardson
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, University of Minnesota, Minneapolis, MN
| | - Tjörvi E Perry
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, University of Minnesota, Minneapolis, MN
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Liu X, Sanchez Perdomo YP, Zheng B, Duan X, Zhang Z, Zhang D. When medical trainees encountering a performance difficulty: evidence from pupillary responses. BMC MEDICAL EDUCATION 2022; 22:191. [PMID: 35305623 PMCID: PMC8934497 DOI: 10.1186/s12909-022-03256-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/13/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical trainees are required to learn many procedures following instructions to improve their skills. This study aims to investigate the pupillary response of trainees when they encounter moment of performance difficulty (MPD) during skill learning. Detecting the moment of performance difficulty is essential for educators to assist trainees when they need it. METHODS Eye motions were recorded while trainees practiced the thoracostomy procedure in the simulation model. To make pupillary data comparable among trainees, we proposed the adjusted pupil size (APS) normalizing pupil dilation for each trainee in their entire procedure. APS variables including APS, maxAPS, minAPS, meanAPS, medianAPS, and max interval indices were compared between easy and difficult subtasks; the APSs were compared among the three different performance situations, the moment of normal performance (MNP), MPD, and moment of seeking help (MSH). RESULTS The mixed ANOVA revealed that the adjusted pupil size variables, such as the maxAPS, the minAPS, the meanAPS, and the medianAPS, had significant differences between performance situations. Compared to MPD and MNP, pupil size was reduced during MSH. Trainees displayed a smaller accumulative frequency of APS during difficult subtask when compared to easy subtasks. CONCLUSIONS Results from this project suggest that pupil responses can be a good behavioral indicator. This study is a part of our research aiming to create an artificial intelligent system for medical trainees with automatic detection of their performance difficulty and delivering instructional messages using augmented reality technology.
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Affiliation(s)
- Xin Liu
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, T6G 2E1, Canada
- Beijing Key Laboratory of Knowledge Engineering for Materials Science, Beijing, 100083, China
| | - Yerly Paola Sanchez Perdomo
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Bin Zheng
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
- Department of Surgery, Faculty of Medicine and Dentistry, 162 Heritage Medical Research Centre, University of Alberta, 8440 112 St. NW. Edmonton, Alberta, T6G 2E1, Canada.
| | - Xiaoqin Duan
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, T6G 2E1, Canada
- Department of Rehabilitation Medicine, Second Hospital of Jilin University, Changchun, Jilin, 130041, China
| | - Zhongshi Zhang
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, T6G 2E1, Canada
- Department of Biological Sciences, University of Alberta, Edmonton, AB, T6G 2E9, Canada
| | - Dezheng Zhang
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China
- Beijing Key Laboratory of Knowledge Engineering for Materials Science, Beijing, 100083, China
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Wagner M, den Boer MC, Jansen S, Groepel P, Visser R, Witlox RSGM, Bekker V, Lopriore E, Berger A, te Pas AB. Video-based reflection on neonatal interventions during COVID-19 using eye-tracking glasses: an observational study. Arch Dis Child Fetal Neonatal Ed 2022; 107:156-160. [PMID: 34413092 PMCID: PMC8384497 DOI: 10.1136/archdischild-2021-321806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to determine the experience with, and the feasibility of, point-of-view video recordings using eye-tracking glasses for training and reviewing neonatal interventions during the COVID-19 pandemic. DESIGN Observational prospective single-centre study. SETTING Neonatal intensive care unit at the Leiden University Medical Center. PARTICIPANTS All local neonatal healthcare providers. INTERVENTION There were two groups of participants: proceduralists, who wore eye-tracking glasses during procedures, and observers who later watched the procedures as part of a video-based reflection. MAIN OUTCOME MEASURES The primary outcome was the feasibility of, and the proceduralists and observers' experience with, the point-of-view eye-tracking videos as an additional tool for bedside teaching and video-based reflection. RESULTS We conducted 12 point-of-view recordings on 10 different patients (median gestational age of 30.9±3.5 weeks and weight of 1764 g) undergoing neonatal intubation (n=5), minimally invasive surfactant therapy (n=5) and umbilical line insertion (n=2). We conducted nine video-based observations with a total of 88 observers. The use of point-of-view recordings was perceived as feasible. Observers further reported the point-of-view recordings to be an educational benefit for them and a potentially instructional tool during COVID-19. CONCLUSION We proved the practicability of eye-tracking glasses for point-of-view recordings of neonatal procedures and videos for observation, educational sessions and logistics considerations, especially with the COVID-19 pandemic distancing measures reducing bedside teaching opportunities.
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Affiliation(s)
- Michael Wagner
- Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Maria C den Boer
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sophie Jansen
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Groepel
- Department of Applied Psychology, University of Vienna, Vienna, Austria
| | - Remco Visser
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ruben S G M Witlox
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Vincent Bekker
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Angelika Berger
- Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Arjan B te Pas
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Andrew Wright G, Patel R, Perez-Edgar K, Fu X, Brown K, Adhikary S, Zurca A. Eye-Tracking Technology to Determine Procedural Proficiency in Ultrasound-Guided Regional Anesthesia. THE JOURNAL OF EDUCATION IN PERIOPERATIVE MEDICINE : JEPM 2022; 24:E684. [PMID: 35707014 PMCID: PMC9176401 DOI: 10.46374/volxxiv_issue1_zurca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Eye-tracking measures attention patterns, which may offer insight into evaluating procedural expertise. The purpose of this study was to determine the feasibility of using eye tracking to assess visual fixation patterns when performing an ultrasound-guided regional anesthesia procedure and to assess for differences between experienced, intermediate, and novice practitioners. Methods Participants performed an ultrasound-guided sciatic nerve block 3 times on a fresh cadaver model while wearing eye-tracking glasses. Gaze fixation and dwell time on each location were compared between participants. Eye-gaze paths were used to derive a measure of entropy, or how often participants switched gaze fixations between locations. Results Five attending anesthesiologists, 5 third-year anesthesiology residents with prior ultrasound-guided regional anesthesia experience, and 5 medical students completed the study. Individuals with more experience were more likely to successfully perform the sciatic nerve block (5/5 attendings, 5/5 residents, 0/5 students; P = .002) and performed the procedure faster (average: attendings 62.6 seconds, residents 106.4 seconds, students 134.4 seconds; P = .089). Participants were progressively faster with practice (Trial 1: 41.8 seconds, Trial 2: 29.2 seconds, Trial 3: 28.9 seconds; P = .012), and the average number of eye shifts per trial decreased from 10.8 to 6.5 to 6 (P = .010). Attending physicians spent significantly less time fixating on the ultrasound monitor compared to trainees (P = .035). Average visual entropy progressively decreased from Trial 1 to Trial 3 (P = .03) and with greater experience (P = .15). There was a strong correlation between entropy and time on task (r(16) = 0.826, P = .001). Conclusions Experienced providers make fewer back-and-forth visual fixations, spend less time in the procedure, and demonstrate less entropy during ultrasound-guided regional anesthesia procedures. Mobile eye-tracking has the potential to provide additional objective measures of performance that may help not only determine procedural competence but also distinguish between levels of proficiency.
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Affiliation(s)
- G Andrew Wright
- is a medical student; is a medical student; is a Professor of Anesthesiology and Perioperative Medicine; is an Associate Professor of Pediatrics at Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, PA
| | - Rahool Patel
- is a medical student; is a medical student; is a Professor of Anesthesiology and Perioperative Medicine; is an Associate Professor of Pediatrics at Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, PA
| | - Koraly Perez-Edgar
- is a Professor of Child Studies and Professor of Psychology; is a graduate student in the Developmental Psychology program at The Pennsylvania State University, Department of Psychology, University Park, PA
| | - Xiaoxue Fu
- is a graduate student in the Developmental Psychology programat The Ohio State University, Nationwide Children's Hospital, Columbus, OH
| | - Kayla Brown
- is a Professor of Child Studies and Professor of Psychology; is a graduate student in the Developmental Psychology program at The Pennsylvania State University, Department of Psychology, University Park, PA
| | - Sanjib Adhikary
- is a medical student; is a medical student; is a Professor of Anesthesiology and Perioperative Medicine; is an Associate Professor of Pediatrics at Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, PA
| | - Adrian Zurca
- is a medical student; is a medical student; is a Professor of Anesthesiology and Perioperative Medicine; is an Associate Professor of Pediatrics at Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, PA
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