Eye tracking metrics and leader's behavioral performance during a post-partum hemorrhage high-fidelity simulated scenario

Emanuele Capogna, Giorgio Capogna, Denise Raccis, Francesco Salvi, Matteo Velardo, Angelica Del Vecchio, Emanuele Capogna, Giorgio Capogna, Denise Raccis, Francesco Salvi, Matteo Velardo, Angelica Del Vecchio

Abstract

Background: The use of eye tracking in the simulated setting can help improve our understanding of what sources of information clinicians are using as they deliver routine patient care. The aim of this simulation study was to observe the differences, if any, between the eye tracking patterns of leaders who performed best in a simulated postpartum hemorrhage (PPH) high-fidelity scenario, in comparison with those who performed worst.

Methods: Forty anesthesia trainees from the University of Catania Medical School were divided into eight teams, to enact four times the same scenario of a patient with postpartum hemorrhage following vaginal delivery. Trainees who were assigned the leader's role wore the eye tracking glasses during the scenario, and their behavioral skills were evaluated by two observers, who reviewed the video recordings of the scenarios using a standardized checklist. The leader's eye tracking metrics, extracted from 27 selected areas of interest (AOI), were recorded by a Tobii Pro Glasses 50 Hz wearable wireless eye tracker. Team performance was evaluated using a PPH checklist. After completion of the study, the leaders were divided into two groups, based on the scores they had received (High-Performance Leader group, HPL, and Low-Performance Leader group, LPL).

Results: In the HPL group, the duration and number of fixations were greater, and the distribution of gaze was uniformly distributed among the various members of the team as compared with the LPL group (with the exception of the participant who performed the role of the obstetrician). The HPL group also looked both at the patient's face and established eye contact with their team members more often and for longer (P < .05). The team performance (PPH checklist) score was greater in the HPL group (P < .001). The LPL group had more and/or longer fixations of technical areas of interest (P < .05).

Conclusions: Our findings suggest that the leaders who perform the best distribute their gaze across all members of their team and establish direct eye contact. They also look longer at the patient's face and dwell less on areas that are more relevant to technical skills. In addition, the teams led by these best performing leaders fulfilled their clinical task better. The information provided by the eye behaviors of "better-performing physicians" may lay the foundation for the future development of both the assessment process and the educational tools used in simulation.

Trial registration: Clinical.Trial.Gov ID n. NCT04395963 .

Keywords: Behavioral skills; Eye tracking; High-fidelity scenario.

Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Areas of interest (AOI) concerning the environment/simulation room
Fig. 2
Fig. 2
Areas of interest (AOI) concerning the participants and the environment/simulation room
Fig. 3
Fig. 3
Areas of interest (AOI) concerning the manikin
Fig. 4
Fig. 4
Radar plot describing duration and number of fixations of the leaders on each of the participants in the scenario. HPL High-performance leader group, LPL Low-performance leader group
Fig. 5
Fig. 5
Radar plot describing number and duration of fixation of the leader on the environment, simulation room, and manikin. HPL High-performance leader group, LPL Low-performance leader group
Fig. 6
Fig. 6
Radar plot describing number and duration of fixation of the leader on the manikin. HPL High-Performance Leader Group, LPL Low-Performance Leader Group
Fig. 7
Fig. 7
Heat maps of the high-performing leaders. The hotter the point (from green to red), the greater the cumulative fixation time in the region of interest
Fig. 8
Fig. 8
Heat maps of the low-performing leaders. The hotter the point (from green to red), the greater the cumulative fixation time in the region of interest

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