Looks can be deceiving: Gaze pattern differences between novices and experts during placement of central lines

• Published in: The American journal of surgery Vol. 217; no. 2; pp. 362 - 367
• Main Authors: Chen, Hong-En, Sonntag, Cheyenne C., Pepley, David F., Prabhu, Rohan S., Han, David C., Moore, Jason Z., Miller, Scarlett R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2019; Elsevier Limited
• Subjects: Automation; Catheterization; Catheterization, Central Venous; Central venous catheterization; Clinical Competence; Cognition & reasoning; Cognitive ability; Education, Medical, Graduate - methods; Experts; Eye movements; Eye tracking; Feedback; Humans; Internship and Residency - methods; Intubation; Laparoscopy; Manikins; Medical personnel; Medical training simulation; Placement; Realism; Residency training; Robotic surgery; Robotics - education; Simulation; Simulator fidelity; Simulators; Skills; Structure-function relationships; Studies; Surgeons; Surgery; Training; Ultrasonic imaging; Ultrasonography, Interventional; Ultrasound; Medical training simulation; Residency training; Eye tracking; Central venous catheterization
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2018.11.007

The objective of this study was to determine whether gaze patterns could differentiate expertise during simulated ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) and if expert gazes were different between simulators of varying functional and structural fidelity. A 2017 study compared eye gaze patterns of expert surgeons (n = 11), senior residents (n = 4), and novices (n = 7) during CVC needle insertions using the dynamic haptic robotic trainer (DHRT), a system which simulates US-IJCVC. Expert gaze patterns were also compared between a manikin and the DHRT. Expert gaze patterns were consistent between the manikin and DHRT environments (p = 0.401). On the DHRT system, CVC experience significantly impacted the percent of time participants spent gazing at the ultrasound screen (p < 0.0005) and the needle and ultrasound probe (p < 0.0005). Gaze patterns differentiate expertise during ultrasound-guided IJCVC placement and the fidelity of the simulator does not impact gaze patterns. •Expert gaze patterns are consistent between simulators of varying structural and functional fidelity.•Gaze patterns differentiate expertise during ultrasound-guided CVC placement.•Novices spend significantly more time tracking tools than experts and senior residents.•Gaze training may complement skills training in image-guided surgical procedures.