Introduction: Eye tracking is the process of measuring an individual's eye movements to register their attentional behavior by using a device called an eye-tracker. Studies conducted using eye-tracking techniques have demonstrated a number of differences in eye movement parameters and patterns between experts and novices. The aim of this preliminary study was to evaluate if there are any differences in eye-tracking metrics between novice and expert anesthesiologists during the performance of an epidural block using an epidural simulator. Methods: Seven experts and seven novices who gave their consent to this preliminary study were asked to perform an epidural technique using an epidural simulator while wearing a pair of Tobii Pro glasses. Number of fixations, fixation duration, heat maps and scan-paths were examined by Tobii Pro Lab Software. Duration of the procedure was also recorded. Results: The observation of the attentional heat map and gaze plot showed different gaze dispersion between experts and novices. The mean total duration of fixations during needle insertion and advancement and catheter introduction was lower in experts than trainees (respectively, 0.18 vs 3.56 sec; P<0.05 and 0.73 vs 2.48 sec; P<0.05). The mean fixation count was greater in experts vs trainees (5 vs 2; P<0.05). The mean duration of the epidural procedure was 104.16 (41) (trainees) vs 65.3 (32.6) seconds (experts) (P<0.05). Expert anesthesiologists spent more time fixating a more specific target location (eg, the point of the epidural needle rather than the syringe's barrel) whilst novices split their attention between tracking their tools and the target location. Discussion: Eye tracking may have interesting implications for the creation of assessment programs, which distinguish skill level through the use of gaze behavior, and may be a promising tool for monitoring training progress towards the development of expertise.

BACKGROUND Current literature demonstrates the ability of eye tracking to provide reliable quantitative data as an objective assessment tool, with potential applications to medical and surgical training to improve performance. OBJECTIVE The aim of this study was to evaluate the changes in gaze behavior in anesthesia novice trainees when performing a simulated epidural technique before and after a hands-on training on the epidural simulator. METHODS We enrolled 48 novice trainees who had never previously performed an epidural block. After a standardized learning module, each trainee practiced the epidural procedure on the epidural simulator while wearing a pair of eye tracking glasses (Tobii Pro Glasses 50 Hz wearable wireless eye tracker). After this baseline recording, each trainee spent two hours practicing with the epidural simulator and afterwards once again performed the eye tracking epidural procedure. Eye tracking metrics and epidural learning (duration of the procedure and number of attempts) before and after the simulated practice were recorded. RESULTS The duration of the epidural procedure was shorter and the number of epidural attempts reduced after the tutorial. Before the tutorial, during needle insertion. the eye tracking metrics showed more visit counts of shorter duration and after the tutorial less visit counts (P=.05) but of longer duration (P=.03). A significant correlation was observed between the number of epidural needle insertions (additional attempts) and the number (OR=2.02 (0.23-1.27; P=.008)) and duration (OR=0.65 (-0.93-0.02; P=.05)) of visits. CONCLUSIONS In novice anesthesia trainees who had never previously performed an epidural block, we observed significant changes in gaze behavior associated with increased performance during the initial phase of epidural technique learning with a simulator. These results may create a prototype for future studies on eye tracking technique as a teaching and evaluating tool in simulation. CLINICALTRIAL Not necessary