Getting Inside the Expert’s Head: An Analysis of Physician Cognitive Processes During Trauma Resuscitations

White, Matthew; Braund, Heather; Howes, Daniel; Egan, Rylan; Gegenfurtner, Andreas; Merriënboer, Jeroen J. G. van; Szulewski, Adam

doi:10.1016/j.annemergmed.2018.03.005

Cited by 36 publications

(37 citation statements)

References 33 publications

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“…Recent publications show its effectiveness assessing or evaluating in simulating scenarios related to anaphylaxis or paediatric trauma [12,22]. In fact, the accuracy of this tool also resulted in its using in real situations [23].…”

Section: Discussionmentioning

confidence: 99%

ABCDE approach to victims by lifeguards: how do they manage a critical patient? A cross sectional simulation study

Fernández-Méndez

Otero-Agra

Abelairas‐Gómez

et al. 2019

Preprint

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6Introduction: Decision-making in emergencies is a multifactorial process based on the 7 rescuer, patient, setting and resources. The eye-tracking system is a proven method for 8 assessing decision-making process that has been used in different fields of science. Our 9 aim was to evaluate the lifeguards' capacity to perform the ABCDE (Airway-Breathing-10 Circulation-Dissability-Exposure) approach when facing a simulated critically ill-11 drowned victim. 12 Methods:A cross sectional simulation study was designed to assess the skills and 13 sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a 14 victim and act according to his/her clinical status following the ABCDE primary 15 assessment approach. Two kind of variables were recorder: those related to quality of 16 each step of the ABCDE approach; visual behaviour using a portable eye-movement 17 system. The eye-tracking system was the Mobile Eye system (Bedford, USA). 18Results: None of the study participants was able to complete correctly the ABCDE 19 approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), 20 Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants 21 spent more time in viewpoints considered as important (65.5±17.4 s) compared with 22 secondary ones (34.6±17.4 s, p = 0.008). This also was represented in the percentage of 3 23 visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary 24 viewpoints: 36.64±15.06). 25 Conclusion: Professional lifeguards failed to fully perform the ABCDE sequence. 26 Evaluation by experts with the help of eye-tracking technology detected lifeguards' 27 limitations in the assessment and treatment of an eventual critically ill victim. Such 28 deficits should be considered in the design and implementation of lifeguards' training 29 programmes.30

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Section: Discussionmentioning

confidence: 99%

ABCDE approach to victims by lifeguards: how do they manage a critical patient? A cross sectional simulation study

Fernández-Méndez

Otero-Agra

Abelairas‐Gómez

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Our study adds to existing knowledge of the application of eye tracking in medical education, but is the first of its kind in pediatric trauma. [5][6][7] In neonatal resuscitation, gaze preference amongst six expert consultants was focused primarily towards the monitor rather than the neonate. 8 In a simulated pediatric intensive care unit (PICU) environment, expert consultants focused their gaze predominantly on the chest and airway of the patient, whereas novice clinicians had visual preference directed towards the defibrillator.…”

Section: Discussionmentioning

confidence: 99%

“…In the future, we hope to compare and contrast eye-tracking behaviours in trainees versus attending physicians. 7 Assuming that experts have a better sense of what is important to focus on, contrasting this to trainee's visual fixation may identify opportunities for behaviour change. 10 Secondly, we hope to study visual eye tracking in other high-stakes clinical contexts (e.g., cardiac arrest) and during technical skills (e.g., intubation).…”

Section: Discussionmentioning

confidence: 99%

Analysis of eye-tracking behaviours in a pediatric trauma simulation

Damji

Borkenhagen

Cheng

2018

CJEM

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Eye-tracking devices are able to capture eye movements, which are further characterized by fixations. The application of eye tracking in a trauma setting has not been explored. Visual fixation can be utilized as a surrogate measure of attention during the management of a trauma patient. We aimed to determine the feasibility of using eye tracking and to characterize eye tracking behaviours of pediatric emergency medicine physicians during management of a simulated pediatric trauma patient. Each participant was equipped with a head-mounted eye-tracking device during a standardized simulated pediatric trauma scenario. Each session was video recorded, with visual fixations defined as >0.2 seconds, and characterized by start time, duration, and the area of interest. Data from seven videos were analysed; 35% of eye fixations were directed towards the mannequin, 16% towards the monitor, and 13% towards the bedside doctor. Visual eye tracking in a trauma simulation is feasible. Frequency of fixations tends to be highest towards the patient. Eye tracking within trauma simulation may provide new insights into quality improvement and inform advancements in pediatric trauma.

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“…Although some elements of CRM performance are observable, (and therefore able to be assessed and studied with currently available tools), other elements, such as the cognitive processes that underlie CRM skills, are not (White et al, 2018). Our understanding of these invisible cognitive processes remains limited.…”

Section: Introductionmentioning

confidence: 99%

“…In studying trauma team leaders in real clinical settings, we have previously demonstrated that a post-hoc cognitive task analysis augmented by review of first person video generated by an eye-tracking device is a useful technique to uncover these cognitive processes (White et al, 2018). In that study, expert trauma team leaders were found to demonstrate logistic awareness, manage uncertainty, strategically direct their gaze, selectively attend to information, and exhibit anticipatory behaviours while treating critically injured patients.…”

Section: Introductionmentioning

confidence: 99%

Through the eyes of the physician

Szulewski

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Getting Inside the Expert’s Head: An Analysis of Physician Cognitive Processes During Trauma Resuscitations

Cited by 36 publications

References 33 publications

ABCDE approach to victims by lifeguards: how do they manage a critical patient? A cross sectional simulation study

ABCDE approach to victims by lifeguards: how do they manage a critical patient? A cross sectional simulation study

Analysis of eye-tracking behaviours in a pediatric trauma simulation

Through the eyes of the physician

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