Impact of an educational intervention on eye gaze behaviour in retinal image interpretation by consultant and trainee ophthalmologists

Abstract

This study uses eye-tracking technology to assess the differences in gaze behaviours between ophthalmologists of different experience levels while interpreting retinal images of diabetic retinopathy. The differences in gaze behaviours before and after a teaching intervention which introduced a suggested search strategy is also investigated. A total of 9 trainees and 10 consultant ophthalmologists interpreted six retinal images. They were then shown a 5-min tutorial that demonstrated a search strategy. This was followed by six further retinal image interpretations. Participants completed questionnaires indicating clinical signs seen, appropriate retinopathy grade, and confidence. Eye movements were tracked during each interpretation.Overall, trainees compared to consultants demonstrated more uncertain and unstructured gaze behaviours. Trainee eye gaze metrics included: longer interpretation time, 36.5 s (SD = 6.2 vs. 31.4 s) (SD = 4.2) (p = 0.024), higher visit count, 17.38 visits (SD = 5.13) versus 12.18 visits(SD = 2.64) (p = 0.01), higher proportion of fixation, 57.0 per cent (SD = 5) versus 50.5 per cent (SD = 5) (p = 0.05) and shorter time to first fixation, 0.232 s (SD = 0.10) versus 0.821 s (SD = 0.77) (p = 0.001), respectively. The teaching intervention resulted in more focused gaze patterns in both groups. Pre-intervention and post-intervention mean proportion fixation on areas of interest were 38.6 per cent (SD = 6.8) and 51.8 per cent (SD = 13.9) for the trainee group, respectively, and 39.9 per cent (SD = 4.1) and 50.9 per cent (SD = 9.3) for the consultant group (p = 0.01).Consultants used more systematic and efficient approaches than trainees during interpretation. After the introduction of a suggested search strategy, trainees showed trends towards consultant eye gaze behaviours. Eye tracking gives an interesting insight into the thought processes of physicians carrying out complex tasks. The implication is that eye tracking may have future use in teaching and assessment. Its use in objectively assessing different teaching strategies could be a valuable tool for medical education.

A Platform for Tracking Surgeon and Observer Gaze as a Surrogate for Attention in Ophthalmic Surgery

“…These data may be inconsistent with some studies of the eye movement patterns among surgeons: previous research has suggested that experts, compared with nonexperts, have more focused attention and elaborate visual representation during the performance of a task; this can be represented by increased fixation rates and a higher proportion of fixation within an area of interest. 11 , 17 , 35 However, Sodergren et al 36 suggested that, even though experts can demonstrate a greater perceptual span and more rapid information acquisition with more fixations of shorter length, in some situations, this group may concentrate their gaze only on pertinent areas of view, with the AOI having a prominent place in the analysis. When analyzing the average gaze distance traveled by each group in Table 3 , our data reveal that expert surgeons may focus on more relevant loci without loss of attention, represented by decreased cartesian distances traveled by their gaze.…”

“…Shahimin et al 16 analyzed patterns in eye movements between ophthalmologists and optometrists when assigning diagnoses to digital fundus photographs assessing fixed AOIs such as the optic disc, macula, and blood vessels. Shirley et al 17 identified that trainees could improve their search strategy after analyzing gaze data from expert clinicians when viewing retinal images. The extraction of metrics and features in eye-tracking research during surgery is currently limited: contemporary platforms fail to provide integration with relevant tools and heterogeneous methods for gaze acquisition.…”

Capturing the clinical decision-making processes of expert and novice diabetic retinal graders using a ‘think-aloud’ approach

“…Workshops have been conducted internationally for clinicians to learn how to incorporate the TA method into training programmes, and feedback suggests that these methods may be effective [ 27 ]. Eye-tracking technology to assess differences in gaze behaviours between experts and novice graders could be included in upcoming DR educational interventions in Vietnam [ 40 , 41 ]. A study in the UK reported that trainees demonstrated more uncertain gaze behaviours compared to consultants when interpreting images for DR [ 41 ].…”

“…Eye-tracking technology to assess differences in gaze behaviours between experts and novice graders could be included in upcoming DR educational interventions in Vietnam [ 40 , 41 ]. A study in the UK reported that trainees demonstrated more uncertain gaze behaviours compared to consultants when interpreting images for DR [ 41 ]. The authors recommended that eye tracking would be beneficial for medical educational interventions in the future [ 41 ].…”

“…A study in the UK reported that trainees demonstrated more uncertain gaze behaviours compared to consultants when interpreting images for DR [ 41 ]. The authors recommended that eye tracking would be beneficial for medical educational interventions in the future [ 41 ]. Regular meetings and discussions on DR cases in hospital settings in Vietnam, together with a range of novice and expert graders may be useful for quality improvement purposes.…”