Abstract
Background
Eye-tracking devices help to understand provider behavior during medical tasks. The aim of this study was to assess participants’ gaze behavior and usability of eye-tracking glasses during airway management in a simulated neonatal resuscitation.
Methods
This study was an observational simulation-based study. The team member assigned to airway management wore head-mounted eye-tracking glasses. Main outcome measures were airway providers’ gaze, dwell time (total amount of time a participant fixates certain areas of interest), and usability of eye-tracking glasses.
Results
Data from 13 participants were included. There were significant differences in dwell time during the scenario (p < 0.001), with participants spending twice as much time on the newborn and instruments as on the monitor and other staff. Participants spent about 25% more time focusing on another provider while the provider was inserting the umbilical vein catheter than in all other times of interest (intervals of time with meaningful events) (p = 0.04). The use of the glasses was perceived easy and not disturbing.
Conclusions
Eye-tracking glasses enhance our understanding of providers’ gaze and perspective during simulated neonatal airway management. Future studies will better characterize the ideal use in real situations.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Katz, T. A. et al. Visual attention on a respiratory function monitor during simulated neonatal resuscitation: an eye-tracking study. Arch. Dis. Child. Fetal Neonatal Ed. 104, F259–F264 (2018).
Law, B. H. Y. et al. Analysis of neonatal resuscitation using eye tracking: a pilot study. Arch. Dis. Child. Fetal Neonatal Ed. 103, F82–F84 (2018).
White, M. R. et al. Getting inside the expert’s head: an analysis of physician cognitive processes during trauma resuscitations. Ann. Emerg. Med. 72, 289–298 (2018).
Mumma, J. M. et al. Bag valve mask ventilation as a perceptual-cognitive skill. Hum. Factors 60, 212–221 (2018).
Damji, O., Lee-Nobbee, P., Borkenhagen, D. & Cheng, A. Analysis of eye-tracking behaviours in a pediatric trauma simulation. CJEM 21, 138–140 (2019).
McNaughten, B. et al. Clinicians’ gaze behaviour in simulated paediatric emergencies. Arch. Dis. Child 103, 1146–1149 (2018).
Szulewski, A. & Howes, D. Combining first-person video and gaze-tracking in medical simulation: a technical feasibility study. ScientificWorldJournal 2014, 975752 (2014).
Williams, B., Quested, A. & Cooper, S. Can eye-tracking technology improve situational awareness in paramedic clinical education? Open Access Emerg. Med. 5, 23–28 (2013).
Henneman, E. A., Marquard, J. L., Fisher, D. L. & Gawlinski, A. Eye tracking: a novel approach for evaluating and improving the safety of healthcare processes in the simulated setting. Simul. Healthc. 12, 51–56 (2017).
Yamada, N. K., Yaeger, K. A. & Halamek, L. P. Analysis and classification of errors made by teams during neonatal resuscitation. Resuscitation 96, 109–113 (2015).
Vine, S. J., Moore, L. J. & Wilson, M. R. Quiet eye training facilitates competitive putting performance in elite golfers. Front. Psychol. 2, 8 (2011).
Wilson, M. R. et al. Gaze training enhances laparoscopic technical skill acquisition and multi-tasking performance: a randomized, controlled study. Surg. Endosc. 25, 3731–3739 (2011).
Brams, S. et al. Does effective gaze behavior lead to enhanced performance in a complex error-detection cockpit task? PLoS ONE 13, e0207439 (2018).
Wyllie, J. et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resuscitation and support of transition of babies at birth. Resuscitation 95, 249–263 (2015).
Perlman, J. M. et al. Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 132, S204–S241 (2015).
Kakkilaya, V. et al. Quality improvement project to decrease delivery room intubations in preterm infants. Pediatrics 143, e20180201 (2019).
Foglia, E. E. et al. Neonatal intubation practice and outcomes: an international registry study. Pediatrics 143, e20180902 (2019).
Marjanovic, N. S., Teiten, C., Pallamin, N. & L’Her, E. Evaluation of emotional excitation during standardized endotracheal intubation in simulated conditions. Ann. Intensive Care 8, 117 (2018).
Browning, M. et al. The use and limits of eye-tracking in high-fidelity clinical scenarios: a pilot study. Int. Emerg. Nurs. 25, 43–47 (2016).
Kok, E. M. et al. Systematic viewing in radiology: seeing more, missing less? Adv. Health Sci. Educ. Theory Pract. 21, 189–205 (2016).
Tien, T. et al. Differences in gaze behaviour of expert and junior surgeons performing open inguinal hernia repair. Surg. Endosc. 29, 405–413 (2015).
Cheng, A., Lang, T. R., Starr, S. R., Pusic, M. & Cook, D. A. Technology-enhanced simulation and pediatric education: a meta-analysis. Pediatrics 133, e1313–e1323 (2014).
Langhan, T. S. et al. Simulation-based training in critical resuscitation procedures improves residents’ competence. CJEM 11, 535–539 (2009).
Mileder, L. P., Urlesberger, B., Szyld, E. G., Roehr, C. C. & Schmolzer, G. M. Simulation-based neonatal and infant resuscitation teaching: a systematic review of randomized controlled trials. Klin. Padiatr. 226, 259–267 (2014).
Wagner, M. et al. Student peer teaching in paediatric simulation training is a feasible low-cost alternative for education. Acta Paediatr. 106, 995–1000 (2017).
Wagner, M. et al. Status quo in pediatric and neonatal simulation in four central European regions: the DACHS survey. Simul. Healthc. 13, 247–252 (2018).
Acknowledgements
We acknowledge the Yale Center for Medical Simulation and Yale Department of Emergency Medicine administrative and technical staff for their contributions to this project, including Jeffrey Hoffman and Luis Cruz.
Author contributions
All authors conceptualized the study and drafted the initial manuscript. The data were analyzed by P.G., I.T.G., K.B., and M.W. The manuscript was drafted and critically reviewed and revised by all authors; all authors approved the final manuscript as submitted.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
About this article
Cite this article
Wagner, M., Gröpel, P., Bibl, K. et al. Eye-tracking during simulation-based neonatal airway management. Pediatr Res 87, 518–522 (2020). https://doi.org/10.1038/s41390-019-0571-9
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41390-019-0571-9
This article is cited by
-
Effect of tele-support on attention levels of emergency medical technicians during simulated out-of-hospital cardiac arrest
Scientific Reports (2025)
-
The newborn delivery room of tomorrow: emerging and future technologies
Pediatric Research (2024)
-
Eye-tracking during simulation-based echocardiography: a feasibility study
BMC Medical Education (2023)
-
Eye-tracking during simulated endotracheal newborn intubation: a prospective, observational multi-center study
Pediatric Research (2023)
-
Human Factors Evaluation of HeartMate 3 Left Ventricular Assist Device Peripherals: An Eye Tracking Supported Simulation Study
Journal of Medical Systems (2023)
