Andreas Gegenfurtner, D. Dagnone, J.J.G. van Merriënboer, McGraw, Nick C J, A. Hall, D. Howes, A. Szulewski, G. Dashi, R. Egan
A new way to look at simulation-based assessment: the relationship between gaze-tracking and exam performance
Canadian Journal of Emergency Medicine (CJEM), vol. 21, no. 1, pp. 129-137
CLINICIAN'S CAPSULEWhat is known about this topic?Gathering visual information effectively is an important task of a physician leader when managing a resuscitation case.What did this study ask?Are there particular visual information-gathering patterns associated with performance in simulated resuscitation scenarios?What did this study find?Certain visual patterns (e.g., focusing on case-specific clinically relevant stimuli) are associated with better performance in a simulated resuscitation setting.Why does this study matter to clinicians?The ability to characterize physician visual patterns across a competence continuum has implications for trainee assessment and medical education.
Andreas Gegenfurtner, Matthew White, Heather Braund, J.J.G. van Merriënboer, D. Howes, A. Szulewski, R. Egan
Getting Inside the Expert's Head: An Analysis of Physician Cognitive Processes During Trauma Resuscitations
Annals of emergency medicine, vol. 72, no. 3, pp. 289-298
Crisis resource management skills are integral to leading the resuscitation of a critically ill patient. Despite their importance, crisis resource management skills (and their associated cognitive processes) have traditionally been difficult to study in the real world. The objective of this study was to derive key cognitive processes underpinning expert performance in resuscitation medicine, using a new eye-tracking-based video capture method during clinical cases.
During an 18-month period, a sample of 10 trauma resuscitations led by 4 expert trauma team leaders was analyzed. The physician team leaders were outfitted with mobile eye-tracking glasses for each case. After each resuscitation, participants were debriefed with a modified cognitive task analysis, based on a cued-recall protocol, augmented by viewing their own first-person perspective eye-tracking video from the clinical encounter.
Eye-tracking technology was successfully applied as a tool to aid in the qualitative analysis of expert performance in a clinical setting. All participants stated that using these methods helped uncover previously unconscious aspects of their cognition. Overall, 5 major themes were derived from the interviews: logistic awareness, managing uncertainty, visual fixation behaviors, selective attendance to information, and anticipatory behaviors.
The novel approach of cognitive task analysis augmented by eye tracking allowed the derivation of 5 unique cognitive processes underpinning expert performance in leading a resuscitation. An understanding of these cognitive processes has the potential to enhance educational methods and to create new assessment modalities of these previously tacit aspects of expertise in this field.
E. Kok, Andreas Gegenfurtner, K. van Geel, H. Jarodzka, J.J.G. van Merriënboer, A. Bruin, A. Szulewski
The challenges of studying visual expertise in medical image diagnosis
Medical Education, vol. 51, no. 1, pp. 97-104
Visual expertise is the superior visual skill shown when executing domain-specific visual tasks. Understanding visual expertise is important in order to understand how the interpretation of medical images may be best learned and taught. In the context of this article, we focus on the visual skill of medical image diagnosis and, more specifically, on the methodological set-ups routinely used in visual expertise research.
We offer a critique of commonly used methods and propose three challenges for future research to open up new avenues for studying characteristics of visual expertise in medical image diagnosis. The first challenge addresses theory development. Novel prospects in modelling visual expertise can emerge when we reflect on cognitive and socio-cultural epistemologies in visual expertise research, when we engage in statistical validations of existing theoretical assumptions and when we include social and socio-cultural processes in expertise development. The second challenge addresses the recording and analysis of longitudinal data. If we assume that the development of expertise is a long-term phenomenon, then it follows that future research can engage in advanced statistical modelling of longitudinal expertise data that extends the routine use of cross-sectional material through, for example, animations and dynamic visualisations of developmental data. The third challenge addresses the combination of methods. Alternatives to current practices can integrate qualitative and quantitative approaches in mixed-method designs, embrace relevant yet underused data sources and understand the need for multidisciplinary research teams.
Embracing alternative epistemological and methodological approaches for studying visual expertise can lead to a more balanced and robust future for understanding superior visual skills in medical image diagnosis as well as other medical fields.
Andreas Gegenfurtner, J.J.G. van Merriënboer, D. Howes, M. Sivilotti, A. Szulewski
Measuring physician cognitive load: Validity evidence for a physiologic and a psychometric tool
Advances in Health Sciences Education - Theory and Practice, no. October, pp. 1-18
In general, researchers attempt to quantify cognitive load using physiologic and psychometric measures. Although the construct measured by both of these metrics is thought to represent overall cognitive load, there is a paucity of studies that compares these techniques to one another. The authors compared data obtained from one physiologic tool (pupillometry) to one psychometric tool (Paas scale) to explore whether they actually measured the construct of cognitive load as purported. Thirty-two participants with a range of resuscitation medicine experience and expertise completed resuscitation-medicine based multiple-choice-questions as well as arithmetic questions. Cognitive load, as measured by both tools, was found to be higher for the more difficult questions as well as for questions that were answered incorrectly (p < 0.001). The group with the least medical experience had higher cognitive load than both the intermediate and experienced groups when answering domain-specific questions (p = 0.023 and p = 0.003 respectively for the physiologic tool; p = 0.006 and p < 0.001 respectively for the psychometric tool). There was a strong positive correlation (Spearman's ρ = 0.827, p < 0.001 for arithmetic questions; Spearman's ρ = 0.606, p < 0.001 for medical questions) between the two cognitive load measurement tools. These findings support the validity argument that both physiologic and psychometric metrics measure the construct of cognitive load.