Examining Clinical Reasoning With Eye Tracking

Objective:

In this project, the investigators plan to apply the eye-tracking technology to medical education with a specific goal of examining cognitive processing during clinical reasoning (CR). The investigators expect that by checking the eye movements of medical trainees during case and image reading, a list of valid behavioral markers could be created, to quantitatively classify the expertise, identify the moment of decision-making difficulty, and decode the source of the judgement errors. To examine differences in CR processes across varying levels of expertise, three categories of participants (novice, intermediate, and expert) will be recruited. While participants' eye motions are tracked, participants will read a trauma case, provide a diagnosis and propose a suitable treatment plan. The investigators postulate that 1) different participant groups will produce significantly different CR outcomes, measured by their score on diagnostic judgement and treatment plan; 2) participants will display different gaze fixation patterns; and 3) combining evidence from clinical judgement and eye behavior analysis will provide useful information regarding the source of judgment errors.

Research Method/Procedures:

Staff and students in the SSRL (Surgical Simulation Research Lab) with a difficulty level of health training background will be enrolled as participants in the study. A trauma case with complex life-threatening situations will be presented. The case is a trauma cases with multiple internal injuries. The case will be summarized into a one-page description and 3 x-ray films. Our participants will need to make a diagnosis and give a treatment plan based on case information displayed on a screen. The total reading time will be 4 minutes. During the case reading, the Tobii X2-60, a high-resolution remote eye-tracker, will be used to capture the participant's eye movements. In addition, the investigators will develop a 15-20 quiz regarding the patient's condition and the participant's final diagnosis. The total score and errors in the quiz will be used to describe participants' overall quality of their clinical reasoning.

The investigators will carefully examine participants' eye motions and report their scanning patterns during case reading. Specifically, the investigators will look for moments when participants rapidly move their eyes (saccade) over a sentence before fixating on a particular word (fixation). These eye behavior parameters have previous associations with mental workload and reasoning processing methods, which can be used to further analyze results.