Presented by: Courtney Yong MD
Indiana University

Introduction

While eye tracking habits have been shown to differ between complete novices with no surgical experience and experts, there has not been evidence to show a gradient of eye tracking behaviors during the development of surgical skills in training. We sought to determine whether there is measurable progress using eye tracking behavior during surgical training.

Materials

With IRB approval, urology residents, fellows, and attendings were recruited to participate in the study. The subjects were asked to watch a deidentified video of the bladder neck dissection during a prostatectomy that no participant had previously seen. The eye tracking habits of the subjects were measured using Tobii-pro glasses (Tobii Pro Lab, Tobii AB, Danderyd Municipality, Sweden). An area-of-interest analysis was conducted with a target/non-target approach, in which an expert clinician identified a region of interest throughout the video. Statistical analysis on the eye tracking measurements was carried out using an independent samples Kruskal-Wallis test.

Results

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13 subjects were recruited: 4 experts (attendings), 5 novices (PGY 1-3), and 4 intermediates (PGY 5 and fellows). Novices were found to have a significantly lower percentage of eye fixations (93.2% ± 1.98) that were on target compared to experts (98.0% ± 1.02), while the intermediates were between the two (95.8% ± 2.35). All three groups were significantly different from each other (p=0.036, figure 1A). Average fixation duration was higher and more variable in intermediate-level trainees (2.44±1.18 seconds), with experts (1.37±0.46 seconds) and novices (1.18±0.32 seconds) having similar shorter fixation duration, although this was not statistically significant. Novices had significantly more total visits for both the target and non-target area than experts, with intermediate level trainees having more variation (p=0.02, figure 1B).

Conclusion

There is a measurable gradient in eye tracking habits from junior residents to senior residents and from senior residents to attendings. Further study into eye tracking habits during training may allow eye tracking as an objective measure for evaluation and assessment of surgical trainees.

Funding

Pilot Grant from the Purdue Institute for Cancer Research

Co-Authors

Haozhi Chen,
Purdue University

Chinade Roper,
Indiana University School of Medicine

Chandru Sundaram, MD
Indiana University

Denny Yu, PhD
Purdue University