Abstract P86: Eye Tracking Identifies Cognitive Deficiencies in Central Line Placement: Implications for Resuscitation Training
Introduction: The IOM and Flexner reports document suboptimal healthcare delivery traceable to deficiencies in medical education. Few tools exist to allow objective monitoring of trainee cognition at either the bedside or during use of simulators. The introduction of an eye tracking device (ETD) offers the opportunity to track the learner’s perspective and identify cognitive processes leading to errors. Without the viewpoint from the learner, enhancing performance and closing feedback loops is difficult.
Hypothesis: An ETD objectively identifies cognitive performance errors in central line (CL) placement.
Methods: Six Emergency Medicine residents formally trained for CL placement participated in the task of inserting a subclavian CL into the Laerdal® IV Torso simulator. The residents wore the ETD which monitored and tracked objects in the cyclopean line of vision while simultaneously recording the scene. The device produced a video image which precisely identified the focus of the learner’s field of view. The performance data was reviewed against a 22 step procedural check list. Tasks performance was recorded to a weighted scoring system described as incomplete(0), partially complete(1), and complete(2). Video data was also reviewed to see if eye movement patterns could be identified in relation to performance.
Results: Only 2 of six residents completed the task satisfactory scoring 38 – 43 of 44 points. The ETD identified cognitive errors for each subject. Data indicated multiple cognitive processes occurred in a fraction of a second before any objective initiation of a step. Errors were associated with saccadic eye movement coupled with delayed task execution. Early cognitive errors led to performance failures later in the process. These errors could be traced to errors in training.
Conclusion: The ETD in CL placement identified cognitive deficiency in task performance with enough precision to redress such errors. Use of an ETD may have important implications in patient training and evaluation in simulated or actual patients undergoing resuscitation procedures, resuscitation management and emergency care management.