• Adam Szulewski, Rylan Egan, Andreas Gegenfurtner, Daniel Howes, Gerhard Dashi, Nick C J McGraw, Andrew K Hall, Damon Dagnone, and van Merrienboer Jeroen J G JJG ǁDepartment of Educational Development and Research,Faculty of Health,Medicine and Life Sciences,Maastricht University,Maastricht,The Nethe.
• *Department of Emergency Medicine,Queen's University,Kingston, ON.
• Can J Emerg Med. 2019 Jan 1; 21 (1): 129-137.

ObjectiveA key task of the team leader in a medical emergency is effective information gathering. Studying information gathering patterns is readily accomplished with the use of gaze-tracking glasses. This technology was used to generate hypotheses about the relationship between performance scores and expert-hypothesized visual areas of interest in residents across scenarios in simulated medical resuscitation examinations.MethodsEmergency medicine residents wore gaze-tracking glasses during two simulation-based examinations (n=29 and 13 respectively). Blinded experts assessed video-recorded performances using a simulation performance assessment tool that has validity evidence in this context. The relationships between gaze patterns and performance scores were analyzed and potential hypotheses generated. Four scenarios were assessed in this study: diabetic ketoacidosis, bradycardia secondary to beta-blocker overdose, ruptured abdominal aortic aneurysm and metabolic acidosis caused by antifreeze ingestion.ResultsSpecific gaze patterns were correlated with objective performance. High performers were more likely to fixate on task-relevant stimuli and appropriately ignore task-irrelevant stimuli compared with lower performers. For example, shorter latency to fixation on the vital signs in a case of diabetic ketoacidosis was positively correlated with performance (r=0.70, p<0.05). Conversely, total time spent fixating on lab values in a case of ruptured abdominal aortic aneurysm was negatively correlated with performance (r= −0.50, p<0.05).ConclusionsThere are differences between the visual patterns of high and low-performing residents. These findings may allow for better characterization of expertise development in resuscitation medicine and provide a framework for future study of visual behaviours in resuscitation cases.

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