title: Visual expertise in paediatric neurology.
abstract: BACKGROUND
  Visual expertise relies on perceptive as well as cognitive processes. At present, knowledge of these processes when diagnosing clinical cases mainly stems from studies with still pictures. In contrast, patient video cases constitute a dynamic diagnostic challenge that may simulate seeing and diagnosing a patient in person.
  
  
  OBJECTIVE
  This study investigates visual attention and the concomitant cognitive processes of clinicians diagnosing authentic paediatric video cases.
  
  
  METHODS
  A total of 43 clinicians with varying levels of expertise took part in this cross-sectional study. They diagnosed four brief video recordings of children: two with seizures and two with disorders imitating seizures. We used eye tracking to investigate time looking at relevant areas in the video cases and a concurrent think-aloud procedure to explore the associated clinical reasoning processes.
  
  
  RESULTS
  More experienced clinicians were more accurate in visual diagnosis and spent more of their time looking at relevant areas. At the same time, they explored data less, yet they built and evaluated more diagnostic hypotheses.
  
  
  CONCLUSIONS
  Clinicians of varying expertise analyse patient video cases differently. Clinical teachers should take these differences into account when optimising educational formats with patient video cases.
authors.affiliation: Aarhus University, Centre of Medical Education, Brendstrupgaardsvej 102, 8200 Aarhus N, Denmark. bafl@dadlnet.dk
authors.forename: Thomas
authors.initials: T
authors.lastname: Balslev
authors.forename: Halszka
authors.initials: H
authors.lastname: Jarodzka
authors.forename: Kenneth
authors.initials: K
authors.lastname: Holmqvist
authors.forename: Willem
authors.initials: W
authors.lastname: de Grave
authors.forename: Arno M M
authors.initials: AM
authors.lastname: Muijtjens
authors.forename: Berit
authors.initials: B
authors.lastname: Eika
authors.forename: Jeroen
authors.initials: J
authors.lastname: van Merriënboer
authors.forename: Albert J J A
authors.initials: AJ
authors.lastname: Scherpbier
mesh_terms: D001288:Attention / Q000502:physiology; D002648:Child; D002983:Clinical Competence; D003071:Cognition / Q000502:physiology; D003951:Diagnostic Errors; D004501:Education, Medical / Q000379:methods; D005133:Eye Movements / Q000502:physiology; D006801:Humans; D007396:Internship and Residency; D009422:Nervous System Diseases / Q000175:diagnosis*; D009460:Neurologic Examination / Q000379:methods*; D009462:Neurology / Q000193:education; D010372:Pediatrics / Q000193:education / Q000379:methods*; D010820:Physicians; D014741:Video Recording; D014796:Visual Perception / Q000502:physiology