title: A passing glance? Differences in eye tracking and gaze patterns between trainees and experts reading plain film bunion radiographs.
abstract: Eye tracking and gaze pattern studies have been used to evaluate human behavior for decades. This is because of its ability to reveal conscious and subconscious behaviors when subjects are tasked with observation, decision making, and surgical performance. Many have popularized the use of this technology for radiographic assessment while evaluating radiologist behaviors, but little has been described for surgeon behavior patterns when evaluating preoperative deformities by radiograph. Because the radiographic assessment strongly influences surgical selection, the present study was designed to evaluate the differences between groups of novice and experienced surgeons' gaze patterns when tasked to describe hallux valgus deformities. The subjects were asked to rate the deformity as "none," "mild," "moderate," or "severe." Using an externally mounted eye tracking system, our study assessed saccades, fixations, overall time spent per radiograph, and the subjects' chosen bunion rating. Both the novice and advanced groups of foot and ankle surgeons were tasked to evaluate 25 total anteroposterior radiographs from patients who presented with a primary complaint of bunion pain. These patients were chosen at random, such that all participating surgeons had no previous patient familiarization. Statistically significant differences were observed with regard to the activity and rating of the moderate bunion films. The experience of surgeons does appear to modify gaze behavior with respect to time and attention, such that less overall time spent per image is needed by the advanced group, with improved efficiency. Future academic curriculum and training techniques could be developed to reflect these potential technical differences in search behavior, diagnostic technique, and surgical selection strategy.
authors.affiliation: Director of Education, Southern Arizona Limb Salvage Alliance, University of Arizona, Tucson, AZ; Member, Interdisciplinary Consortium of Advanced Motion Performance (iCAMP), University of Arizona, Tucson, AZ; Member, Board of Directors, Freeside Atlanta Technology Space, Atlanta, GA; and Faculty, The Podiatry Institute, Decatur, GA. Electronic address: ngiovinco@gmail.com.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Giovinco
authors.affiliation: President, Freeside Atlanta Technology Space, Atlanta, GA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Sutton
authors.affiliation: Research Associate, Southern Arizona Limb Salvage Alliance, University of Arizona, Tucson, AZ.
authors.forename: John D
authors.initials: JD
authors.lastname: Miller
authors.affiliation: Resident, Southern Arizona Limb Salvage Alliance, University of Arizona, Tucson, AZ.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Rankin
authors.affiliation: Faculty, The Podiatry Institute, Decatur, GA.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Gonzalez
authors.affiliation: Director of Education, Southern Arizona Limb Salvage Alliance, University of Arizona, Tucson, AZ; Member, Interdisciplinary Consortium of Advanced Motion Performance (iCAMP), University of Arizona, Tucson, AZ; Member, Board of Directors, Freeside Atlanta Technology Space, Atlanta, GA; and Faculty, The Podiatry Institute, Decatur, GA.
authors.forename: Bijan
authors.initials: B
authors.lastname: Najafi
authors.affiliation: Member, Interdisciplinary Consortium of Advanced Motion Performance (iCAMP), University of Arizona, Tucson, AZ; and Director of Education, Southern Arizona Limb Salvage Alliance, University of Arizona, Tucson, AZ.
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
mesh_terms: D001288:Attention / Q000502:physiology; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D005133:Eye Movements / Q000502:physiology*; D006215:Hallux Valgus / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D019637:Orthopedic Procedures; D011859:Radiography; D012720:Severity of Illness Index; D013647:Task Performance and Analysis; D014796:Visual Perception
keywords: ergonomic; gaze; hallux valgus; radiograph; saccadic data; surgery