title: The use and limits of eye-tracking in high-fidelity clinical scenarios: A pilot study.
abstract: OBJECTIVE
  To explore the potential of mobile eye-tracking to identify healthcare students' area of visual interest and its relationship to performance ratings.
  
  
  BACKGROUND
  Eye-tracking identifies an individual's visual attention focus, and has been used as a training technique in medicine and in nursing. In this study participants wore a point of view (PoV) camera within a spectacle frame during simulation education experiences.
  
  
  METHODS
  Thirty-nine final year nursing and paramedicine students individually participated in three 8 minute clinical simulations with debriefing using videoed eye-tracking recordings. Coloured dots on the video depicted the participant's pupil fixation on five targeted areas. Data extracted from the video camera were collated to report time spent on each target (their 'gaze').
  
  
  RESULTS
  The mean total gaze of expert designated targets in the environment for three 8 minute scenarios was 40-77%. Of 35 participants' focus on three main areas of interest, their priority was the patient's head (34%), the patient's trunk (24%) and their clinical assistant (5%), with significant differences between nursing and paramedic disciplines (P < 0.05). Objectively rated clinical performance improved significantly by the third scenario (P ≤ 0.001). Participants were positive regarding use of eye tracking during debriefing.
  
  
  CONCLUSIONS
  Eye tracking has the potential to enhance debriefing and educational outcomes, although there are limitations to gaze capture in high fidelity environments and resource cost is high. Further study is warranted to enable better understanding of how expert clinicians achieve high levels of performance.
authors.affiliation: School of Nursing and Midwifery, Monash University, Berwick, Vic. 3806, Australia. Electronic address: mark.browning@monash.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Browning
authors.affiliation: School of Nursing and Midwifery, Monash University, Berwick, Vic. 3806, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Cooper
authors.affiliation: School of Nursing and Midwifery, Monash University, Berwick, Vic. 3806, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Cant
authors.affiliation: School of Nursing and Midwifery, Monash University, Berwick, Vic. 3806, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Sparkes
authors.affiliation: School of Nursing & Midwifery, The University of Queensland, Herston Campus, QLD, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Bogossian
authors.affiliation: Department of Community Emergency Health & Paramedic Practice, Monash University, Vic., Australia.
authors.forename: Brett
authors.initials: B
authors.lastname: Williams
authors.affiliation: La Trobe Rural Health School, La Trobe University, Bendigo, Vic., Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: O'Meara
authors.affiliation: Department of Community Emergency Health & Paramedic Practice, Monash University, Vic., Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Ross
authors.affiliation: La Trobe Rural Health School, La Trobe University, Bendigo, Vic., Australia.
authors.forename: Graham
authors.initials: G
authors.lastname: Munro
authors.affiliation: School of Nursing & Midwifery, The University of Queensland, Herston Campus, QLD, Australia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Black
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D016544:Patient Simulation; D010865:Pilot Projects; D013334:Students / Q000523:psychology*; D014794:Visual Fields
keywords: Clinical; Debriefing; Education; Eye-tracking; Gaze; Point of view (PoV); Simulation