Eye tracking for skills assessment and training: a systematic review.

BACKGROUND The development of quantitative objective tools is critical to the assessment of surgeon skill. Eye tracking is a novel tool, which has been proposed may provide suitable metrics for this task. The aim of this study was to review current evidence for the use of eye tracking in training and assessment. METHODS A systematic literature review was conducted in line with PRISMA guidelines. A search of EMBASE, OVID MEDLINE, Maternity and Infant Care, PsycINFO, and Transport databases was conducted, till March 2013. Studies describing the use of eye tracking in the execution, training or assessment of a task, or for skill acquisition were included in the review. RESULTS Initial search results returned 12,051 results. Twenty-four studies were included in the final qualitative synthesis. Sixteen studies were based on eye tracking in assessment and eight studies were on eye tacking in training. These demonstrated feasibility and validity in the use of eye tracking metrics and gaze tracking to differentiate between subjects of varying skill levels. Several training methods using gaze training and pattern recognition were also described. CONCLUSIONS Current literature demonstrates the ability of eye tracking to provide reliable quantitative data as an objective assessment tool, with potential applications to surgical training to improve performance. Eye tracking remains a promising area of research with the possibility of future implementation into surgical skill assessment.

[1]  D. Fisher,et al.  Nurses' behaviors and visual scanning patterns may reduce patient identification errors. , 2011, Journal of experimental psychology. Applied.

[2]  M. S. Atkins,et al.  Analysis of eye gaze: Do novice surgeons look at the same location as expert surgeons during a laparoscopic operation? , 2012, Surgical Endoscopy.

[3]  Kazuhiro Ueda,et al.  Reading Speed, Comprehension and Eye Movements While Reading Japanese Novels: Evidence from Untrained Readers and Cases of Speed-Reading Trainees , 2012, PloS one.

[4]  A. Darzi,et al.  Value of orientation training in laparoscopic cholecystectomy , 2011, The British journal of surgery.

[5]  Mark R. Wilson,et al.  Perceptual impairment and psychomotor control in virtual laparoscopic surgery , 2011, Surgical Endoscopy.

[6]  H. Heekeren,et al.  Provided for Non-commercial Research and Educational Use Only. Not for Reproduction, Distribution or Commercial Use. Advances in Coupling Perception and Action: the Quiet Eye as a Bidirectional Link between Gaze, Attention, and Action , 2022 .

[7]  Christopher D. Wickens,et al.  Pilots' Monitoring Strategies and Performance on Automated Flight Decks: An Empirical Study Combining Behavioral and Eye-Tracking Data , 2007, Hum. Factors.

[8]  E. Krupinski,et al.  Eye-movement study and human performance using telepathology virtual slides: implications for medical education and differences with experience. , 2006, Human pathology.

[9]  G Schneider,et al.  Visual attention of anaesthetists during simulated critical incidents. , 2011, British journal of anaesthesia.

[10]  T Pickersgill,et al.  The European working time directive for doctors in training , 2001, BMJ : British Medical Journal.

[11]  A. Darzi,et al.  Objective assessment of technical skills in surgery , 2003, BMJ : British Medical Journal.

[12]  Michael J Schwartz,et al.  Eye Metrics as an Objective Assessment of Surgical Skill , 2010, Annals of surgery.

[13]  R. Aggarwal,et al.  Non-technical skills assessment in surgery. , 2011, Surgical oncology.

[14]  Guang-Zhong Yang,et al.  Collaborative eye tracking: a potential training tool in laparoscopic surgery , 2012, Surgical Endoscopy.

[15]  T. Grantcharov,et al.  Objective assessment of laparoscopic skills using a virtual reality stimulator , 2005, Surgical Endoscopy.

[16]  Reed G. Williams,et al.  Feasibility, reliability and validity of an operative performance rating system for evaluating surgery residents. , 2005, Surgery.

[17]  Mark R. Wilson,et al.  Quiet eye training expedites motor learning and aids performance under heightened anxiety: the roles of response programming and external attention. , 2012, Psychophysiology.

[18]  Greg Wood,et al.  Quiet-eye training for soccer penalty kicks , 2011, Cognitive Processing.

[19]  Rolf Zon,et al.  Eye Movements as an Indicator of Situation Awareness in a Flight Simulator Experiment , 2012 .

[20]  Laura E. Thomas,et al.  Moving eyes and moving thought: On the spatial compatibility between eye movements and cognition , 2007, Psychonomic bulletin & review.

[21]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[22]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[23]  T. Crawford,et al.  How do radiologists do it? The influence of experience and training on searching for chest nodules. , 2006 .

[24]  Mark R. Wilson,et al.  Gaze training enhances laparoscopic technical skill acquisition and multi-tasking performance: a randomized, controlled study , 2011, Surgical Endoscopy.

[25]  A. Darzi,et al.  Orientation Strategies in Natural Orifice Translumenal Endoscopic Surgery , 2011, Annals of surgery.

[26]  R. Reznick,et al.  Objective structured assessment of technical skill (OSATS) for surgical residents , 1997, The British journal of surgery.

[27]  Tal Oron-Gilad,et al.  Drivers' perception of vulnerable road users: a hazard perception approach. , 2012, Accident; analysis and prevention.

[28]  Andrew T. Duchowski,et al.  Eye Tracking Methodology: Theory and Practice , 2003, Springer London.

[29]  C. Wickens,et al.  Differences in attentional strategies by novice and experienced operating theatre scrub nurses. , 2011, Journal of experimental psychology. Applied.

[30]  Mark R. Wilson,et al.  The influence of quiet eye training and pressure on attention and visuo-motor control. , 2011, Acta psychologica.

[31]  Mark R. Wilson,et al.  Cheating experience: Guiding novices to adopt the gaze strategies of experts expedites the learning of technical laparoscopic skills. , 2012, Surgery.

[32]  José J. Cañas,et al.  Behavioral and eye-movement measures to track improvements in driving skills of vulnerable road users: First-time motorcycle riders , 2011 .

[33]  Tal Oron-Gilad,et al.  Age, skill, and hazard perception in driving. , 2010, Accident; analysis and prevention.

[34]  H. A. Mooij,et al.  Visualising scanning patterns of pathologists in the grading of cervical intraepithelial neoplasia , 2003, Journal of clinical pathology.

[35]  Mark R. Wilson,et al.  Psychomotor control in a virtual laparoscopic surgery training environment: gaze control parameters differentiate novices from experts , 2010, Surgical Endoscopy.

[36]  Alejandro Lleras,et al.  Covert shifts of attention function as an implicit aid to insight , 2009, Cognition.

[37]  Henry R. Kranzler,et al.  Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study. , 2013, JAMA internal medicine.

[38]  P. Tugwell,et al.  The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses , 2014 .

[39]  A R Jadad,et al.  Assessing the quality of reports of randomized clinical trials: is blinding necessary? , 1996, Controlled clinical trials.

[40]  S. Haymes,et al.  Gaze behavior among experts and trainees during optic disc examination: does how we look affect what we see? , 2011, Investigative ophthalmology & visual science.

[41]  Anand K. Gramopadhye,et al.  Evaluating the Effects of Virtual Training in an Aircraft Maintenance Task , 2008 .

[42]  Michael B Wallace,et al.  Association Between Visual Gaze Patterns and Adenoma Detection Rate During Colonoscopy: A Preliminary Investigation , 2011, The American Journal of Gastroenterology.

[43]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[44]  Paul M. Fitts,et al.  Eye movements of aircraft pilots during instrument-landing approaches. , 1950 .