Submission
| Title: | Intraoperative Cognitive Load in Surgical Training: Eye-Tracking Insights on Trainees and Attending Surgeons |
| Presenter: | Alex Nelson |
| Institution: | Indiana University School of Medicine |
| Authors: | Alex Nelson, BA,1 Nicholas Anton, MS,2 Mohammed Kalantar, MD, MPH,2 Ryan Toy,3 Denny Yu, PhD, CPE,3 Dimitrios Stefanidis, MD, PhD,2 1 Indiana University School of Medicine; 2 Indiana University School of Medicine, Department of Surgery; 3 Purdue University, School of Industrial Engineering |
Abstract
| Background/Significance/Rationale: | Cognitive load (CL) is the amount of mental resources required to complete a task and process information in working memory. In a surgical setting, high CL increases errors, decreases attention to critical details, and slows down decision-making, which compromise patient safety. Few studies, however, have measured surgeon CL in the clinical environment using objective measures. The purpose of this study was to use objective eye-tracking methods to measure surgeons’ and trainees’ intraoperative CL. |
| Methods: | In this pilot, general surgery attendings and residents performed gastrointestinal procedures on the Da Vinci Robot while wearing a mobile eye tracker. The quantitative eye-tracking metrics of average fixation duration (AFD), fixation to saccade (F:S) ratio, and mean pupil size between attending and trainee experimental groups were compared to determine differences in intraoperative CL. Second-by-second eye-tracking metrics were compared between attendings and trainees from two distinct procedures, case 1 and case 2. |
| Results/Findings: | A total of six attending (n = 3) and trainee (n = 3) general surgeons participated. While operating, trainees had a lower AFD (M=0.775, SD= 0.093) compared to attendings (M=0.842, SD=0.152) and lower F:S (M=0.497, SD=0.102) than attendings (M=0.592, SD=0.243). During case 1, trainees had a significantly higher (p< 0.001) mean pupil size (M=4.594, SD=0.47) compared to attendings (M=3.584, SD=0.35), and a significantly lower (p< 0.001) AFD (Mdn=210) compared to attendings (Mdn=281). During case 2, trainees had a significantly higher (p< 0.001) mean pupil size (M=3.615, SD=0.37) and a significantly lower (p< 0.001) AFD (Mdn=130) compared to attendings (M=3.576, SD=0.27, AFD: Mdn=130). |
| Conclusions/Discussion: | In this pilot study, we determined eye tracking metrics can be used to objectively detect higher intraoperative CL in trainees compared to attending surgeons. |
| Translational/Human Health Impact: | By measuring CL objectively in the OR, educators can create more effective learning environments for aspiring surgeons and improve patient outcomes. |
