Nelson : Eye-Tracking can Detect Cognitive Load differences between Trainees and Attending Surgeons during robotic surgery
Intraoperative Cognitive Load in Surgical Training: Eye-Tracking Insights on Trainees and Attending Surgeons
Indiana University School of Medicine
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
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.
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.
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).
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.