An investigation into the effects of real vs. stimulated cases and level of experience on the distribution of visual attention during induction of general anaesthesia.

In anaesthesia, patient simulators have been used for training and research. However, insights from simulator-based research may only translate to real settings if the simulation elicits the same behaviour as the real setting. To this end, we investigated the effects of the case (simulated case vs. real case) and experience level (junior vs. senior) on the distribution of visual attention during the induction of general anaesthesia. We recorded eye-tracking data from 12 junior and 12 senior anaesthetists inducing general anaesthesia in a simulation room and in an actual operating room (48 recordings). Using a classification system from the literature, we assigned each fixation to one of 24 areas of interest and classified the areas of interest into groups related to monitoring, manual, and other tasks. Anaesthetists gave more visual attention to monitoring related areas of interest in simulated cases than in real cases (p = 0.001). We observed no effect of the factor case for manual tasks. For other tasks, anaesthetists gave more visual attention to areas of interest related to other tasks in real cases than in simulated cases (p < 0.001). Experience level did not have an effect on the distribution of visual attention. The results showed that there were differences in the distribution of visual attention by between real and simulated cases. Therefore, researchers need to be careful when translating simulation-based research on topics involving visual attention to the clinical environment.