Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
Department of Education, Queen's University, Kingston, Ontario, Canada; Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario, Canada.
Ann Emerg Med. 2018 Sep;72(3):289-298. doi: 10.1016/j.annemergmed.2018.03.005. Epub 2018 Apr 23.
Crisis resource management skills are integral to leading the resuscitation of a critically ill patient. Despite their importance, crisis resource management skills (and their associated cognitive processes) have traditionally been difficult to study in the real world. The objective of this study was to derive key cognitive processes underpinning expert performance in resuscitation medicine, using a new eye-tracking-based video capture method during clinical cases.
During an 18-month period, a sample of 10 trauma resuscitations led by 4 expert trauma team leaders was analyzed. The physician team leaders were outfitted with mobile eye-tracking glasses for each case. After each resuscitation, participants were debriefed with a modified cognitive task analysis, based on a cued-recall protocol, augmented by viewing their own first-person perspective eye-tracking video from the clinical encounter.
Eye-tracking technology was successfully applied as a tool to aid in the qualitative analysis of expert performance in a clinical setting. All participants stated that using these methods helped uncover previously unconscious aspects of their cognition. Overall, 5 major themes were derived from the interviews: logistic awareness, managing uncertainty, visual fixation behaviors, selective attendance to information, and anticipatory behaviors.
The novel approach of cognitive task analysis augmented by eye tracking allowed the derivation of 5 unique cognitive processes underpinning expert performance in leading a resuscitation. An understanding of these cognitive processes has the potential to enhance educational methods and to create new assessment modalities of these previously tacit aspects of expertise in this field.
危机资源管理技能是领导危重病患者复苏的重要组成部分。尽管它们很重要，但危机资源管理技能（及其相关认知过程）在传统上很难在现实世界中进行研究。本研究的目的是利用一种新的基于眼动追踪的视频捕获方法，从复苏医学的专家表现中得出关键的认知过程。
在 18 个月的时间里，对 4 名专家创伤团队领导的 10 例创伤复苏进行了分析。每位医生团队领导在每个案例中都配备了移动眼动追踪眼镜。每次复苏后，参与者都通过基于提示回忆协议的修改后的认知任务分析进行了汇报，该协议通过查看他们自己在临床遭遇中的第一人称视角眼动追踪视频进行了补充。
眼动追踪技术成功地应用于辅助分析临床环境中专家表现的定性分析。所有参与者都表示，使用这些方法有助于揭示他们认知中以前无意识的方面。总体而言，从访谈中得出了 5 个主要主题：逻辑意识、管理不确定性、视觉固定行为、选择性关注信息和预测行为。
认知任务分析与眼动追踪相结合的新方法得出了领导复苏中专家表现的 5 个独特认知过程。对这些认知过程的理解有可能增强教育方法，并为该领域中这些先前隐性专业知识的新评估模式创造条件。
