Changes in Gaze Behavior during the Learning of the Epidural Technique with a Simulator in Anesthesia Novices

Background: Current literature demonstrates the ability of eye tracking to provide reliable quantitative data as an objective assessment tool, with potential applications to medical and surgical training to improve performance. Objective: The aim of this study was to evaluate the changes in gaze behavior in anesthesia novice trainees when performing a simulated epidural technique before and after a hands-on training on the epidural simulator. Methods: We enrolled 48 novice trainees who had never previously performed an epidural block. After a standardized learning module, each trainee practiced the epidural procedure on the epidural simulator while wearing a pair of eye tracking glasses (Tobii Pro Glasses 50 Hz wearable wireless eye tracker). After this baseline recording, each trainee spent two hours practicing with the epidural simulator and afterwards once again performed the eye tracking epidural procedure. Eye tracking metrics and epidural learning (duration of the procedure and number of attempts) before and after the simulated practice were recorded. Results: The duration of the epidural procedure and of the epidural needle advancement phase (P < 0.05) and the number of epidural attempts (P < 0.001) were reduced after the tutorial. When considering the eye tracking metrics, after the tutorial, the number of visit counts decreased and their duration increased (P < 0.05). The number of epidural needle insertions (additional attempts) showed a significant positive correlation with the visits number (aOR = 2.02 (95% CI = 1.26 - 3.55;P = 0.008)) and a significant negative correlation with the visit duration (aOR = 0.65 (95% CI = 0.39 - 0.99;P = 0.05)). Conclusion: We observed significant changes in gaze behavior associated with increased performance during the epidural technique learning with a simulator in anesthesia trainees who had never previously performed an epidural block. These results may create a prototype for future studies on eye tracking technique as a teaching and evaluating tool in simulation.