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Evaluating the Value of Eye-Tracking Augmented Debriefing in Medical Simulation-A Pilot Randomized Controlled Trial
Heather Braund1, Andrew K Hall, Kyla Caners
1From the Faculty of Health Sciences (H.B.), Office of Professional Development and Educational Scholarship; Faculty of Education, School of Medicine, Department of Biomedical and Molecular Sciences (H.B.), Queen's University, Kingston; Department of Emergency Medicine (A.K.H.), University of Ottawa, Ottawa; Royal College of Physicians and Surgeons of Canada (A.K.H.); Department of Emergency Medicine (K.C., D.D.), Queen's University; Departments of Emergency Medicine/Public Health Sciences (M.W.), Queen's University; Queen's Health Sciences (D.D.), Kingston; Department of Medicine (J.S.), McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University; Department of Medicine (M.S.), Centre for Simulation-Based Learning, McMaster University; Centre for Simulation-Based Learning (B.W.), McMaster University, Hamilton; Departments of Critical Care Medicine and Emergency Medicine (D.H.), Clinical Simulation Centre, Queen's University; Kingston General Hospital Research Institute (A.G.D.); Department of Family Medicine (W.W.), Queen's University; Departments of Emergency Medicine and Psychology (A.S.), Fellowship Program in Resuscitation and Reanimation; and Educational Scholarship Lead, Postgraduate Medical Education (A.S.), Queen's University, Kingston, ON, Canada.
Introduction:
Debriefing after simulation facilitates reflective thinking and learning. Eye-tracking augmented debriefing (ETAD) may provide advantages over traditional debriefing (TD) by leveraging video replay with first-person perspective. This multisite randomized controlled trial compared the impact of ETAD with TD (without eye-tracking and without video) after simulation on 4 outcomes: (1) resident metacognitive awareness (the primary outcome), (2) cognitive load (CL) of residents and debriefers, (3) alignment of resident self-assessment and debriefer assessment scores, and (4) resident and debriefer perceptions of the debriefing experience.
Method:
Fifty-four emergency medicine residents from 2 institutions were randomized to the experimental (ETAD) or the control (TD) arm. Residents completed 2 simulation stations followed by debriefing. Before station 1 and after station 2, residents completed a Metacognition Awareness Inventory (MAI). After each station, debriefers and residents rated their CL and completed an assessment of performance. After the stations, residents were interviewed and debriefers participated in a focus group.
Results:
There were no statistically significant differences in mean MAI change, resident CL, or assessment alignment between residents and debriefers. Debriefer CL was lower in the experimental arm. Interviews identified 4 themes: (1) reflections related to debriefing approach, (2) eye-tracking as a metacognitive sensitizer, (3) translation of metacognition to practice, and (4) ETAD as a strategy to manage CL. Residents reported that eye tracking improved the specificity of feedback. Debriefers relied less on notes, leveraged video timestamps, appreciated the structure of the eye-tracking video, and found the video useful when debriefing poor performers.
Conclusions:
There were no significant quantitative differences in MAI or resident CL scores; qualitative findings suggest that residents appreciated the benefits of the eye-tracking video review. Debriefers expended less CL and reported less perceived mental effort with the new technology. Future research should leverage longitudinal experimental designs to further understand the impact of eye-tracking facilitated debriefing.
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