Enhancing Transesophageal Echocardiography Training in Cardiac Anesthesia Fellows Using Wearable Eye-Tracking...

The training of Adult Cardiothoracic Anesthesiology (ACTA) fellows in transesophageal echocardiography (TEE) is essential for their development, but assessing technical proficiency remains challenging. While hands-on experience is the cornerstone of learning, traditional evaluation methods primarily focus on image interpretation, neglecting the assessment of image acquisition techniques and visual attention. We describe our experience using wearable eye-tracking technology to objectively assess the TEE skills of ACTA fellows. Since 2023, our ACTA fellows have been equipped with Tobii Pro Glasses 3 (Tobii Pro, Danderyd, Sweden) during weekly preoperative TEE examinations. These glasses record video and track gaze patterns in real-time, allowing for the analysis of fellows' focus and performance over time. The gaze data is processed using Tobii Pro Lab Analyzer, creating heat maps and measuring the time spent on specific TEE views. One attending physician, considered an expert, also participates to provide a benchmark for comparison. Our initial experience suggests that eye-tracking technology can provide valuable insights into the fellows' gaze patterns, enabling objective measurement of their focus during TEE procedures. While limitations such as scheduling conflicts, case type, and variable imaging windows were noted, our experience demonstrates the feasibility of this technology in evaluating technical skills. This approach offers a promising method for refining TEE education and feedback in cardiac anesthesia fellowship. Further research is needed to explore additional metrics such as gaze efficiency and time to image acquisition to enhance TEE training for fellows.