Leader-follower dynamics in medical training: A dual mobile eye-tracking analysis of teacher-student gaze patterns

In medical training, learning typically involves individuals interacting asymmetrically: instructors who explain and demonstrate and learners who follow these instructions. However, there are also moments when learners lead the interaction, for example by pointing out unclear connections. This shifting 'dance of leadership' manifests in measurable patterns of visual attention, whose impact on learning is not well understood.

Using dual mobile eye-tracking methodology, we explored the joint eye movements of 29 teacher-student pairs (mean age = 24 years ± 3; 16 females) during a simulated sonography training in an OR environment. Using diagonal cross-recurrence analysis, we computed the gaze lag time for one person to couple the other's gaze pattern, which we used as a proxy for leader-follower behaviors. Afterward, we quantified the relative frequency of leading behaviors across distinct regions within the training environment and examined their relationship to learning performance metrics.

We found that leader-follower behavior varied substantially. Teachers consistently led attention on the sonography monitor, showing tight coupling and minimal variation, reflecting its role as the procedural core. Students more frequently initiated gaze toward anatomical references and during interpersonal interactions. Importantly, only teacher-led guidance toward anatomical references was positively correlated with learning outcomes (r = .50, p < .01).

This study reveals that visual leadership during sonography training follows a two-tiered structure: instructor-dominated domains for technical execution and learner-engaged zones for exploration and social interaction. These insights about leader-follower dynamics could be used for targeted analysis and adaptation of clinical teaching situations.