Accepted for/Published in: JMIR Medical Education
Date Submitted: Dec 21, 2020
Date Accepted: Sep 20, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Evaluating Eye Tracking Technology for Understanding how Medical Students Interpret a 12-Lead Electrocardiogram: A Quantitative Approach
ABSTRACT
Background:
It is common among healthcare practitioners that accurate interpretation of a 12-lead electrocardiogram demands high levels of skill and expertise. There is a variation amongst healthcare practitioners in their ability to read ECGs accurately and quickly. Moreover, guidelines or best-practices for a standard interpretation process are inexistant. This causes a chasm between skilled interpreters and medical students who are just beginning to develop this skill.
Objective:
This study aims to use the eye tracking methodology to research whether eye fixation can be used to gain a deeper understanding into how medical students acquire the ECG interpretation skill.
Methods:
Each one of the sixteen recruited medical students was asked to interpret ten different types of 12-lead ECGs, while their eye movements were recorded using a Tobii X60 eye tracker. The device uses corneal reflection technology to non-intrusively record the interpreter’s eye movements. The frequency of sampling is 60Hz. Fixations’ heatmaps of where medical students looked at were generated from the collected dataset. A statistical analysis was conducted on the fixations’ count and duration using the Mann Whitney U test, and the Kruskal Wallis test.
Results:
A total number of 16 medical students interpreting 10 ECGs each were recorded. Each interpretation lasted for a duration of 30 seconds. The mean accuracy of the interpretations was 55.63% with a standard deviation of 4.63 %. After analyzing the average fixation duration, we find that on average students study the three lower leads (rhythm strips) the most with a top-down approach (lead II has highest fixation time (mean = 2727 ms, SD = 456) followed by leads V1 (mean = 1476 fixations, SD = 320), V5 (mean = 1301 fixations, SD = 236). We also find a strong correlation between some of the eye tracking features like the time spent fixating and the fixation count (r = 0.87). Finally, by analyzing the time to the first fixation, we understand that medical students develop a personal system of interpretation that adapts and reacts to the nature and the complexity of the diagnosis. We also find that medical students consider some leads as their guiding point towards finding a hint leading to the correct interpretation.
Conclusions:
The use of eye tracking methodology provided a more precise insight into how medical students learn how to interpret a 12-lead ECG. Clinical Trial: NA
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