• Matthew R White, Heather Braund, Daniel Howes, Rylan Egan, Andreas Gegenfurtner, van Merrienboer Jeroen J G JJG School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands., and Adam Szulewski.
• Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
• Ann Emerg Med. 2018 Sep 1; 72 (3): 289-298.

Study ObjectiveCrisis resource management skills are integral to leading the resuscitation of a critically ill patient. Despite their importance, crisis resource management skills (and their associated cognitive processes) have traditionally been difficult to study in the real world. The objective of this study was to derive key cognitive processes underpinning expert performance in resuscitation medicine, using a new eye-tracking-based video capture method during clinical cases.MethodsDuring an 18-month period, a sample of 10 trauma resuscitations led by 4 expert trauma team leaders was analyzed. The physician team leaders were outfitted with mobile eye-tracking glasses for each case. After each resuscitation, participants were debriefed with a modified cognitive task analysis, based on a cued-recall protocol, augmented by viewing their own first-person perspective eye-tracking video from the clinical encounter.ResultsEye-tracking technology was successfully applied as a tool to aid in the qualitative analysis of expert performance in a clinical setting. All participants stated that using these methods helped uncover previously unconscious aspects of their cognition. Overall, 5 major themes were derived from the interviews: logistic awareness, managing uncertainty, visual fixation behaviors, selective attendance to information, and anticipatory behaviors.ConclusionThe novel approach of cognitive task analysis augmented by eye tracking allowed the derivation of 5 unique cognitive processes underpinning expert performance in leading a resuscitation. An understanding of these cognitive processes has the potential to enhance educational methods and to create new assessment modalities of these previously tacit aspects of expertise in this field.Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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