An observational study using eye tracking to assess resident and senior anesthetists' situation awareness and visual perception in postpartum hemorrhage high fidelity simulation.

Arnaud Desvergez,Jean-Bernard Gouyon,Médéric Descoins,Arnaud Winer,Andrea Cortegiani

doi:10.1371/journal.pone.0221515

Abstract

BackgroundThe postpartum hemorrhage (PPH) is the leading cause of maternal mortality in the world. Human factors and especially situation awareness has primarily responsibility to explain suboptimal cares. Based on eye tracking and behavior analysis in high fidelity simulation of PPH management, the goal of this study is to identify perceptual and cognitive key parameters of the expertise.MethodsTwo groups of fifteen anesthetists (residents and experienced anesthetists) watched the beginning of a severe simulated PPH management. During this first experimental phase, situation awareness was assessed using SAGAT (Situation Awareness Global Assessment Technique) questionnaire and visual behavior was analyzed with eye tracking. In the continuity of the video sequence, they have to step in the PPH situation and to provide care to the simulated patient. Performance of cares was evaluated and self-assessed as well as cognitive load.ResultsNo statistical difference between the residents and experienced anesthetists was observed on performance of simulated PPH management. The mean expected practice score was 76.9 ± 13.9%). Assessment of situation awareness (65 ± 7%), cognitive load (74.4 ± 11.3%) and theoretical knowledge of PPH (52.4 ± 3.5%) were also not statistically different between the two groups. Only results of self-assessed performance (respectively 66.1 ± 16.6 and 47.0 ± 20.8 for experts and residents) and eye-tracking data revealed that experts tended to get accurate evaluation of their performance and to monitor more the blood loss of the patient. Experts have in average 8.28% more fixating points than Novices and gazed the blood loss region longer (865 ms ± 439 vs. 717 ms ± 362).ConclusionsThis study pointed out the limits of classical assessment of performance, and human factors based on questionnaires to identify expertise in simulated PPH care. A neuroscientific approach with new technology like eye tracking could provide new objective and more sensitive insights on human factors in simulated medical emergency situations.

Highlights

The postpartum hemorrhage (PPH) is the leading cause of maternal mortality in the world [1,2,3]
Two groups of fifteen anesthetists watched the beginning of a severe simulated PPH management. During this first experimental phase, situation awareness was assessed using SAGAT (Situation Awareness Global Assessment Technique) questionnaire and visual behavior was analyzed with eye tracking
No statistical difference between the residents and experienced anesthetists was observed on performance of simulated PPH management

Summary

Introduction

The postpartum hemorrhage (PPH) is the leading cause of maternal mortality in the world [1,2,3]. In France, 20% of maternal deaths are attributable to PPH with a large regional disparity [4]. In 2017, a survey estimated that 100% of maternal care was non-optimal with preventable deaths in 100% of cases [5]. Retrospective real life case studies indicate a lack of recognition of the initial severity of patients and ineffective treatment choices, concerning the anesthetic management of PPH (recognition and management of hemorrhagic shock, use of transfusion, anesthetic strategy) [6,7,8]. The analysis of the human factor in anesthesia resuscitation brings a new grid of reading within the framework of the complex and inter-professional management of this serious pathology. Based on eye tracking and behavior analysis in high fidelity simulation of PPH management, the goal of this study is to identify perceptual and cognitive key parameters of the expertise

Objectives

Methods

Results

Conclusion