Comparison of a perfusion simulator to a clinical operating room: evaluation of eye tracking data and subjective perception. A pilot study.

BACKGROUND: With the aim of evaluating the perfusion simulator at the German Heart Center Berlin, similarity between simulation and clinical operation room (OR) was investigated regarding subjective perception and eye movement. METHODS: Eight perfusionists performed an operation on the heart-lung machine (HLM) wearing eye tracking glasses, each in real OR and simulator. The three most important phases for perfusionists (going on bypass, cardioplegia administration and coming off bypass) were considered. Additional to eye tracking data as objective measure, questionnaires were completed, and interviews conducted afterwards. RESULTS: The structure of simulator and real OR is perceived as basically the same. Yet there are differences in the HLM-models used and the temporal sequence. Different perception of both situations is reported in interviews and reflected in significant differences in the rating scales (NASA-TLX) on three of six subscales. In eye tracking data, certain AOIs could be identified for the individual phases, both in OR and simulator-an indication of fundamental similarity. However, differences regarding the proportions of the individual AOIs, especially in the first and third phase, are leading to the assumption that the simulator, and especially the simulation process, is only valid to a limited extent regarding subjective perception and eye tracking data. CONCLUSION: The use of the simulator for (advanced) training is accepted and explicitly requested by perfusionists. Yet further research is needed to identify the decisive factors (like simulation duration or additional tasks) for a valid execution in the simulator. Furthermore, a larger sample size should be regarded to allow statistical analysis.

Simulation in perfusion: evaluating the efficacy of a specific training with eye-tracking.

BACKGROUND: With the aim of integrating simulation training into the training of perfusionists, we examined whether the participants were able to transfer a specific learning content to the same and different situations and assessed their feedback on the simulation training. Eye-tracking was tested as a measure and supplemented by additional measures. METHODS: A 2 × 2 mixed design was used, with test time (pre- and post-test) and training group (same and different content training) as factors. In the pre- and post-test, the participant had to handle a critical situation on the cardiopulmonary bypass, namely, a drop in arterial partial oxygen pressure. Between the two test times, the participant practised under guidance the handling of either the same critical situation (Group 1) or a different one, that is, impaired venous return (Group 2). Dependent measures were fixations of the eyes on specific areas of interest on the heart-lung machine, measures of latency and subjective assessments. Moreover, participants gave feedback on the simulation training. RESULTS: Fixation analyses showed that the training led to an increased gaze on areas of interest relevant to the drop in arterial partial oxygen pressure in both groups, with a significant increase only for Group 1. The surveys revealed a great interest in the integration of simulation training into education. CONCLUSION: In combination with other measures, eye-tracking is suitable for the evaluation of simulation training. Due to the positive training effects and positive participant feedback, the integration of simulation into the training of perfusionists is advocated. Concerning transfer of learning content, more research is needed.

Evaluation of attention, perception, and stress levels of clinical cardiovascular perfusionists during cardiac operations: a pilot study.

BACKGROUND: Performing cardiopulmonary bypass is a complex task which involves evaluating visual input from patient monitors and technical parameters displayed at the heart-lung machine console as well as reacting to other sensory input. Only few studies are available concerning the competency requirements for clinical cardiovascular perfusionists, including attention, perception, and coping with mental stress. This study aims at evaluating attention, perception, and stress levels of clinical cardiovascular perfusionists during cardiopulmonary bypass. METHODS: Nine clinical cardiovascular perfusionists voluntarily offered to participate in the study. Participants were asked to wear Tobii 2 eye-tracking glasses throughout the procedures. Specific time points were analyzed (cardiopulmonary bypass on, initial cardioplegia delivery, steady state, cross-clamp off, and weaning from cardiopulmonary bypass). Data acquisition was supplemented by participants' self-evaluation regarding their stress levels and by National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaires. RESULTS: Seven datasets were sufficient to be evaluated. The clinical cardiovascular perfusionists' professional experience ranged from 0.5 to 24 years. Evaluation of eye-tracking data revealed large variations in areas of interest hits, fixation, and dwell times. Across all phases, the venous reservoir, mean arterial pressure, arterial pump display, cardioplegia control, and data management system received the highest levels of attention. Pupil diameter measurements increased at start of cardiopulmonary bypass, cardioplegia delivery, and weaning off, but returned to base level during steady state. Clinical cardiovascular perfusionists' self-evaluation showed that subjective stress level was highest at the start and the end of the procedure. NASA TLX questionnaires revealed medium-to-high mental and temporal workloads, but low physical workloads. Performance, effort, and frustration indices showed medium workloads. CONCLUSION: During cardiopulmonary bypass, perfusionists are subjected to stress. Peak stress levels were highest during start and end of cardiopulmonary bypass. Furthermore, visual attention and perception varied between the operative phases. Further studies are indicated to evaluate the design of heart-lung machines and stress-coping strategies during cardiopulmonary bypass.