Looks can be deceiving: Gaze pattern differences between novices and experts during placement of central lines.

BACKGROUND: The objective of this study was to determine whether gaze patterns could differentiate expertise during simulated ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) and if expert gazes were different between simulators of varying functional and structural fidelity. METHODS: A 2017 study compared eye gaze patterns of expert surgeons (n = 11), senior residents (n = 4), and novices (n = 7) during CVC needle insertions using the dynamic haptic robotic trainer (DHRT), a system which simulates US-IJCVC. Expert gaze patterns were also compared between a manikin and the DHRT. RESULTS: Expert gaze patterns were consistent between the manikin and DHRT environments (p = 0.401). On the DHRT system, CVC experience significantly impacted the percent of time participants spent gazing at the ultrasound screen (p < 0.0005) and the needle and ultrasound probe (p < 0.0005). CONCLUSION: Gaze patterns differentiate expertise during ultrasound-guided IJCVC placement and the fidelity of the simulator does not impact gaze patterns.

Evaluating Surgical Resident Needle Insertion Skill Gains in Central Venous Catheterization Training.

BACKGROUND: Training for ultrasound-guided central venous catheterization (CVC) is typically conducted on static manikin simulators with real-time feedback from a skilled observer. Dynamic haptic robotic trainers (DHRTs) are an alternative method that simulates various patient anatomies and provides consistent feedback for each insertion. This study evaluates CVC needle insertion efficiency and skill gains of both methods. MATERIALS AND METHODS: Fifty-two first-year surgical residents were trained by placing internal jugular (IJ) CVC needles in manikins (n = 26) or robots (n = 26). Manikin-trained participants received verbal feedback from an experienced observer, whereas robotically trained participants received quantitative feedback from the personalized DHRT learning interface. All participants were pretested on a Blue Phantom manikin; participants completed posttesting on a Blue Phantom manikin (n = 26) or a novel manikin (n = 26) with different vessel depth and position. During pretests and posttests residents were timed, motion-tracked, and scored on an IJ CVC checklist. RESULTS: (1) All skills on the IJ CVC checklist showed significant (P < 0.014) improvements from pretests to posttest; (2) Average angle of insertion, path length, and jerk improved significantly (P < 0.005); (3) Average procedural completion time, with standard error (SE) reported, decreased significantly from pretest (M = 3.516 min, SE = 0.277) to posttest (M = 1.997, SE = 0.409). CONCLUSIONS: No significant group differences were observed in overall skill gains, but residents' average procedural completion time decreased significantly from pretests to posttest. Overall results support DHRT as an effective method for training IJ CVC skills.