Tracking success: Exploring the application of eye tracking for simulator validation in the clinical and simulated environments

Introduction: Simulation-based training (SBT) is used to train medical residents before they perform procedures on patients, yet most simulators do not have reporting on their validation readily available. In SBT, there is no obvious standard for how validity tests of simulators should be conducted, or which type of validity should be used. Eye-tracking can be used to determine validity by comparing gaze patterns of physicians between the clinical and simulator environments, and between novices and experts. This exploratory study utilizes eye tracking to assess the validity of a central venous catheterization simulator, the Dynamic Haptic Robotic Trainer (DHRT)+. Methods: Expert physicians (N = 5) conducted Ultrasound-Guided Internal Jugular Central Venous Catheterization (US-IJCVC) wearing the Tobii Glasses 3 eye tracker in the operating room for nonemergent cardiac procedures, and on the DHRT+. Novice residents (N = 12) conducted US-IJCVC wearing an eye tracker on the DHRT+. For analysis, US-IJCVC was divided into six standard segments and gaze metrics were assessed. Results: Paired sample t-tests comparing expert gaze between the operating room and the DHRT+ indicated predictive validity (p<.05) for five out of six segments of US-IJCVC. Mann-Whitney U tests between novices and experts on the DHRT+ indicated construct validity (p<.05) for three out of six segments of the procedure. Conclusion: The results of this exploratory study indicate initial evidence of both predictive and construct validity on the DHRT+ and help to lay groundwork for using eye tracking in clinical research for simulator validation.