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Pediatric electrocardiogram (ECG) interpretation is difficult to master. Understanding how experienced pediatric electrophysiologists (EPs) visually process ECGs using eye tracking technology (ETT) may allow for development of novel educational tools.
Objective
To establish characteristics of expert and novice gaze patterns using ETT during assessment of ECGs.
Methods
Using a Tobii Pro Fusion screen-based ETT, 3 EPs (10-25 yrs experience) and 18 pediatric trainees (8 residents, 10 cardiology fellows) read 5 ECGs from patients with pulmonary hypertension, WPW, Long QT, hypertrophic cardiomyopathy, and anomalous left coronary artery from the pulmonary artery. Visual parameters [Time to Diagnosis (TTD), Percentage of Time (%T) fixating on unique areas of interest (AOI), number of times the location of viewing shifted within an AOI (Fixation Count), the number of times gaze shifted away from and back to an AOI (Gaze Shifts)] and diagnostic accuracy were compared between trainees and EPs.
Results
Trainees had less efficient gaze patterns, indicated by longer TTD, higher Gaze shifts and Fixation Counts for all ECGs. EPs spent a higher %T at key diagnostic leads, septal leads, and lateral leads. Trainees spent a higher %T at anterior and inferior leads. Diagnostic accuracy was 66% for trainees vs. 100% for EPs.
Conclusion
Trainees and EPs have significant differences in visual diagnostic strategy during ECG interpretation. Trainee gaze patterns are less efficient with less attention at key diagnostic leads compared to EPs. Importantly, this study established distinct regional attention patterns that can be used to establish an educational model for ECG interpretation.
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