Quantify difference between physicians and medical students in clinical reasoning: evidence from eye-tracking

Abstract

Background: The assessment of clinical reasoning in health trainees is vital yet poses challenges. We tracked the eye movements of participants while they were reviewing a neurological case with the goal of finding behavioral evidence to improve health education. Methods: Eleven medical students and seventeen expert physicians were required to read a neurological case within a 150-second timeframe. The case included descriptive text, a brain CT scan, and an electrocardiogram (ECG). Participants completed a multiple-choice questions (MCQs) test after reading the case. Eye movements of participants in case reading on eleven patient-related information areas (PRIAs) were compared between experts and novices, contrasted with the remaining areas. Results: Experts spent significantly more time fixating on PRIAs during case reading than novices (42.1% vs. 29.2%, adjusted p = 0.010). Experts demonstrated significantly fewer gaze shifts between Text and CT images (2.0 times) and between CT and ECG images (2.4 times) compared to novices (6.2 and 5.4 times), with adjusted p-values of 0.002 and 0.019, respectively. A positive correlation was found between the fixation rate on PRIAs and MCQs outcome (r = 0.402, p = 0.034). Conclusion: Eye-tracking provides rich and reliable data reflecting physicians’ ability to gather patient-relevant information during patient assessment.