The effects of gaze-display feedback on medical students' self-monitoring and learning in radiology

Ellen M Kok; Diederick C Niehorster; Anouk van der Gijp; Dirk R Rutgers; William F Auffermann; Marieke van der Schaaf; Liesbeth Kester; Tamara van Gog

doi:10.1007/s10459-024-10322-6

The effects of gaze-display feedback on medical students' self-monitoring and learning in radiology

Adv Health Sci Educ Theory Pract. 2024 Mar 31. doi: 10.1007/s10459-024-10322-6. Online ahead of print.

Authors

Ellen M Kok¹, Diederick C Niehorster^{2

3}, Anouk van der Gijp⁴, Dirk R Rutgers⁴, William F Auffermann⁵, Marieke van der Schaaf⁶, Liesbeth Kester⁷, Tamara van Gog⁷

Affiliations

¹ Department of Education, Utrecht University, P.O. Box 80140, 3508 CS, Utrecht, The Netherlands. e.m.kok@uu.nl.
² Lund University Humanities Lab, Lund University, Lund, Sweden.
³ Department of Psychology, Lund University, Lund, Sweden.
⁴ Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁵ School of Medicine, University of Utah, Utah, USA.
⁶ Utrecht Center for Research and Development in Health Professions Education, University Medical Center Utrecht, Utrecht, The Netherlands.
⁷ Department of Education, Utrecht University, P.O. Box 80140, 3508 CS, Utrecht, The Netherlands.

PMID: 38555550
DOI: 10.1007/s10459-024-10322-6

Abstract

Self-monitoring is essential for effectively regulating learning, but difficult in visual diagnostic tasks such as radiograph interpretation. Eye-tracking technology can visualize viewing behavior in gaze displays, thereby providing information about visual search and decision-making. We hypothesized that individually adaptive gaze-display feedback improves posttest performance and self-monitoring of medical students who learn to detect nodules in radiographs. We investigated the effects of: (1) Search displays, showing which part of the image was searched by the participant; and (2) Decision displays, showing which parts of the image received prolonged attention in 78 medical students. After a pretest and instruction, participants practiced identifying nodules in 16 cases under search-display, decision-display, or no feedback conditions (n = 26 per condition). A 10-case posttest, without feedback, was administered to assess learning outcomes. After each case, participants provided self-monitoring and confidence judgments. Afterward, participants reported on self-efficacy, perceived competence, feedback use, and perceived usefulness of the feedback. Bayesian analyses showed no benefits of gaze displays for post-test performance, monitoring accuracy (absolute difference between participants' estimated and their actual test performance), completeness of viewing behavior, self-efficacy, and perceived competence. Participants receiving search-displays reported greater feedback utilization than participants receiving decision-displays, and also found the feedback more useful when the gaze data displayed was precise and accurate. As the completeness of search was not related to posttest performance, search displays might not have been sufficiently informative to improve self-monitoring. Information from decision displays was rarely used to inform self-monitoring. Further research should address if and when gaze displays can support learning.

Keywords: Eye tracking; Feedback; Gaze display; Medical image perception; Radiograph interpretation; Self-monitoring.

Grants and funding

05-17-301/NRO PROO