Visual expertise in paediatric neurology

BackgroundVisual expertise relies on perceptive as well as cognitive processes. At present, knowledge of these processes when diagnosing clinical cases mainly stems from studies with still pictures. In contrast, patient video cases constitute a dynamic diagnostic challenge that may simulate seeing and diagnosing a patient in person.AimsThis study investigates visual attention and the concomitant cognitive processes of clinicians diagnosing authentic paediatric video cases.MethodsA total of 43 clinicians with varying levels of expertise took part in this cross-sectional study. They diagnosed four brief video recordings of children: two with seizures and two with disorders imitating seizures. We used eye tracking to investigate time looking at relevant areas in the video cases and a concurrent think-aloud procedure to explore the associated clinical reasoning processes.ResultsMore experienced clinicians were more accurate in visual diagnosis and spent more of their time looking at relevant areas. At the same time, they explored data less, yet they built and evaluated more diagnostic hypotheses.ConclusionsClinicians of varying expertise analyse patient video cases differently. Clinical teachers should take these differences into account when optimising educational formats with patient video cases.

► We examined eye movements and think-aloud in clinicians analysing video cases.
► Clinicians of varying expertise analysed patient video cases differently.
► More experienced clinicians looked more at relevant areas.
► More experienced clinicians were more accurate in visual diagnosis.
► More experienced clinicians built and evaluated more diagnostic hypotheses.