The influence of anaesthetists’ experience on workload, performance and visual attention during simulated critical incidents


Development of accurate Situation Awareness (SA) depends on experience and may be impaired during excessive workload. In order to gain adequate SA for decision making and performance, anaesthetists need to distribute visual attention effectively. Therefore, we hypothesized that in more experienced anaesthetists performance is better and increase of physiological workload is less during critical incidents. Additionally, we investigated the relation between physiological workload indicators and distribution of visual attention. In fifteen anaesthetists, the increase of pupil size and heart rate was assessed in course of a simulated critical incident. Simulator log files were used for performance assessment. An eye-tracking device (EyeSeeCam) provided data about the anaesthetists’ distribution of visual attention. Performance was assessed as time until definitive treatment. T tests and multivariate generalized linear models (MANOVA) were used for retrospective statistical analysis. Mean pupil diameter increase was 8.1 % (SD ± 4.3) in the less experienced and 15.8 % (±10.4) in the more experienced subjects (p = 0.191). Mean heart rate increase was 10.2 % (±6.7) and 10.5 % (±8.3, p = 0.956), respectively. Performance did not depend on experience. Pupil diameter and heart rate increases were associated with a shift of visual attention from monitoring towards manual tasks (not significant). For the first time, the following four variables were assessed simultaneously: physiological workload indicators, performance, experience, and distribution of visual attention between “monitoring” and “manual” tasks. However, we were unable to detect significant interactions between these variables. This experimental model could prove valuable in the investigation of gaining and maintaining SA in the operation theatre.

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We gratefully acknowledge the contribution of Klaus Bartl and Stefan Kohlbecher from the Institute of Clinical Neurosciences of the Ludwig-Maximilian-University Munich for technical assistance with the EyeSeeCam as well as Thomas Villgrattner and Heinz Ulbrich from the Institute of Applied Mechanics of the Technical University Munich who provided the camera actuation mechanics. The simulator environment was provided by the Department of Anaesthesiology, Klinikum rechts der Isar, Technical University, Munich. Funding was solely provided by the Department of Anaesthesia, Technical University Munich, Klinikum rechts der Isar.

Ethical standards

The authors declare that the experiments comply with the current laws of the country in which they were performed. Ethical approval for this study (Project No. 2411/09) was provided by the Ethical Committee of the Klinikum rechts der Isar, Technical University Munich. All participants gave written informed consent.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Correspondence to Christian M. Schulz.

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Schulz, C.M., Schneider, E., Kohlbecher, S. et al. The influence of anaesthetists’ experience on workload, performance and visual attention during simulated critical incidents. J Clin Monit Comput 28, 475–480 (2014).

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  • Eye-tracking
  • Workload
  • Situation awareness
  • Visual attention
  • Gaze behaviour
  • EyeSeeCam