Experience, skill and attentional capacity predict situation awareness of operators performing coronary angiography

Abstract Introduction: We evaluated the intra-operative situational awareness (as measured with detection accuracy and latency) capacity of interventional cardiologists during the performance of physics-based virtual reality simulation of a coronary angiography procedure. Methods: Using a between groups repeated measures design we assessed experienced and mid-level interventional cardiologists (ICs) using eye tracking glasses and physics-based virtual reality simulation. We assessed their intra-operative procedure performance errors, situation awareness, and attentional capacity as they performed a coronary angiogram. The main outcomes were intra-operative performance errors, situation awareness as measure of the operators capacity and latency to detect and correctly respond to salient visual stimuli. Results: We showed that experienced cardiologists had considerably better situation awareness. They demonstrated faster stimulus identification and report latencies (4.5 times quicker, p < 0.001). Furthermore, trainees detection latency scores strongly predicted total technical error scores (r = 0.93). Conclusions: This study showed that experienced ICs had a greater capacity to detect, recognise, and make judgements about deviations from optimal performance intra-operatively. The results from this study almost certainly apply to all image guided medical interventional procedures and have important patient safety implications.