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In this paper, we present a review of how the various aspects of any study using an eye tracker (such as the instrument, methodology, environment, participant, etc.) affect the quality of the recorded eye-tracking data and the obtained eye-movement and gaze measures. We take this review to represent the empirical foundation for reporting guidelines of any study involving an eye tracker. We compare this empirical foundation to five existing reporting guidelines and to a database of 207 published eye-tracking studies. We find that reporting guidelines vary substantially and do not match with actual reporting practices. We end by deriving a minimal, flexible reporting guideline based on empirical research (Section “An empirically based minimal reporting guideline”).

Radiologists can visually detect abnormalities on radiographs within 2s, a process that resembles holistic visual processing of faces. Interestingly, there is empirical evidence using functional magnetic resonance imaging (fMRI) for the involvement of the right fusiform face area (FFA) in visual-expertise tasks such as radiological image interpretation. The speed by which stimuli (e.g., faces, abnormalities) are recognized is an important characteristic of holistic processing. However, evidence for the involvement of the right FFA in holistic processing in radiology comes mostly from short or artificial tasks in which the quick, ‘holistic’ mode of diagnostic processing is not contrasted with the slower ‘search-to-find’ mode. In our fMRI study, we hypothesized that the right FFA responds selectively to the ‘holistic’ mode of diagnostic processing and less so to the ‘search-to-find’ mode. Eleven laypeople and 17 radiologists in training diagnosed 66 radiographs in 2s each (holistic mode) and subsequently checked their diagnosis in an extended (10-s) period (search-to-find mode). During data analysis, we first identified individual regions of interest (ROIs) for the right FFA using a localizer task. Then we employed ROI-based ANOVAs and obtained tentative support for the hypothesis that the right FFA shows more activation for radiologists in training versus laypeople, in particular in the holistic mode (i.e., during 2s trials), and less so in the search-to-find mode (i.e., during 10-s trials). No significant correlation was found between diagnostic performance (diagnostic accuracy) and brain-activation level within the right FFA for both, short-presentation and long-presentation diagnostic trials. Our results provide tentative evidence from a diagnostic-reasoning task that the FFA supports the holistic processing of visual stimuli in participants’ expertise domain.

Background Grandiosity is designated as a hallmark trait of narcissism. The current study tested whether narcissistic traits are related to overestimation of a range of agentic performances. Method Eighty-five non-patients executed six objective tasks to assess their level of (emotional) intelligence, first impression, attractiveness, social skills and learning performance. They were also asked to estimate their level of functioning in these six areas. This estimation was given on two moments: before and after performing the objective tasks. Our main variable of interest was the degree to which subjective estimation exceeds objective scores. Results Narcissistic traits were related to overestimation of (emotional) intelligence, attractiveness and social skills, particularly at a global level before performing the tasks. Limitations The use of a homogenous student sample; Mainly agentic performances, were studied. Conclusion Overall, the findings provide a theoretical validation of unwarranted feelings of grandiosity as a core narcissistic criterion. Copyright © 2016 John Wiley & Sons, Ltd.

‘Eye tracking may be valuable for informing assessments of competency progression during medical education and training’ [1]. Brunye et al. [1] and other researchers (e.g. [2]) have made this suggestion to argue the relevance of using eye tracking to investigate medical image interpretation. Eye tracking is a technique to measure the movements of the eyes to investigate what a person looks at, for how long, and in what order [3]. It can help us to go beyond mere outcome measures (i.e. the percentage of cases correctly diagnosed) and provide an insight into the process of medical image interpretation. Whereas previous research has shown that eye tracking is a very useful tool to investigate the interpretation of medical images (such as angiograms), the field is not yet at a point where eye tracking can be used for competency assessment in clinical practice. In this commentary on ‘Eye-tracking during dynamic medical image interpretation: a pilot feasibility study comparing novice vs expert cardiologists’ [1] I discuss what eye tracking could add to competency assessment, which eye-tracking measures are potential markers of expertise, and what is still needed before they can be used for competency assessment.

Rationale and Objectives Radiologists commonly use comparison films to improve their differential diagnosis. Educational literature suggests that this technique might also be used to bolster the process of learning to interpret radiographs. We investigated the effectiveness of three comparison techniques in medical students, whom we invited to compare cases of the same disease (same-disease comparison), cases of different diseases (different-disease comparison), disease images with normal images (disease/normal comparison), and identical images (no comparison/control condition). Furthermore, we used eye-tracking technology to investigate which elements of the two cases were compared by the students. Materials and Methods We randomly assigned 84 medical students to one of four conditions and had them study different diseases on chest radiographs, while their eye movements were being measured. Thereafter, participants took two tests that measured diagnostic performance and their ability to locate diseases, respectively. Results Students studied most efficiently in the same-disease and different-disease comparison conditions: test 1, F (3, 68) = 3.31, P = .025, η p 2 = 0.128; test 2, F (3, 65) = 2.88, P = .043, η p 2 = 0.117. We found that comparisons were effected in 91% of all trials (except for the control condition). Comparisons between normal anatomy were particularly common (45.8%) in all conditions. Conclusions Comparing cases can be an efficient way of learning to interpret radiographs, especially when the comparison technique used is specifically tailored to the learning goal. Eye tracking provided insight into the comparison process, by showing that few comparisons were made between abnormalities, for example.

People know surprisingly little about their own visual behavior, which can be problematic when learning or executing complex visual tasks such as search of medical images. We investigated whether providing observers with online information about their eye position during search would help them recall their own fixations immediately afterwards. Seventeen observers searched for various objects in "Where's Waldo'' images for 3 s. On two-thirds of trials, observers made target present/absent responses. On the other third (critical trials), they were asked to click twelve locations in the scene where they thought they had just fixated. On half of the trials, a gaze-contingent window showed observers their current eye position as a 7.58 diameter "spotlight.'' The spotlight "illuminated'' everything fixated, while the rest of the display was still visible but dimmer. Performance was quantified as the overlap of circles centered on the actual fixations and centered on the reported fixations. Replicating prior work, this overlap was quite low (26%), far from ceiling (66%) and quite close to chance performance (21%). Performance was only slightly better in the spotlight condition (28%, p = 0.03). Giving observers information about their fixation locations by dimming the periphery improved memory for those fixations modestly, at best.

ContextVisual expertise is the superior visual skill shown when executing domain‐specific visual tasks. Understanding visual expertise is important in order to understand how the interpretation of medical images may be best learned and taught. In the context of this article, we focus on the visual skill of medical image diagnosis and, more specifically, on the methodological set‐ups routinely used in visual expertise research.MethodsWe offer a critique of commonly used methods and propose three challenges for future research to open up new avenues for studying characteristics of visual expertise in medical image diagnosis. The first challenge addresses theory development. Novel prospects in modelling visual expertise can emerge when we reflect on cognitive and socio‐cultural epistemologies in visual expertise research, when we engage in statistical validations of existing theoretical assumptions and when we include social and socio‐cultural processes in expertise development. The second challenge addresses the recording and analysis of longitudinal data. If we assume that the development of expertise is a long‐term phenomenon, then it follows that future research can engage in advanced statistical modelling of longitudinal expertise data that extends the routine use of cross‐sectional material through, for example, animations and dynamic visualisations of developmental data. The third challenge addresses the combination of methods. Alternatives to current practices can integrate qualitative and quantitative approaches in mixed‐method designs, embrace relevant yet underused data sources and understand the need for multidisciplinary research teams.ConclusionEmbracing alternative epistemological and methodological approaches for studying visual expertise can lead to a more balanced and robust future for understanding superior visual skills in medical image diagnosis as well as other medical fields.

Previous studies have generally found no relation between IQ and chess skill in chess experts. This lack of a relation could be due to the influence of practice being more important than IQ in chess expertise. An alternative explanation is that IQ is relatively high and might therefore be restricted in range in chess experts. The current study investigated the contribution of practice, IQ and motivation to chess performance prospectively in a group of young, novice chess players in which IQ restriction of range did not play a role. Children who entered their first chess course were asked to complete weekly diaries indicating the amount of practice and their enjoyment of the course. IQ and motivation were measured using standardized tests. Using pith analysis, we found that IQ and practice independently predicted chess performance on a chess test at the end of the course: Motivation influenced performance indirectly, by moderating the amount of practice that was undertaken. The results indicate that, at the early stages of expertise development, IQ and motivation influence chess performance.

To prevent radiologists from overlooking lesions, radiology textbooks recommend “systematic viewing,” a technique whereby anatomical areas are inspected in a fixed order. This would ensure complete inspection (full coverage) of the image and, in turn, improve diagnostic performance. To test this assumption, two experiments were performed. Both experiments investigated the relationship between systematic viewing, coverage, and diagnostic performance. Additionally, the first investigated whether systematic viewing increases with expertise; the second investigated whether novices benefit from full-coverage or systematic viewing training. In Experiment 1, 11 students, ten residents, and nine radiologists inspected five chest radiographs. Experiment 2 had 75 students undergo a training in either systematic, full-coverage (without being systematic) or non-systematic viewing. Eye movements and diagnostic performance were measured throughout both experiments. In Experiment 1, no significant correlations were found between systematic viewing and coverage, r = −.10, p = .62, and coverage and performance, r = −.06, p = .74. Experts were significantly more systematic than students F 2,25 = 4.35, p = .02. In Experiment 2, significant correlations were found between systematic viewing and coverage, r = −.35, p

Summary Models of expertise differences in radiology often do not take into account visual differences between diseases. This study investigates the bottom-up effects of three types of images on viewing patterns of students, residents and radiologists: focal diseases (localized abnormality), diffuse diseases (distributed abnormality) and images showing no abnormalities (normal). Participants inspected conventional chest radiographs while their eye movements were recorded. Regardless of expertise, in focal diseases, participants fixated relatively long at specific locations, whereas in diffuse diseases, fixations were more dispersed and shorter. Moreover, for students, dispersion of fixations was higher on diffuse compared with normal images, whereas for residents and radiologists, dispersion was highest on normal images. Despite this difference, students showed relatively high performance on normal images but low performance on focal and diffuse images. Viewing patterns were strongly influenced by bottom-up stimulus effects. Although viewing behavior of students was similar to that of radiologists, they lack knowledge that helps them diagnose the disease correctly. Copyright © 2012 John Wiley & Sons, Ltd.

Radiologists commonly use comparison films to improve their differential diagnosis. Educational literature suggests that this technique might also be used to bolster the process of learning to interpret radiographs. We investigated the effectiveness of three comparison techniques in medical students, whom we invited to compare cases of the same disease (same-disease comparison), cases of different diseases (different-disease comparison), disease images with normal images (disease/normal comparison), and identical images (no comparison/control condition). Furthermore, we used eye-tracking technology to investigate which elements of the two cases were compared by the students.We randomly assigned 84 medical students to one of four conditions and had them study different diseases on chest radiographs, while their eye movements were being measured. Thereafter, participants took two tests that measured diagnostic performance and their ability to locate diseases, respectively.Students studied most efficiently in the same-disease and different-disease comparison conditions: test 1, F(3, 68) = 3.31, P = .025, ηp(2) = 0.128; test 2, F(3, 65) = 2.88, P = .043, ηp(2) = 0.117. We found that comparisons were effected in 91% of all trials (except for the control condition). Comparisons between normal anatomy were particularly common (45.8%) in all conditions.Comparing cases can be an efficient way of learning to interpret radiographs, especially when the comparison technique used is specifically tailored to the learning goal. Eye tracking provided insight into the comparison process, by showing that few comparisons were made between abnormalities, for example.

In his response to criticisms Ericsson argues that conclusions about expertise development cannot be drawn from studies in the general population, and that it is possible that, in chess, intelligence and expertise are uniformly related across development. We respond here that if we want to study the development of expertise across the lifespan, research needs to take into account samples from the general population, such as novices. Moreover, studies in the general population are needed to study a factor that might have troubled previous research in the field and therefore might have implications for current theories of expertise development, which is a possible restriction of range in crucial variables such as intelligence. We argue for a longitudinal, multifaceted approach to study expertise development, starting with unselected samples of novices and taking into account practice, intelligence and motivation simultaneously, to prevent restriction of range and allow for further and stronger conclusions on the relation between intelligence and chess expertise.

A recently published AM Last Page presents five common methodological pitfalls of experimental research in medical education. In this Last Page, we present four statistical pitfalls and their more appropriate alternatives. Pitfalls are illustrated with a case of a fictitious researcher who conducts a study with elements that are common in many medical education experiments.

Comparison learning is a promising approach for learning complex real-life visual tasks. When medical students study radiological appearances of diseases, comparison of images showing diseases with images showing no abnormalities could help them learn to discriminate relevant, disease-related information. Medical students studied 12 diseases on chest x-ray images. They were randomly assigned to a group (n = 31) that compared radiographs of diseases with normal images and a group (n = 30) that only studied radiographs of diseases. On a visual diagnosis test, students who compared with normal images during study were better able to diagnose focal diseases (i.e., lesions at one location) than students who could not compare, but for the diagnosis of diffuse diseases (i.e., involving both lungs) there was no significant difference between groups. Results show that comparison with normal images made it easier to discriminate relevant information for focal diseases.

Being overconfident when estimating scores for an upcoming exam is a widespread phenomenon in higher education and presents threats to self-regulated learning and academic performance. The present study sought to investigate how overconfidence and poor monitoring accuracy vary over the length of a college course, and how an intervention consisting of (1) a monitoring exercise and (2) a monitoring and regulation strategy, improves students’ monitoring accuracy and academic performance. Moreover, we investigated how personality factors (i.e., grandiose and vulnerable narcissism, optimism) influence monitoring accuracy. We found that the monitoring and regulation strategy positively influenced monitoring accuracy and exam scores, whereas the monitoring exercise that confronted students with their overconfidence protected students against overconfidence in the second exam score prediction but did not affect exam score. The results further revealed that exam score predictions lowered from the start to the end of the course for both poor and high performing students, but still leaving poor performers overconfident and high performers underconfident. Topic knowledge gained in the course did not wash out the dunning kruger effect, and results indicate that poor and high performers use different cues when predicting exam scores. Both grandiose and vulnerable narcissism contributed to overconfidence on exam score predictions but not on the monitoring exercise. These findings underline the potential of the monitoring and regulation strategy intervention and ask for upscaling it to include measurements of self-regulated learning activities.