The Use of Hand Motion Metrics and Eye Tracking for Objective Evaluation of Procedural Skills Development in Ultrasound-Guided Procedures
Jacqueline Hannan, PhD
Published July 3, 2025 | Clinics in Medical Education
Issue 7 | Volume 1 | June 2025
Ultrasound-guided procedures are core competences in anesthesiology, but their technical complexity can pose challenges for training and introduce patient safety threats [1,2]. All ultrasound-guided procedures have common motion and require needle tracking in the three-dimensional space for precision and to avoid causing structural harm. Currently, training in these procedures relies on subjective assessment and remains highly variable, leading to inconsistent performance and increased complication rates. Additionally, common educational approaches focus on a time-based learning model with an assumption of proficiency after a specific amount of exposure, failing to account for the diverse learning trajectories of each trainee. An alternative competency-based approach with repeated practice in a safe setting ensures a more equal skill level among trainees when compared to a timebased approach [3].
In teaching a variety of anesthesia procedural skills, adding simulation training has resulted in improved performance, a reduction in needle passes, and decreased complications [4,5]. However, these skills are often trained with a fixed number of practice sessions in a calm setting, neglecting the need to perform the procedure with divided attention in an environment with distractions, such as beeping alarms, talking, and multitasking [6]. In surgical programs, overtraining residents beyond proficiency has enhanced trainee performance and multitasking ability [7,8]. These results from training laparoscopic surgery skills provide evidence for conducting extensive pre-clinical training to support patient safety and effective learning experiences in the clinical environment, along with improved retention of trained skills. Pairing this training approach with the implementation of objective measures to quantify proficiency can help track the advancement of trainees’ procedural skills towards expert-level performance.
FIGURE 1
Hand motion can be defined and quantified using aircraft principal axes, measuring the angular motion along the cartesian coordinate frame as pitch, yaw, and roll [9].
Biomechanical analysis of hand motion has emerged as a promising method for objectively evaluating procedural skill, and results show that improving hand motion metrics (reduced path length, fewer movements, and continuous needle tip tracking) correlate with higher visual assessment scores across various procedures [9–13]. At Beth Israel Deaconess Medical Center (BIDMC), researchers have demonstrated the feasibility of using hand motion metrics to differentiate between novice and expert operators and evaluate for improvement in echocardiography procedures and radial artery access [12,13]. In addition to hand motion analysis, eye tracking has been leveraged in medical training to provide context about the operator’s attention, giving a first-person perspective to support technique improvement [14]. By leveraging these technologies, objective measures can be derived to perform anesthesia procedural skills with expert-level competency.
FIGURE 2
Aircraft principal axes
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