Eye-Tracking Analysis of Attention Disruptions Under Realistic Interruptions During Trauma Management; A Cross-sectional Study in a Simulated Virtual Reality.

INTRODUCTION: Distractions and interruptions may interfere with concentration, working memory, and timely decision-making. This study aimed to analyze the visual attention patterns of medical interns during the management of a multiple-trauma patient in a realistic virtual reality (VR) emergency scenario using eye-tracking technology integrated into VR simulation. METHODS: This cross-sectional simulation-based study was conducted among 15 medical interns at Tehran University of Medical Sciences. Participants were exposed to a 242-second high-fidelity VR trauma scenario representing a crowded ED with multiple environmental distractions and interruptions. Eye-tracking data were collected using the HTC Vive Pro Eye headset. The scenario was divided into four predefined temporal intervals. Areas of interest (AOIs) were defined and classified as relevant (main patient, key treatment team members, and essential equipment) or distractors (nonessential environmental and emotional stimuli). Main outcome measures included cumulative gaze time on relevant and distractor AOIs, gaze time outside defined AOIs, and the Relevant/Distractor ratio. RESULTS: A total of 253,075 gaze samples were obtained, with a mean of 16,871.7 ± 2,097.0 samples per participant. The mean duration of valid eye-tracking data was 238.5 ± 12.3 seconds per participant, corresponding to approximately 98.6% of the total scenario time. Across all intervals, gaze was predominantly directed toward relevant AOIs, and this pattern became progressively stronger over time. The Relevant/Distractor ratio increased from 3.41 ± 1.58 in the initial interval to 27.60 ± 26.12 in the final interval, while attention to distractor AOIs decreased from 19.2% to 4.7%. Spatially, the head and face of the main injured patient, the emergency medicine resident, and the patient monitor consistently attracted the greatest attention. CONCLUSION: Medical interns progressively adopted a more structured and goal-directed visual attention strategy, increasingly prioritizing vital clinical information over distracting stimuli. VR-based eye tracking appears to be a feasible and informative tool for assessing attentional behavior and may support targeted educational interventions in trauma training.