Oral presentation assessment and image reading behaviour on brain computed tomography reading in novice clinical learners: an eye-tracking study

Chi Hung Liu, June Hung, Chun Wei Chang, John J.H. Lin*, Elaine Shinwei Huang, Shu Ling Wang, Li Ang Lee, Cheng Ting Hsiao, Pi Shan Sung, Yi Ping Chao, Yeu Jhy Chang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: To study whether oral presentation (OP) assessment could reflect the novice learners’ interpretation skills and reading behaviour on brain computed tomography (CT) reading. Methods: Eighty fifth-year medical students were recruited, received a 2-hour interactive workshop on how to read brain CT, and were assigned to read two brain CT images before and after instruction. We evaluated their image reading behaviour in terms of overall OP post-test rating, the lesion identification, and competency in systematic image reading after instruction. Students’ reading behaviour in searching for the target lesions were recorded by the eye-tracking technique and were used to validate the accuracy of lesion reports. Statistical analyses, including lag sequential analysis (LSA), linear mixed models, and transition entropy (TE) were conducted to reveal temporal relations and spatial complexity of systematic image reading from the eye movement perspective. Results: The overall OP ratings [pre-test vs. post-test: 0 vs. 1 in case 1, 0 vs. 1 in case 2, p < 0.001] improved after instruction. Both the scores of systematic OP ratings [0 vs.1 in both cases, p < 0.001] and eye-tracking studies (Case 1: 3.42 ± 0.62 and 3.67 ± 0.37 in TE, p = 0.001; Case 2: 3.42 ± 0.76 and 3.75 ± 0.37 in TE, p = 0.002) showed that the image reading behaviour changed before and after instruction. The results of linear mixed models suggested a significant interaction between instruction and area of interests for case 1 (p < 0.001) and case 2 (p = 0.004). Visual attention to the target lesions in the case 1 assessed by dwell time were 506.50 ± 509.06 and 374.38 ± 464.68 milliseconds before and after instruction (p = 0.02). However, the dwell times in the case 2, the fixation counts and the frequencies of accurate lesion diagnoses in both cases did not change after instruction. Conclusion: Our results showed OP performance may change concurrently with the medical students’ reading behaviour on brain CT after a structured instruction.

Original languageEnglish
Article number738
JournalBMC Medical Education
Issue number1
Publication statusPublished - 2022 Dec


  • Assessment
  • Brain CT education
  • Eye-tracking
  • Oral presentation
  • Reading behaviour

ASJC Scopus subject areas

  • Education


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