Using Eye-Tracking Technology to Design Innovative Learning Material in Medical Education: An Interventional Study in A Pharmacology Module
Authors: Alshagga Mustafa Ahmed , Lim Audrey Yan Li , Nejad Hamzeh Kateb , Alkebsi Abdolkodose , Othman Azli Shahril , Rahman Shamima Abdul , Ibrahim Ibrahim Abdulaziz , Hamid Aini , SA Al-Maweri , Alhadramy Osama , Alsharif Alla , Fadel Hani T. , Kassim Saba , Price Jessica 
Published: July 2023

Background:
Mounting evidence suggests that knowledge-retrieval practice is associated with improvement in retention. Eye-tracking technology has recently gained a lot of interest in educational research. Hence, the objectives of the present study were: 1) to compare between two specially designed educational diagrams for pharmacology of Autonomic nervous system (ANS) in terms of total fixation duration (TFD) and performance (assessed by multiple-choice questions related to the ANS pharmacology), among non-science students, and 2) to measure the performance of medical (MBBS) and pharmacology (BPharm) students before and after the exposure to a specially designed educational ANS Pharmacology diagram over 1 week.
Methods:
The present quasi-experiment study was conducted among non-science undergraduate students as well as MBBS and BPharm students. Eye-tracking technology was used to compare the “image” and “word” attractiveness of two specially designed educational diagrams for ANS pharmacology in non-science students (First Phase). Pre, post, and retention tests were carried out following exposure to the educational diagram, printed on front and back of customised t-shirts, to measure long-term memory, application and lecture learning among MBBS and BPharm students (Second Phase).
Results:
The TFD on the 'Image' as the area of interest (AOI) was longer for Diagram # 1 compared to Diagram # 2 among non-science students (3.96±1.12 sec and 3.43±0.87 sec, respectively, p> 0.05). On the contrary, Diagram # 2 had longer TFD on the 'Words' AOI compared to Diagram # 1 (1.24±0.52 sec and 0.99±0.64 sec, respectively, p> 0.05. Diagram # 2 also attracted the students’ eye gaze for both “Image” and “Word”. Therefore, Diagram # 2 was selected as the learning stimulus for the second interventional phase. MBBS and BPharm students completed a pre-test, were then exposed to customised t-shirts with the selected educational diagram for a week and completed a post-test 1 week and 1-year later to evaluate the retention of ANS pharmacology knowledge. Repeated measures analysis demonstrated a significant recall of knowledge (F (1.987, 162.9) = 20.53, p< 0.01). The mean at pre-test was 2.12±0.15, while at post-test (1 week) was 3.36 ±0.16 (p< 0.0001). The 1-year post-test retention was 2.7 ±0.14 (p< 0.01). Application and lecture-related questions showed no significant differences at pre, post and retention tests.
Conclusions:
Within the limitation of this quasi-experiment, specially designed educational Diagram # 2 was found to be more attractive and informative for learning “images" and related "words" in the short-term than Diagram # 1. Furthermore, special designed educational diagrams, printed on customised t-shirts, were associated with a significant improvement of long-term memory for pharmacy and medical students. The findings of the present study suggests that eye-tracking can be useful in designing learning material and knowledge retrieval outside the class for ANS pharmacology, and it might be a promising method in medical education in general.