Visual interpretation of clinical images among dental students using eye-tracking technology.

Background: Tele-consultations are increasingly used for screening and diagnosis. Only a few studies have assessed dental students' visual attention to clinical images.

Aim: To (i) determine dental students' gaze behavior, visual fixations, and diagnostic competence while viewing clinical images, and (ii) explore potential opportunities to strengthen the teaching-learning approaches.

Design: Tobii Pro Nano-device captured the eye-tracking data for 65 dental undergraduate students in this cross-sectional study. The predetermined areas of interest (AOI) for all five clinical photographs were uploaded onto Tobii software. All participants used a think-aloud protocol with no restrictions to view time.

Results: A total of 325 clinical pictures were analyzed, and the average view time was 189.25 ± 76.90 s. Most participants started at the center of the image (three frontal photos), spent a significant share of their view time on prominent findings, did not follow a systematic pattern, and exhibited diagnostic incompetence. Also, most participants followed a "Z" viewing pattern (oscillating movement from left to right) for the remaining two pictures.

Conclusions: Subjects frequently fixated on the prominent AOI, however, failed to make the correct diagnosis. Their view patterns revealed no sequential viewing. Therefore, emphasizing knowledge about common dental abnormalities and focusing on full coverage of clinical pictures can improve dental students' diagnostic competence and view patterns.