Physiological Differences Between Emergency Medicine Residents and Novices During Cricothyrotomy: Evidence from Brain, Eye, and Heart Rate Measurements

Non-invasive physiological measurements have gained use to distinguish levels of surgical expertise, but validation is limited across different medical skills. This study focused on cricothyrotomy (CCT), a lifesaving emergency airway procedure with rare incidence, which can hinder skill learning and retention. Electroencephalography (EEG), heart rate variability (HRV), and pupil diameter (PD), were recorded when 12 emergency medicine residents and 18 novices each performed 3 repetitions of the CCT procedure on a high-fidelity manikin. The results showed stronger activation in the left prefrontal lobe among residents, suggesting their greater engagement than novices, as supported by residents’ significantly higher performance scores. Residents also exhibited significantly lower frontal theta power and smaller pupil diameter than novices, indicating residents’ lower cognitive workload. No significant differences were observed for the HRV metrics. These results demonstrate the potential of physiological measurements to optimize CCT expertise assessment and inform training design.