Multiagent First-Person Perspective Analysis for Leadership Assessment in Pediatric Emergency Simulations: A Feasibility Study

Clinical Snapshot

Key Findings

• P Value: Not applicable - no statistical testing

• Effect Size: Not applicable - feasibility study

• Primary Outcome: Technical feasibility achieved with 77.1% analyzable session duration

• Nnt Or Sensitivity: 29.3% frame exclusion rate from object tracking

• Confidence Interval: Not reported

Clinical Application

Technically feasible but requires significant technological infrastructure and expertise Would require substantial investment in smart glass technology and software development; unclear alignment with RACGP simulation training requirements or Royal Australasian College of Physicians assessment frameworks Limited to simulation-based training environments in pediatric critical care

Abstract

BACKGROUND: Conventional leadership assessments provide structured ratings but offer limited observer-independent metrics. Because leadership and teamwork are interdependent, capturing team dynamics requires multiagent, time- and space-synchronized analysis. This pilot study examined the feasibility of applying multiagent, spatiotemporally synchronized first-person perspective analysis (FPA) in emergency simulations. METHODS: This exploratory simulation study was conducted in a real patient-care room within the PICU of our institution. Two physicians-a critical care specialist (L1) and a pediatric resident (L2)-each completed one scenario as team leader. Leadership behaviors were evaluated using the Ottawa Global Rating Scale, focusing on Situational Awareness and Communication. Wearable smart glasses recorded first-person video and gaze data, enabling identification of fixations within five predefined areas ("patient," "member," "device," "screen," and "unknown"). Eye-contact events were quantified using face detection based on You Only Look Once, version 8, a deep learning-based object detection model, combined with gaze-vector estimation, and analyzed in relation to the timing of verbal communication. RESULTS: Multiagent, time-synchronized FPA was implemented without device- or software-related interruption, and no critical data loss occurred. The mean analyzable session duration relative to total operating time was 77.1%, and the mean percentage of frames excluded from object tracking was 29.3%, primarily due to target objects being outside the field of view. As secondary, illustrative findings, Ottawa Global Rating Scale scores indicated that both leaders were rated within the competent range. FPA further showed that both leaders spent approximately 80% of the scenario fixating on predefined relevant areas (L1: 599/731 s; L2: 565/693 s). Greater patient-directed fixation and balanced gaze transitions were observed in L1, whereas L2 showed prolonged fixation within nonspecific areas. L1 also established eye contact with team members more frequently during direct orders or information sharing. CONCLUSIONS: This study demonstrates the feasibility of multiagent, time-synchronized FPA for extracting gaze-based behavioral information relevant to leadership assessment in emergency simulations.

References

1. 1.Nozawa, H., Kunikata, A., Sakai, Y., Ouyang, L., Furuta, R., Sato, Y., & Matsui, H. (2026). Multiagent first-person perspective analysis for leadership assessment in pediatric emergency simulations: A feasibility study. Critical Care Explorations, Article CCE.0000000000001428. https://doi.org/10.1097/CCE.0000000000001428