The Impact of Pharmacist Expertise on Information Gathering During Prescription and Medication Verification: Eye-Tracking in a Simulated Experiment

Abstract: In Japan, pharmacists perform "prescription verification" to assess the medical and pharmaceutical validity of prescriptions and "medication verification" to ensure that dispensed medications match the prescriptions. These processes are critical for patient safety. Experienced pharmacists are generally more accurate and efficient than novices, but their expertise remains largely tacit and unshared. This study aimed to compare eye-gaze patterns between experienced and novice pharmacists in a simulated verification task and to clarify how expertise influences information-gathering behaviors.[Methods] In the simulated verification experiment, 22 fictional prescriptions (each containing three medications) and 66 corresponding medication packages were prepared. Eleven of these prescriptions included typical dispensing errors based on actual incidents at our hospital. Eight pharmacists participated (novices: five with 1–2 years of experience; experts: three with over 20 years of experience) and performed the medication verification as they would in routine practice. Eye-tracking data were collected using Tobii Pro Glasses 2 (100 Hz). Average fixation duration and fixation count were calculated using Tobii Pro Lab. The statistical analysis of these data was conducted using the Mann–Whitney U test to compare the two groups of experts and novices (Matlab R2024b). Additionally, Heatmaps and Gaze plots were generated, and these data were input into Google NotebookLM to analyze the differences in gaze patterns between the two groups.[Results] The statistical analysis showed that experts had significantly longer average fixation durations than novices (experts: 263.0 ± 19.8 ms; novices: 182.3 ± 16.8 ms; U = 6.00, z = –0.45, p = .036). However, no significant difference was observed in total fixation counts (experts: 4333.3 ± 380.7; novices: 5708.2 ± 913.8; U = 8.00, z = –4.62, p = .071). Heatmaps indicated that experts broadly scanned patient names and multiple prescription items, whereas novices concentrated on limited information such as medication names and dosage instructions. Gaze plots revealed that experts tended to have longer saccades, rapidly shifting between distinct information blocks, while novices displayed shorter saccades with repetitive focus on limited areas.[Discussion] Although the total number of fixations was not significantly different between novices and experts, novices exhibited significantly shorter average fixation durations. In addition, the fixation areas for novices were limited to critical information areas on the prescription, and they frequently moved back and forth between limited information blocks. This suggests that novices may frequently recheck minimum required information such as medication names and dosage instructions in a short time. On the other hand, experts had longer average fixation durations and may have been deeply concentrating on the target, reading the information thoroughly in a single fixation, suggesting deeper cognitive processing during each fixation. Experts also showed broader visual coverage of the prescription, potentially enhancing verification accuracy through comprehensive checking. These findings may contribute to the development of eye-tracking-based expertise assessment, feedback-driven training programs, and improved prescription interface designs for pharmacists.

Keywords: Medication Safety, Eye-Tracking, Pharmacist Expertise

DOI: 10.54941/ahfe1006961

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