What are you looking at?

Above all the practice of medicine is a discipline of direct contact; diagnosis is built on history and examination. In paediatrics there may only be a second-hand narrative so the art of recognising illness from observation alone makes it an even more appealing but challenging career. Medical education has previously concerned itself with teaching the clinical signs of illness (e.g. chest retractions) or abnormal postures or positions adopted (i.e. in a child with a dystonia) or the sounds made (i.e. stridor in upper airways instruction). Furthermore clinically important visual or auditory patterns are not always found by directly looking at the patient. For example, it is also important to teach how to recognize the waveforms of abnormal electrical traces representing breathing (capnography) or cardiac patterns (asystole). Medical pedagogy has traditionally centred on teaching how to determine normal from abnormal by teaching what students needed to look at. The advent of accessible technology to adequately determine the direction of gaze has opened up a new paradigm of educational investigation in understanding where a person is looking and for how long, therefore helping us understand how to look at patients.