Eye-tracking in nursing simulation: A scoping review of educational design and assessment

• Eye-tracking identifies gaze patterns linked to judgment and situational awareness. • This review clarifies how gaze metrics inform design, assessment, and skill learning. • Findings guide simulation design and feedback to strengthen clinical reasoning skills. To synthesize how eye-tracking technology has been applied in nursing simulation and identify its contributions to educational design, learner assessment, and skill development. A scoping review following the Arksey and O’Malley framework and PRISMA-ScR guidelines. PubMed, EBSCOhost, Scopus, and Web of Science were searched (September 2025), supplemented by manual screening. Eligible studies involved nursing participants, used eye-tracking as a primary method, and were conducted in simulation-based learning settings. Fourteen studies met the inclusion criteria. Three themes emerged: (1) expert-novice gaze pattern differences, showing broader AOI coverage and more efficient scanning among experts; (2) cognitive-load indicators such as pupil dilation and fixation duration that varied by task complexity and experience; and (3) gaze-based feedback that enhanced reflective learning using visualizations, including heatmaps and gaze replays. Eye-tracking provides objective insight into learners’ cognitive processes, supporting improved simulation design, assessment of clinical judgment and situational awareness, and the extraction of teachable visual-scanning strategies. Standardization and multimodal approaches are needed to advance future research.