Eye movements as predictors of student experiences during nursing simulation learning events

Abstract

Although the "eye-mind link" hypothesis posits that eye movements provide a direct window into cognitive processing, linking eye movements to specific cognitions in real-world settings remains challenging. This challenge may arise because gaze metrics such as fixation duration, pupil size, and saccade amplitude are often aggregated across timelines that include heterogeneous events. To address this, we tested whether aggregating gaze parameters across participant-defined events could support the hypothesis that increased focal processing, indicated by greater gaze duration and pupil diameter, and decreased scene exploration, indicated by smaller saccade amplitude, would predict effective task performance. Using head-mounted eye trackers, nursing students engaged in simulation learning and later segmented their simulation footage into meaningful events, categorizing their behaviors, task outcomes, and cognitive states at the event level. Increased fixation duration and pupil diameter predicted higher student-rated teamwork quality, while increased pupil diameter predicted judgments of effective communication. Additionally, increased saccade amplitude positively predicted students' perceived self-efficacy. These relationships did not vary across event types, and gaze parameters did not differ significantly between the beginning, middle, and end of events. However, there was a significant increase in fixation duration during the first five seconds of an event compared to the last five seconds of the previous event, suggesting an initial encoding phase at an event boundary. In conclusion, event-level gaze parameters serve as valid indicators of focal processing and scene exploration in natural learning environments, generalizing across event types.

Keywords: Event cognition; Mobile eye-tracking; Simulation education.

Fig. 1

Overhead footage of a simulation room

Fig. 2

Egocentric eye-tracking footage captured by Tobii Glasses 3. The red circle represents the student’s fixations, and the red lines represent saccades

Fig. 3

Student’s view of their event-level guided reflection questions

Fig. 4

The relationship between mean fixation duration and team quality

Fig. 5

The relationship between mean saccade amplitude and self-efficacy scores

Fig. 6

Visualization of gaze parameters categorized by event types. Error bars are standard deviations