Visualizing expert judgment

Nippon Sport Science University uses eye tracking to visualize the knowledge and skills of experienced nurses in emergency medical care in education. 

In pre-hospital emergency care, swift and accurate decision-making is critical to improving patient outcomes. Experienced nurses, known as "grand nurses," play a key role by drawing on deep knowledge, sharp situational awareness, and calm judgment under pressure. Yet, these advanced skills—shaped through years of practice—are difficult to teach using conventional methods. To address this, Hitoshi Shiraishi of the Department of Faculty of Medical Science at Nippon Sport Science University conducted a study analyzing how nurses' gaze behavior during intravenous access in ambulances differs based on years of experience. By using eye tracking technology, the research aims to capture the expertise of seasoned nurses and translate it into more effective training, bridging the gap between experience and education in emergency care. 

Exploring the gaze of novice and experienced nurses using Tobii Pro Glasses 3 

The researchers conducted a study to examine how nurses’ experience levels affect their gaze behavior during intravenous access in ambulances. Using
Tobii Pro Glasses 3, researchers collected eye tracking data in the confined space of an ambulance without disrupting natural actions. This approach made it possible to capture and analyze the tacit knowledge of experienced nurses, which is often hard to convey through conventional education. 

Ten nurses from the Emergency and Critical Care Centre of Nippon Medical School Tama Nagayama Hospital participated in the study, with 4 to 17 years of experience. They were classified into four groups — newcomer, fully competent, mid-career, and expert — based on the Japan Nursing Association’s Clinical Ladder. 

Hitoshi Shiraishi identified ten areas of interest (AOIs), such as the patient’s face, infusion bags, upper arm, monitors, and interactions with family members and paramedics. Gaze behavior was analyzed using metrics like frequency, duration, and distribution. The study also assessed practical actions, including whether explanations were given to the patient’s family. The findings aim to support more effective training by making expert decision-making processes observable and teachable. 

Major differences in situational awareness, equipment deployment and communication 

The study revealed differences in gaze behavior, equipment use, and communication between nurses based on experience. Expert nurses focused their gaze on key areas like monitors and the patient’s face, enabling them to assess situations accurately. In contrast, new nurses moved their gaze frequently, with a narrower field of observation, indicating lower situational awareness. 

In terms of equipment deployment, experienced nurses organized tools efficiently using stretchers and chairs, while less experienced nurses placed items on the floor, which made management more difficult. 

Communication also varied by experience. Expert nurses directed their gaze purposefully toward family members, gathered necessary information quickly, and provided clear explanations. New nurses, despite frequent eye movement, tended to give brief statements such as “I'm going to start an IV,” showing a less developed communication approach. 

Overall, expert nurses demonstrated the ability to manage their gaze, make decisions, and act effectively in the challenging ambulance environment. New nurses faced challenges in responding to environmental factors, resulting in cluttered gaze patterns and insufficient focus on critical areas. The findings suggest that enhancing situational awareness and decision-making in such settings should be a key focus of nurse training. 

Eye tracking to improve nurses’ education programs 

The study confirmed clear differences in gaze behavior between experienced and novice nurses. Expert nurses consistently identified and focused on key areas within limited time frames, with their eye movements reflecting experience-based judgment and intuitive responses. These behaviors, once considered difficult to articulate, were visualized and objectively analyzed using eye tracking data. 

The results suggest that providing feedback on gaze patterns during training can help learners become more aware of their actions, improving educational outcomes. Hitoshi Shiraishi sees potential in applying this approach to nursing education, especially in emergency care settings. Future plans include expanding the study to more hospitals and nurses, test for the external validity of the findings and support the development of targeted educational programs.