Eye-tracking technology applied to regional anaesthesia task performance, safety and skill acquisition: a scoping review

TY - JOUR

T1 - Eye-tracking technology applied to regional anaesthesia task performance, safety and skill acquisition

T2 - a scoping review

AU - Natto, Osama

AU - Hardman, Jonathan G

AU - McLeod, Graeme

AU - Hewson, David W

N1 - Publisher Copyright: © 2026 The Author(s). Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/

PY - 2026/6/25

Y1 - 2026/6/25

N2 - BACKGROUND: Regional anaesthesia training is constrained by limited clinical exposure, variable supervision, and resource-intensive simulation requirements. Eye-tracking technology offers a potential method for quantifying visual attention and perceptual strategies during procedural tasks. This scoping review aimed to identify, map and critically appraise the literature evaluating eye tracking in regional anaesthesia, with a focus on task performance, safety and skill acquisition.METHODS: We systematically searched databases from inception seeking eligible articles including primary research, abstracts and peer-reviewed opinion pieces evaluating eye tracking in any regional anaesthesia simulated or clinical context. Two reviewers screened studies and extracted data. Data fields included methodological, participant and technological characteristics, eye-tracking metrics and procedural or participant outcomes. Study quality and risk of bias were appraised.RESULTS: Fourteen articles met inclusion criteria. Most studies were simulation-based and showed substantial heterogeneity in design, participant characteristics and reported eye-tracking metrics. Across studies, expert practitioners consistently showed more efficient gaze behaviour, characterised by fewer and longer fixations in clinically relevant areas of interest. However, few studies correlated eye-tracking metrics with validated measures of procedural competence. Evidence for educational benefit or safety improvement remains preliminary. Only one study was conducted in a clinical environment.CONCLUSIONS: Eye tracking provides insight into visual strategies associated with regional anaesthesia expertise but does not yet establish a causal relationship with procedural competence or patient outcomes. Current evidence is limited by small study sample sizes, methodological inconsistency and limited clinical translation. Future research should prioritise validation against objective competence measures and evaluation in clinical environments before bedside implementation can be considered.

AB - BACKGROUND: Regional anaesthesia training is constrained by limited clinical exposure, variable supervision, and resource-intensive simulation requirements. Eye-tracking technology offers a potential method for quantifying visual attention and perceptual strategies during procedural tasks. This scoping review aimed to identify, map and critically appraise the literature evaluating eye tracking in regional anaesthesia, with a focus on task performance, safety and skill acquisition.METHODS: We systematically searched databases from inception seeking eligible articles including primary research, abstracts and peer-reviewed opinion pieces evaluating eye tracking in any regional anaesthesia simulated or clinical context. Two reviewers screened studies and extracted data. Data fields included methodological, participant and technological characteristics, eye-tracking metrics and procedural or participant outcomes. Study quality and risk of bias were appraised.RESULTS: Fourteen articles met inclusion criteria. Most studies were simulation-based and showed substantial heterogeneity in design, participant characteristics and reported eye-tracking metrics. Across studies, expert practitioners consistently showed more efficient gaze behaviour, characterised by fewer and longer fixations in clinically relevant areas of interest. However, few studies correlated eye-tracking metrics with validated measures of procedural competence. Evidence for educational benefit or safety improvement remains preliminary. Only one study was conducted in a clinical environment.CONCLUSIONS: Eye tracking provides insight into visual strategies associated with regional anaesthesia expertise but does not yet establish a causal relationship with procedural competence or patient outcomes. Current evidence is limited by small study sample sizes, methodological inconsistency and limited clinical translation. Future research should prioritise validation against objective competence measures and evaluation in clinical environments before bedside implementation can be considered.

KW - eye tracking

KW - medical education

KW - peripheral nerve blockade

KW - skill acquisition

KW - ultrasound guided regional anaesthesia

UR - https://www.scopus.com/pages/publications/105042630435

U2 - 10.1016/j.bja.2026.04.068

DO - 10.1016/j.bja.2026.04.068

M3 - Review article

C2 - 42350172

SN - 0007-0912

JO - British journal of anaesthesia

JF - British journal of anaesthesia

ER -