One favorite trick of mine is to print out 1:1 drill pattern drawings and center-punch through the paper onto my metal workpiece for all the drill locations. Fast and accurate.
Basically, 2D printers (you know, those $150 things) are exceptionally high precision and accuracy tools for making 2D drawings. I've been using printers for years and it never occurred to me you could use it to print a (for example) 10cm square.
Fusion360 seems to try to prevent you from exporting PDFs with the free hobbyist version. One tip that I discovered was to create a CUPS printer on a Linux VM that saves PDF files.
(I found it printed slightly off sized if I sent a 2D drawing straight to the printer.)
Yeah, you have to correctly configure the output to get dimensional accuracy. but it shouldn't involve finding some magic scaling factor for X and Y that makes things accurate.
I've used Inkscape to make basic shapes, and pay for Fusion 360. TBH I've never actually thought to take one of my 3D Fusion models and use it to make a 2D template for drilling. That makes sense...