# The Current Landscape of Ophthalmology Training in Europe

## TL;DR

Ophthalmology training in Europe is evolving toward a competency-based system, but significant differences remain across countries.

## Contribution

This review synthesizes current training structures and reforms in European ophthalmology, highlighting progress and challenges toward harmonization.

## Key findings

- Residency programs vary in length and surgical exposure across Europe.
- The 2024 European Training Requirements introduced standardized assessment methods like EPAs and e-portfolios.
- Simulation-based training is becoming essential but is not uniformly adopted.

## Abstract

Ophthalmology training across Europe has undergone a significant transformation over the last two decades. Although individual countries retain distinct systems for resident recruitment, training structure, and surgical exposure, the overarching goal has been to converge toward competency-based education guided by the European Board of Ophthalmology (EBO) and the European Union of Medical Specialists (UEMS).

This narrative review draws on official EBO and UEMS policy documents, recent peer-reviewed literature, national curricula, and surveys of residents and educators. It examines the structure and duration of training, curriculum reforms, surgical exposure, simulation, fellowship opportunities, and the influence of European legislation on professional mobility.

Residency programs in Europe vary in length from four to six years, with considerable heterogeneity in surgical case volume, fellowship opportunities, and access to simulation. The 2024 European Training Requirements (ETR) introduced Entrustable Professional Activities (EPAs), programmatic assessment, and e-portfolios, providing a common reference for national curricula. The EBO Diploma (EBOD) serves as a recognized benchmark for harmonization. Simulation-based cataract training has moved from optional to integral, though adoption remains inconsistent. Pressures such as the European Working Time Directive (EWTD) and the COVID-19 pandemic have altered clinical exposure, while digital education and mobility programs offer compensatory mechanisms.

European ophthalmology training is moving toward harmonized outcomes but retains structural variation between countries. Achieving consistency will require aligning national curricula with the ETR, mandating simulation milestones, investing in faculty development, and formalizing fellowship standards to ensure equitable access and readiness for independent practice.