Microlearning in ophthalmic surgery training: an integrative narrative review

Introduction

Global eye health is facing unprecedented challenges, driven in part by population aging and the rising prevalence of chronic eye diseases. The demand for eye care services continues to increase, encompassing not only refraction correction, glaucoma and cataract surgery, but also the diagnosis, treatment and long-term monitoring of retinal diseases such as age-related macular degeneration and diabetic retinopathy (1,2). Timely access to eyecare is essential to prevent avoidable blindness, improve quality of life, and reduce the broader societal and economic burden associated with vision impairment and significant morbidity (2). Delayed care often results in advanced disease, increased morbidity, and greater healthcare costs.

In high-income settings, these pressures translate into increasingly complex healthcare delivery systems that require coordinated, multidisciplinary care pathways and multiple patient interactions with specialized providers. This contributes to indirect costs, including repeated work absences for patients and caregivers. Conversely, in low- and middle-income countries (LMICs) and underserved regions, persistent surgical backlogs, workforce shortages, and inequitable access to high-quality surgical training continue to limit the delivery of safe and effective eye care (1-3). These global disparities highlight the need for scalable, efficient, and context-sensitive educational strategies that address both workforce capacity and the quality of care (1,2).

Traditional models of surgical training, often based on the Halstedian apprenticeship approach of “see one, do one, teach one” approach, have been foundational but are increasingly insufficient to ensure standardized, safe, and reproducible skill acquisition in modern clinical environments (3,4).In response, competency-based medical education (CBME) has emerged as a transformative framework that emphasizes outcomes, accountability, and the demonstration of competence in the real world (5). A key operational component of CBME is the use of entrustable professional activities (EPAs), which define discrete, observable units of professional work that trainees can be trusted to perform once sufficient competence has been demonstrated (6,7). EPAs provide a structured bridge between competencies and clinical practice, supporting formative and summative entrustment decisions. EPAs vary in complexity and the anticipated time needed for unsupervised practice decisions. Beyond training time, competence-driven education is based on learning progression and on what learners can do (8).

Microlearning involves the delivery of short, focused learning designed to address specific skills, often through digital platforms such as brief videos, interactive, or step-by-step skill procedural guides (9-11). These concise learning interventions can support the acquisition of technical, cognitive, and attitudinal skills, including surgical steps, decision-making processes, and safety principles, relevant to ophthalmic practice (12,13). Microlearning is particularly suited to just-in-time teaching (JiTT) approaches, enabling learners to access targeted information at the point of care and has been increasingly integrated into continuing professional development (CPD) and lifelong learning frameworks (14-16).

One of the key advantages of microlearning is its flexibility and potential for broad accessibility. Because it can be delivered through low-cost digital platforms, it may support more equitable access to educational resources across diverse geographic and economic contexts (17,18). This is particularly relevant in LMICs, where traditional training infrastructure may be limited (1-3). While not a substitute for comprehensive training programs, microlearning can complement existing educational models by enhancing access to experts, reinforcing knowledge, and supporting ongoing skills development (19).

The integration of microlearning with simulation-based education (SBE) and microcredentialing offers further opportunities to strengthen ophthalmic surgical training in both technical and non-technical skills essential for safe surgical practice. Simulation provides a safe environment for deliberate practice, enabling learners to develop technical proficiency and clinical judgment without risk to patients (17,18). Microcredentialing, in turn, allows for the formal recognition of specific competencies and skills, supporting motivation, accountability, and transparency in professional development (19-22). The combination of these educational strategies can align training with CBME and EPA frameworks, and support both technical and non-technical skill development, including communication, professionalism, and teamwork, which are essential for safe surgical practice (23-25).

From a theoretical perspective, the effectiveness of microlearning can be understood through the cognitive load theory perspective, which emphasizes the importance of managing memory and structuring information into manageable units to enhance learning and retention (26). In addition, social constructivist and experiential learning theories highlight the role of interaction, reflection, and practice in the development of professional competence (27). Integrating these perspectives supports a more holistic approach to surgical education, in which learners actively engage with content, apply knowledge in context, and develop through guided experience(28-30).

Clinician educators must balance multiple responsibilities, including patient care, research, administration, and teaching, often within resource-constrained environments (5,6). Within this context, traditional faculty development approaches may be resource-intensive and difficult to scale. Microlearning has emerged as a promising educational strategy that aligns well with workplace-based learning environments and the needs of busy clinicians (31-34).

Nevertheless, the implementation of CBME in surgical disciplines continues to face practical challenges, including limited faculty time, resource constraints, and difficulties in scaling training and assessment models (5,6).

While microlearning, microcredentialing and simulation have each demonstrated educational value, they are often applied in isolation rather than as part of an integrated, coherent training framework. There is a lack of consolidated evidence on how these approaches can be effectively combined and aligned with CBME and EPA frameworks in ophthalmic surgical education, particularly in ophthalmology across diverse and resource-constrained settings. The impact of such integrated strategies on long-term clinical performance, workforce capacity, and patient outcomes remains insufficiently explored.

The aim of this integrative narrative review is to explore how the integration of microlearning, simulation, and microcredentialing can enhance ophthalmic surgical education and support competency-based training across diverse and resource-constrained settings. We present this article in accordance with the Narrative Review reporting checklist (available at https://aes.amegroups.com/article/view/10.21037/aes-2025-1-76/rc).

Methods

Literature, identified through PubMed and PubMed Central (PMC) searches, was conducted in October 2025 using the following keywords: “microlearning, microcredentialing, simulation, ophthalmology education, and competency-based medical education”. To follow a 5-year interval, studies published between 2019 and October 2025 were included. The inclusion criteria included English-language articles with abstracts available, focusing on medical or surgical education. Editorials and opinion articles were excluded unless conceptually significant.

The review incorporates examples from both high-resource settings and LMICs to ensure a global perspective. Snowballing research was conducted whenever it was justified by the interest and contemporaneity of the studies found. Classical articles sustaining learning theories were also included wherever deemed relevant.

All abstracts were reviewed, and potentially eligible articles were read in full. The final list of studies that met the eligibility criteria was cross-checked by the authors, with any discrepancies resolved through discussion.

This narrative review adopted a theory-informed integrative approach. The analysis was guided by principles from cognitive and social constructivism, experiential learning, and CBME. To address the research objective, we conducted a qualitative summary of existing literature with the emphasis on synthesizing evidence and innovations informing global ophthalmic surgical training.

The search strategy is summarized in Table 1.

Eighty-four articles were initially reviewed and thirteen subsequently removed due to duplication or failing to meet inclusion criteria. Additionally, seven references were incorporated pertaining to global digital platforms involved in health professions education projects within the scope of our review. Four additional sources were added to better illustrate the learning theories and frameworks relevant to the topic. Findings across different studies were compared and the quality and relevance of the sources critically assessed.

Key content and thematic findings

This integrative review highlights the potential of integrating microlearning, microcredentialing, and SBE to support competency-based ophthalmic surgical training across diverse contexts. Collectively, these approaches offer a complementary framework that is well aligned with the principles of CBME particularly with respect to measurable outcomes, progressive skill acquisition, and workplace-relevant performance (35).

Educational foundations

CBME shifts from time and volume-based training models toward competence demonstrated through authentic real-world performance. EPAs operationalize CBME by defining specific, observable clinical tasks, that trainees must perform independently once competence is achieved (36).

Microlearning structures education into short, targeted modules, often digital and case-based, each focused on a single objective or skill (37). A central strength of microlearning is its ability to segment complex surgical procedures into discrete, manageable components that can be aligned with EPAs. This modular structure supports both learning and assessment by enabling targeted practice and feedback on specific elements of performance (38). Evidence from cognitive science suggests that structuring through chunking, spaced repetition, and retrieval practice can enhance knowledge retention and facilitate transfer to clinical settings (31,39). When embedded within CBME frameworks, microlearning modules could therefore contribute to more transparent and outcomes-driven training pathways. These modules could include interactive case scenarios that portray best practices in team communication in the operating room, non-technical skills exercises with examples and counterexamples, annotated video demonstrations of key steps in a surgical procedure, or any other diagnostic or therapeutic maneuvers, including pre- and post-operative care.

Microlearning leverages chunking and, through its accessibility, facilitates spaced repetition and retrieval practice, thereby strengthening long-term retention and supporting progressive learning. From a social learning perspective, SBE debriefings and peer dialogue align with the concept of the zone of proximal development (40), enabling learners to progress from observation to independent performance with appropriate scaffolding.

Microlearning in ophthalmic education

Ophthalmology prioritizes CBME models, which emphasize demonstrable skills, practical competence, and regular assessments. Significant efforts have been undertaken to harmonize and standardize ophthalmic surgical training across Europe and globally (41,42). Comprehensive frameworks address these issues by defining roles and competencies, including professionalism, advocacy, leadership, communication, collaboration, and scholarship, beyond medical expertise (42), and by supporting team-based and flexible workforce development, especially in LMICs. However, significant regional disparities remain. Learners integrate complex skills more effectively when skills are segmented into sequenced, observable units. Embedding microlearning within CBME frameworks helps ensure that learning remains outcomes-driven and directly aligned with patient care needs. Microlearning naturally fits into CBME and EPAs by breaking complex skills into manageable, observable units that align with a modular structure. Each module can explicitly target an EPA milestone, e.g., performing a central, curvilinear, continuous capsulorhexis. Procedures can be chunked into their components to focus on and master each component and then combine them all together. This can be applied to training ophthalmic procedures, such as cataract surgery.

SBE improves technical skills, procedural confidence, and clinical decision-making in surgical disciplines (43). In ophthalmology, assessment tools such as the Ophthalmology Surgical Competency Assessment Rubrics (OSCARs) offer validated frameworks for providing formative feedback and evaluating performance (44,45). Micromodules with constructive, timely feedback can be built using these rubrics. A microlearning example could be performing a central, continuous, curvilinear, capsulorhexis that could include: (I) a two-minute annotated video highlighting technique nuances, (II) an interactive decision-tree case exploring complication’s management, (III) simulator practice with faculty remote feedback, (IV) a reflective prompt such as “How would you explain to a patient about an intraoperative complication, such as a capsule tear?”. Table 2 summarizes alignment of microlearning and EPA framework.

Formative and summative assessment evidence of incremental competence can be retrieved from completion and performance data gathered from microlearning modules (21). OSCARs can be used to provide detailed formative feedback and thus track skill development. EPAs, in contrast, guide summative entrustment decisions and progression within the CBME framework by determining whether a trainee can be trusted to perform the entire procedure independently (7). In this way, OSCARs can generate structured, procedure-specific evidence to directly support EPA entrustment decisions.

Digital microlearning modules can be rapidly updated to reflect new surgical devices, techniques, and evidence. This learning modality, applicable across specialties, can quickly and cost-effectively meet learners’ needs at the point of care, support workforce upskilling, and expand access to learning opportunities, especially in underserved and remote areas. Microcredentialing can formally recognize specific competencies. When integrated with CBME and EPAs, microcredentialing can scaffold motivation, support transparency, and foster professional progression.

Simulation-enhanced microlearning in ophthalmic surgical training

Traditional surgery curricula often overemphasize technical skills, such as instrument handling and manual dexterity, while underrepresenting equally critical domains, such as team communication, professionalism, situational awareness, and patient-centered care (39,46). Microlearning modules can fill this gap by including brief, interactive case-scenario videos that highlight complication management, address ethics, and cover crisis communication. They can be supplemented with reflective questions on consent and shared decision-making (26,31).

The integration of microlearning with simulation allows learners to acquire knowledge in concise formats to immediately apply it in practice, reinforcing cognitive, psychomotor, and professional domains. This combined approach can transform a passive learning experience into an interactive one and support the development of non-technical competencies, including communication, professionalism, and teamwork. Despite often being underrepresented in traditional surgical curricula, they have increasingly been recognized as critical determinants of patient safety and quality of care (47).

Embedding non-technical competencies into microlearning modules aligns with CBME’s holistic vision of practice-ready graduates and supports the development of reflective, ethical, and resilient surgeons. SBE requires faculty development, improves technical skills, procedural confidence, and clinical decision-making in surgical disciplines (48-50).

Global health and equity

High-income countries typically benefit from well-developed simulation infrastructure, structured curricula, and established accreditation systems. In contrast, many LMICs face persistent barriers, including limited access to simulators, shortages of trained educators, and competing demands for clinical services (1-3). These disparities underscore the urgent need for effective and transformative educational strategies. Online microlearning and microcredentialing can be particularly valuable for professionals in LMICs, through facilitated access and flexibility to rapidly learn, adapt to new techniques and technologies, and progress within global practice standards (17). Microcredentialing awards tasks for competence and provides verifiable evidence of learning and competency development (51). Microlearning and microcredentials are emerging globally in ophthalmic education to develop procedural and surgical skills and strengthen competency-based training for eye care professionals (52). Rapid advances in techniques and technology, combined with the rise of artificial intelligence (AI), are transforming access to education, teaching, and assessment (19). These methods have been increasingly used in health professions education since the pandemic for quick, ongoing learning (53,54). The main benefits include (I) accessibility for professionals in underserved regions, (II) rapid response to evolving technologies, and (III) certification of specific competencies with transparent workforce CPD (55-57).

Several organizations have been working on innovative, adaptable educational models, such as the Aravind Eye Hospital (58) through stepwise, simulation-supported training paired with peer mentorship. Orbis International (59) with mobile simulation labs and remote mentoring, and the Ophthalmology Foundation (60) developing microlearning videos and infographics for ophthalmologist-educators.

Collaborative platforms

From a systems perspective, integrating microlearning and microcredentialing offers potential advantages for addressing global disparities in ophthalmic education. Workforce shortages, uneven distribution of training resources, and limited access to simulation infrastructure remain significant barriers, particularly in LMICs. Global digital microlearning platforms may help mitigate some of these challenges by enabling broader access to educational content, supporting asynchronous learning, and reducing dependence on physical infrastructure. Hosting peer-reviewed microlearning modules with remote feedback and mentorship aligned with EPAs can facilitate cross-institutional benchmarking for quality improvement. These platforms help transform isolated learners and educators into connected communities of practice, consistent with constructivist principles (61). The co-creation of microlearning modules could be effectively operationalized by ophthalmology societies, particularly at the supranational level as Ophthalmology Foundation and ORBIS International have been advancing these initiatives. The Ophthalmology Foundation offers an open-access four-module microlearning program on CPD fundamentals, and a thematic series of four infographics on good practices of SBE that were drawn from the four corresponding articles previously published in the Pan-American Journal of Ophthalmology (61-63). Several modules from a comprehensive online faculty program on health professions education are offered in a microlearning format via this organization’s official YouTube channel, which also features short videos on other topics (64,65).

Microcredentials provide a mechanism for documenting and recognizing competence development, thereby enhancing learner motivation and supporting workforce development initiatives.

Microlearning formats

Combining several effective educational strategies in microsurgery training programs enhances skill development (66). Video-based microlearning supports stepwise teaching methods, which have significantly enhanced surgical performance by enabling faster task completion, raising competency scores, and reducing complications. These techniques are now recognized as an effective core component of modern surgical education (49). Microlearning modules, particularly those in scenario- or video-based formats, offer opportunities to address healthcare competencies in a structured, scalable manner. When combined with reflective practice and feedback, they can contribute to the development of professional identity and ethical decision-making (25,26).

SBE using microlearning is a safe and effective method for skill acquisition and supplements traditional training, improving both technical skills and confidence. Incorporating various microlearning formats that complement SBE, into the curriculum can facilitate flexible learning and reinforce ophthalmic surgical competencies (52,67-69).

• Video-based micro-modules are short, focused surgical videos allowing trainees to repeatedly review procedures, techniques, and critical steps. Systematic reviews have highlighted video education as one of the most impactful microlearning strategies for skill development and retention (52,67,68,69);
• Stepwise, virtual SBE consists of interactive computer or virtual reality simulation learning experiences that enable breaking surgical tasks into manageable steps. Learners progress through each phase at their own pace, reinforcing technique and precision in a risk-free environment (53);
• Case-based learning and quizzes as brief, digitally delivered clinical scenarios and question banks provide real-time practice and feedback, fostering clinical reasoning (69);
• Digital feedback loops, as immediate targeted feedback on task performance, like peer or mentor review of an uploaded skills development video, can integrate microlearning platforms and timely correct errors, and accelerate mastery;
• Interactive digital clinical pearls and flashcards for rapid skill review;
• Flip learning using very brief video clips as preparatory didactics to maximize in-person SBE outcomes (68), and
• Just-in-time mobile checklists/rubrics for quick reference at practice settings.

Faculty development and CPD

Skilled surgeon-educators are essential but are often unequally distributed, particularly in rural or underserved areas. Microlearning can also support educators’ training by offering flexible modules on teaching, assessment, feedback, curriculum design, and nurturing reflective practice. By engaging with discrete learning microlearning blocks, clinician-educators can build a certified body of knowledge tailored to their personal context and needs, like a Lego^® construction. From basic to more advanced levels, microlearning can meet the needs of both highly self-motivated and self-directed learners (70).

Microlearning can offer valuable training for clinician-surgeons and clinical teams, and microcredentials provide (re)assurance through verified documentation of specialized expertise to supervising surgeons, patients, and regulatory bodies, thereby enhancing scalable, team-based care (71). This assurance can also support scalable, team-based patient care (31). Additionally, microcredentialing encourages faculty engagement and strengthens professional identity by formally recognizing educational and clinical proficiency (52). Learners track their growth; educators identify gaps and institutions could benchmark progress. When embedded within EPAs and CBME, microcredentials can enhance learner agency and accountability while supporting reflective self-assessment.

Challenges and mitigation

Despite their promise, microlearning and microcredentialing present notable challenges and require careful design, development and integration. Table 3 summarizes the challenges and their mitigation strategies.

Fragmentation

Microlearning, by its nature, risks fragmenting complex knowledge if not carefully integrated within a coherent curriculum or CPD framework. Without appropriate alignment to CBME frameworks and EPAs, isolated learning modules may fail to capture the holistic nature of clinical practice.

Quality

Ensuring quality and consistency of content is another challenge, particularly in rapidly evolving digital environments. Peer review, regular updating, faculty oversight and institutional support are essential to maintain educational standards.

Faculty workload

Faculty development and recognition also can be a potential barrier. The development, implementation, and evaluation of high-quality microlearning resources require time, expertise, and institutional support. Collaborative approaches, including shared repositories and co-creation of content, may help distribute this burden and enhance sustainability.

Recognition

Variability in the recognition and accreditation of microcredentials across institutions and regulatory bodies can be challenging and may limit their broader adoption.

Research indicates that faculty development recognition and institutional support cultivates a culture of scholarly teaching and contributes to institutional quality improvement (72).

Infrastructure gaps

Infrastructure constraints remain a critical consideration, particularly in resource-limited settings. While microlearning can reduce reliance on traditional training infrastructure, access to reliable internet connectivity, digital devices, and simulation tools and equipment is not universal. Hybrid approaches that combine online and offline resources, along with low-cost simulation strategies, may be necessary to ensure equitable implementation.

This review has several limitations that may limit the extent to which its findings can be applied. While the research relies on a few peer-reviewed articles from limited sources, a growing number of publications over the last five years offer useful insights. The findings combine past perspectives, support our claims, and suggest future research directions to improve ophthalmic surgery training practices through innovative methods across various settings.

Future directions and recommendations

Zhang and West examined CBME and microcredentialing to highlight the importance of microlearning, noting its effectiveness when properly designed (37). Our integrative review supports this and further notes limited research, especially on ophthalmology education and ophthalmic surgery training. Given the worldwide demand for eyecare services, from primary care to complex surgical procedures, alongside a global shortage of eyecare professionals, it is crucial to prepare and upskill not only ophthalmologist surgeons but also allied personnel and clinical teams to meet the increasing need for current and safe eyecare. Microlearning and microcredentialing, including simulation-based learning within a CBME environment, could play a vital role in achieving this by leveraging the following factors. Exploring a longitudinal approach that associates microlearning with clinical outcomes represents a promising area of research to reinforce the efficacy of this educational strategy.

International collaboration

To advance global ophthalmic surgical education, it is essential to develop peer-reviewed repositories of standardized microlearning units that are accessible worldwide. These repositories should align with the CBME and EPA frameworks, ensuring consistent, high-quality training across institutions and regions.

Research

Combining microlearning with simulation shows promise in improving knowledge and skills in CBME. Further research should assess their impact on long-term clinical performance, educator abilities, patient outcomes, and organizational effects. Future studies should compare the effectiveness, cost, and scalability of these methods with traditional methods across diverse healthcare settings. Rigorous studies will help establish the effectiveness of microlearning approaches and guide future improvements.

Policy integration

Advocacy efforts are needed to promote national recognition of microcredentials within CPD and certification processes. Integrating microlearning credentials into the policies of formal national certification systems will enhance their value and encourage broader adoption in professional training.

Faculty capacity-building

Institutions should prioritize faculty development by delivering scalable education informed by experiential, cognitive, and social constructivist learning theories. This includes training educators in the specific features and benefits of microlearning, enabling them to effectively design, implement, oversee, and facilitate these learner-centered approaches.

Technology equity

Investment in low-cost simulation and digital tools is crucial, particularly for LMICs. Providing equitable access to technology will help bridge infrastructure gaps and enable more learners to benefit from microlearning.

AI-enhanced personalization

Leveraging AI to personalize microlearning pathways based on learner analytics can optimize educational outcomes. Tailored experiences will address individual learning needs and foster more effective skill development.

Figure 1 gives recommendations for microlearning and illustrates what a microlearning-based infographic can look like.

Figure 1 Recommendations for designing effective microlearning modules in clinical skills training.

Conclusions

Microlearning is a flexible, scalable approach to modern ophthalmic surgical education that aligns closely with the principles of CBME. When integrated with simulation-based training and supported by microcredentialing frameworks, it has the potential to enhance both technical and non-technical competencies, support faculty development, and promote lifelong learning.

These approaches are particularly relevant in the context of global eye health, where increasing demand for services, workforce shortages, and persistent inequities in access to training require innovative and adaptable educational solutions. By enabling targeted, accessible, and context-sensitive learning, microlearning can strengthen training capacity across diverse settings.

However, successful implementation depends on thoughtful integration within structured curricula, rigorous quality assurance, and alignment with established competency frameworks such as CBME and EPAs. Investment in faculty development, digital infrastructure, and international collaboration will be essential to maximize the impact of these approaches.

The combination of microlearning, microcredentialing, and simulation offers a promising pathway toward more responsive, equitable, and learner-centered ophthalmic surgical education. Continued research and collaboration will be critical to ensure that these innovations translate into improved clinical competence and better patient outcomes.

Longitudinal data linking microlearning to clinical outcomes is needed, along with an evaluation of patient satisfaction with surgeries under this training approach, with special attention to ophthalmology surgery and ophthalmic procedural skills. Although the literature supports microlearning, microcredentialing, and CBME through EPAs, more rigorous research is needed on their combined impact, especially in ophthalmology. Our review highlights this gap in educational and clinical outcomes.

Key points

• The combined use of microlearning and microcredentialing provides a scalable approach to reducing global inequities in ophthalmic education by enhancing access, flexibility, and alignment with international competency standards.
• Microlearning and SBE support modular CBME in ophthalmic surgery, and strengthen technical and non-technical skills while improving retention through evidence-based learning strategies.
• Without careful integration into CBME frameworks, microlearning, combined or not with SBE, risks fragmenting knowledge and requires strong quality assurance, faculty support, and institutional oversight.
• Advancing these approaches will require international collaboration, formal recognition of microcredentials, equitable investment in technology, and robust research on long-term clinical and patient outcomes.

Acknowledgments

We thank Dr. Daleen Struwig for kindly reviewing, editing, and providing valuable advice for the manuscript.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Eye Science for the series “Optimizing Ophthalmology Surgery Training Through Active Learning Strategies”. The article has undergone external peer review.

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://aes.amegroups.com/article/view/10.21037/aes-2025-1-76/rc

Peer Review File: Available at https://aes.amegroups.com/article/view/10.21037/aes-2025-1-76/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aes.amegroups.com/article/view/10.21037/aes-2025-1-76/coif). The series “Optimizing Ophthalmology Surgery Training Through Active Learning Strategies” was commissioned by the editorial office without any funding or sponsorship. H.P.F. and M.L. served as the unpaid Guest Editors of the series. H.P.F. serves as an unpaid editorial board member of Annals of Eye Science from October 2024 to December 2026. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Resnikoff S, Lansingh VC, Washburn L, et al. Estimated number of ophthalmologists worldwide (International Council of Ophthalmology update): will we meet the needs?. Br J Ophthalmol 2020;104:588-92. [Crossref] [PubMed]
2. Burton MJ, Ramke J, Marques AP, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021;9:e489-551. [Crossref] [PubMed]
3. Krungkraipetch L, Krungkraipetch N, Leelawongs S. Global disparities in ophthalmology education and alignment with international council of ophthalmology guidelines among medical students: a systematic review and meta-analysis. BMC Med Educ 2025;25:452. [Crossref] [PubMed]
4. Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010;376:1923-58. [Crossref] [PubMed]
5. Holmboe ES, Sherbino J, Long DM, et al. The role of assessment in competency-based medical education. Med Teach 2010;32:676-82. [Crossref] [PubMed]
6. Ten Cate O. Entrustment Decisions: Bringing the Patient Into the Assessment Equation. Acad Med 2017;92:736-8. [Crossref] [PubMed]
7. ten Cate O, Hennus MP. Entrustable professional activities and entrustment decision-making for compe-tency-based education in the health professions: an introduction. In: ten Cate O, Burch VC, Chen HC, et al. editors. Entrustable Professional Activities and Entrustment Decision-Making inHealth Professions Education. London: Ubiquity Press; 2024:3-14.
8. ten Cate O. Entrustable professional activities: a new approach to defining and assessing clinical competence. Acad Med 2005;80:982-7.
9. Thillainadesan J, Le Couteur DG, Haq I, et al. When I say … microlearning. Med Educ 2022;56:791-2. [Crossref] [PubMed]
10. Yunianti NPW, Khaerudin , Kusumawardani D. Microlearning as a digital learning strategy in higher health education: literature review. JPTK 2025;22:
11. Monib WK, Qazi A, Apong RA. Microlearning beyond boundaries: A systematic review and a novel framework for improving learning outcomes. Heliyon 2025;11:e41413. [Crossref] [PubMed]
12. Zaffos LE. Microlearning Through TikTok: A Descriptive and Comparative Study of TikTok and Traditional Lecture for Nurse Residents. William Carey University. 2024.
13. Lee YM. Mobile microlearning: a systematic literature review and its implications. Interact Learn Environ 2021;31:4636-51.
14. Yilmaz Y, Papanagnou D, Fornari A, et al. The Learning Loop: Conceptualizing Just-in-Time Faculty Development. AEM Educ Train 2022;6:e10722. [Crossref] [PubMed]
15. Dahiya S, Bernard A. Microlearning: The Future of CPD/CME. J Eur CME 2021;10:2014048. [Crossref] [PubMed]
16. Mitchell S, Hart J, Gharaibeh M, et al. Principles to award learning achievements for lifelong learning in health using micro-credentials: an international Delphi study. Hum Resour Health 2025;23:7. [Crossref] [PubMed]
17. Liew SC, Tan MP, Breen E, et al. Microlearning and online simulation-based virtual consultation training module for the undergraduate medical curriculum - a preliminary evaluation. BMC Med Educ 2023;23:796. [Crossref] [PubMed]
18. Issenberg SB, McGaghie WC, Petrusa ER, et al. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005;27:10-28. [Crossref] [PubMed]
19. Womack-Adams K, Morbitzer KA, Ondek C, et al. A review of microcredentials in health professions continuing professional development. Front Med (Lausanne) 2025;12:1532811. [Crossref] [PubMed]
20. Zdunek K, Dobrowolska B, Dziurka M, et al. Challenges and opportunities of micro-credentials as a new form of certification in health science education-a discussion paper. BMC Med Educ 2024;24:1169. [Crossref] [PubMed]
21. Vordenberg SE, Fusco NM, Ward KE, et al. An Integrative Review of Micro-Credentials and Digital Badges for Pharmacy Educators. Am J Pharm Educ 2024;88:100660. [Crossref] [PubMed]
22. Varadarajan S, Koh JHL, Daniel BK. A systematic review of the opportunities and challenges of micro-credentials for multiple stakeholders: learners, employers, higher education institutions and government. Int J Educ Technol High Educ 2023;20:13. [Crossref] [PubMed]
23. Oliver B. Making micro-credentials work for learners, employers and providers. Available online: https://dteach.deakin.edu.au/wp-content/uploads/sites/103/2019/08/Making-micro-credentials-work-Oliver-Deakin-2019-full-report.pdf.
24. Sud R, Khanduja S. Implementing competency-based medical education in post-graduate ophthalmology training: Understanding key concepts and methodologies and overcoming challenges. Indian J Ophthalmol 2022;70:3701-6. [Crossref] [PubMed]
25. Martin GC, Tanoubi I, Barjol A, et al. Beyond the microscope: embracing soft skills in ophthalmology for enhanced patient care and clinician well-being. Eye (Lond) 2024;38:2485-7. [Crossref] [PubMed]
26. Lopez S. The Impact of Cognitive Load Theory on the Effectiveness of Microlearning Modules. European Journal of Education and Pedagogy 2024;5:29-35.
27. Do HN, Do BN, Nguyen MH. 3How do constructivism learning environments generate better motivation and learning strategies? The Design Science Approach. Heliyon 2023;9:e22862. [Crossref] [PubMed]
28. Goodwin AM, Oliver SW, McInnes I, et al. Professionalism in medical education: the state of the art. Int J Med Educ 2024;15:44-7. [Crossref] [PubMed]
29. Lee AG, Beaver HA, Greenlee E, et al. Teaching and assessing systems-based competency in ophthalmology residency training programs. Surv Ophthalmol 2007;52:680-9. [Crossref] [PubMed]
30. Luo H, Li W. Impact of microlearning on developing soft skills of university students across disciplines. Front Psychol 2025;16:1491265. [Crossref] [PubMed]
31. Labuschagne MJ, du Preez I, Prior Filipe H. An Illustration is Worth Ten Thousand Words: An Extraordinary Approach to Presenting Information Through Infographics. Med Sci Educ 2025;35:691-701. [Crossref] [PubMed]
32. De Gagne JC, Park HK, Hall K, et al. Microlearning in Health Professions Education: Scoping Review. JMIR Med Educ 2019;5:e13997. [Crossref] [PubMed]
33. Prior Filipe H, Paton M, Tipping J, et al. Microlearning to improve CPD learning objectives. Clin Teach 2020;17:695-9. [Crossref] [PubMed]
34. Hug T. Microlearning: a new pedagogical challenge. eLearning Papers. 2007;7:1-12.
35. Filipe HP, Yaïci R, Ivekovic R, et al. Competency-based European training requirements for the specialty of ophthalmology. Recommendations from the UEMS section of ophthalmology and the European Board of Ophthalmology. Acta Ophthalmologica 2026;104:e204-15.
36. Lucey CR, Thibault GE, Ten Cate O. Competency-Based, Time-Variable Education in the Health Professions: Crossroads. Acad Med 2018;93:S1-5. [Crossref] [PubMed]
37. Zhang J, West RE. Designing Microlearning Instruction for ProfessionalDevelopment Through a Competency Based Approach. TechTrends 2020;64:310-8.
38. Ericsson KA. Deliberate practice and acquisition of expert performance: a general overview. Acad Emerg Med 2008;15:988-94. [Crossref] [PubMed]
39. Sweller J. Cognitive load theory and individual differences. Learn Individ Differ 2024;110:102423.
40. Kantar LD, Ezzeddine S, Rizk U. Rethinking clinical instruction through the zone of proximal development. Nurse Educ Today 2020;95:104595. [Crossref] [PubMed]
41. Dormegny L, Prior Filipe H, Dormegny-Jeanjean LC, et al. Is it the right time to promote competency-based European Training Requirements in Ophthalmology? A European Board of Ophthalmology survey. Acta Ophthalmol 2025;103:404-15. [Crossref] [PubMed]
42. Yu M, Keel S, Mills JA, et al. Investigating the need and structure for a comprehensive eye care competency framework. BMJ Open Ophthalmol 2022;7:e001112.
43. Flanagan JL, De Souza N. Simulation in Ophthalmic Training. Asia Pac J Ophthalmol (Phila) 2018;7:427-35. [Crossref] [PubMed]
44. Dean WH, Murray NL, Buchan JC, et al. Ophthalmic Simulated Surgical Competency Assessment Rubric for manual small-incision cataract surgery. J Cataract Refract Surg 2019;45:1252-7. [Crossref] [PubMed]
45. Schuwirth LW, Van der Vleuten CP. Programmatic assessment: From assessment of learning to assessment for learning. Med Teach 2011;33:478-85. [Crossref] [PubMed]
46. Mukhalalati BA, Taylor A. Adult Learning Theories in Context: A Quick Guide for Healthcare Professional Educators. J Med Educ Curric Dev 2019;6:2382120519840332. [Crossref] [PubMed]
47. Lee R, Raison N, Lau WY, et al. A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology. Eye (Lond) 2020;34:1737-59. [Crossref] [PubMed]
48. Kaur K, Gurnani B, Venkatesh D, et al. Commentary: Changing era of modern cataract surgery - The role of virtual reality-based simulators in manual small-incision cataract surgery training modules. Indian J Ophthalmol 2022;70:4016-7. [Crossref] [PubMed]
49. Filipe HP, Grau A, Musa P, et al. Good practices in simulation-based education in Ophthalmology – A thematic series. An initiative of the Simulation Subcommittee of the Ophthalmology Foundation Part I: Initiating and maintaining simulation-based training. Pan-Am J Ophthalmol 2023;5:41.
50. Labuschagne M, Thomsen ASS, Lansingh V, et al. Good practices in simulation-based education in ophthalmology. A thematic series. An initiative of the Simulation Subcommittee of the Ophthalmology Foundation Part III: Curriculum development for simulation based education in ophthalmology training programs. Pan-Am J Ophthalmol 2023;5:38.
51. Funa AA. Digital badges as rewards in science education: Students’ perceptions and experiences. Dalat Univ J Sci 2024;14:107-27.
52. Prakasam RK, Yelagondula VK, Snigdha S, et al. Analysing the effectiveness of Just-A-Minute Optometry Clinical Pearls: a micro-learning tool in continuing optometry education. Clin Exp Optom 2025;108:293-301. [Crossref] [PubMed]
53. Dedeilia A, Sotiropoulos MG, Hanrahan JG, et al. Medical and Surgical Education Challenges and Innovations in the COVID-19 Era: A Systematic Review. In Vivo 2020;34:1603-11. [Crossref] [PubMed]
54. Kalavani K, Azami-Aghdash S, Zahra zare, et al. Challenges and Strategies for Educating Medical Students During the COVID-19 Pandemic: A Systematic Review. Gazi Med J 2025;36:226-35.
55. Saeed S, Raza M, Kaleem S, et al. Combatting with challenges in medical education during COVID-19 pandemic: A mixed-methods study on the effectiveness of e-learning in pediatric clinical clerkship of a university hospital, Pakistan. E-Learning and Digital Media 2024;21:255-72.
56. Kim KJ. Moving forward: embracing challenges as opportunities to improve medical education in the post-COVID era. Humanit Soc Sci Commun 2022;9:419. [Crossref] [PubMed]
57. Papapanou M, Routsi E, Tsamakis K, et al. Medical education challenges and innovations during COVID-19 pandemic. Postgrad Med J 2022;98:321-7. [Crossref] [PubMed]
58. Aravind Eye Care System. Training Reports. 2022. Available online: https://aravind.org/wp-content/uploads/2023/07/Activity-Report-2022-2023.pdf.
59. Orbis International. Simulation Training Impact Report. 2021. Available online:https://www.orbis.org/en/annual-report-2021.
60. Ophthalmology Foundation. Available online: https://ophthalmologyfoundation.org/faculty-development-programs/cpd.
61. Wenger E. Communities of practice: learning, meaning, and identity. Cambridge: Cambridge University Press; 1998.
62. Simulation-Based Education. Ophthalmology Foundation. Available online: https://ophthalmologyfoundation.org/faculty-development-programs/resources/simulation-based-education/.
63. Labuschagne M, Thomsen ASS, Lansingh V, et al. Good practices in simulation-based education in ophthalmology. A thematic series. An initiative of the Simulation Subcommittee of the Ophthalmology Foundation Part III: Curriculum development for simulation based education in ophthalmology training programs. Pan-Am J Ophthalmol 2023;5:39.
64. Teaching Skills for Ophthalmic Educators Online Series. Available online: https://ophthalmologyfoundation.org/courses/teaching_skills/.
65. Teaching skills videos. Available online: https://www.youtube.com/playlist?list=PLzQaFIZQVXENXCzBEK6-Se-GtsBxBK0B4.
66. Beris A, Kostas-Agnantis I, Gkiatas I, et al. Microsurgery training: A combined educational program. Injury 2020;51 Suppl 4:S131-4. [Crossref] [PubMed]
67. Nguyen G, Palmer J, Ludeman E, et al. Evaluating the Efficacy of Microsurgical Training Methods in Ophthalmology Education: A Systematic Review and Meta-analysis. J Acad Ophthalmol (2017) 2021;13:e216-27. [Crossref] [PubMed]
68. Youssef SC, Aydin A, Canning A, et al. Learning Surgical Skills Through Video-Based Education: A Systematic Review. Surg Innov 2023;30:220-38. [Crossref] [PubMed]
69. Ho CM, Yeh CC, Wang JY, et al. Preclass video nanolearning or microlearning in blended medical education. Front Med (Lausanne) 2025;12:1639475. [Crossref] [PubMed]
70. Hunt T, Carter R, Zhang L, et al. Micro-credentials: the potential of personalized professional development. Development and Learning in Organizations: An International Journal 2020;34:33-5.
71. Poudel S, Kurashima Y, Kapsampelis P, et al. What do surgical trainees and educators around the world need: a global needs assessment survey from 6 regions around the world. Global Surg Educ 2025;4:18.
72. Ahmed Y, Taha MH, Khayal S. Integrating Research and Teaching in Medical Education: Challenges, Strategies, and Implications for Healthcare. J Adv Med Educ Prof 2024;12:1-7. [Crossref] [PubMed]
73. Lee R, Raison N, Lau WY, et al. A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology. Eye (Lond) 2020;34:1737-59. [Crossref] [PubMed]
74. Nguyen G, Palmer J, Ludeman E, et al. Evaluating the Efficacy of Microsurgical Training Methods in Ophthalmology Education: A Systematic Review and Meta-analysis. J Acad Ophthalmol (2017) 2021;13:e216-27. [Crossref] [PubMed]
75. Youssef SC, Aydin A, Canning A, et al. Learning Surgical Skills Through Video-Based Education: A Systematic Review. Surg Innov 2023;30:220-38. [Crossref] [PubMed]
76. Kaur K, Gurnani B, Venkatesh D, et al. Commentary: Changing era of modern cataract surgery - The role of virtual reality-based simulators in manual small-incision cataract surgery training modules. Indian J Ophthalmol 2022;70:4016-7. [Crossref] [PubMed]
77. Ho CM, Yeh CC, Wang JY, et al. Preclass video nanolearning or microlearning in blended medical education. Front Med (Lausanne) 2025;12:1639475. [Crossref] [PubMed]
78. Hunt T, Carter R, Zhang L, et al. Micro-credentials: the potential of personalized professional development. Development and Learning in Organizations: An International Journal 2020;34:33-5.
79. Poudel S, Kurashima Y, Kapsampelis P, et al. What do surgical trainees and educators around the world need: a global needs assessment survey from 6 regions around the world. Global Surg Educ 2025;4:18.
80. Ahmed Y, Taha MH, Khayal S. Integrating Research and Teaching in Medical Education: Challenges, Strategies, and Implications for Healthcare. J Adv Med Educ Prof 2024;12:1-7. [Crossref] [PubMed]
81. Funa AA. Digital badges as rewards in science education: Students’ perceptions and experiences. Dalat Univ J Sci 2024;14:107-27.