Navigating the fragmented learning journey: early-career ophthalmologists' experiences of learning in residency

Early ophthalmology training requires rapid development of clinical skills in high-pressure environments. However, the disconnect between formal curricula and residents' lived experiences remains under-researched. This study aims to identify modifiable educational and structural barriers, and to understand ophthalmology residents' requirements for tools to support learning and non-surgical skill acquisition.

Qualitative study involving semi-structured one-to-one interviews with 27 ophthalmology residents in the UK and Germany. Interviews explored the lived experiences of non-surgical skill acquisition during early training, as well as perceived gaps and priorities for improvement. Transcripts were analysed using reflexive thematic analysis.

Six key themes were identified. The learning journey was felt to be fragmented, and learning needs occasionally fell secondary to clinical service demands. Experiences also varied across hospitals and regions. Essential clinical skills (e.g. fundoscopy, imaging interpretation) were frequently learned in emergency settings or busy clinic environments with limited structured supervision and feedback, and available resources for learning were described as "fragmented" and "variable in quality". Participants cited inconsistent feedback and poor work-life balance as significant sources of emotional burden. Consequently, many relied on self-organised peer networks to compensate for gaps in formal support. Participants expressed a desire for mentorship as well as a technology-enabled integrated learning environment to address some of these gaps.

Careful consideration is needed to bridge the gap between formal curricula and real-world experiences, particularly as contemporary training experiences appear to rely heavily on improvisation and self-motivation rather than structured training. Formal integration of non-surgical skills training and mentorship into the clinical workflow may help reduce uncertainty and variability in training outcomes.