How past European Board of Ophthalmology (EBO) candidates acquired theoretical knowledge: an EBO survey

BACKGROUND: The European Board of Ophthalmology (EBO), whose mission is to guarantee high standards of care in ophthalmology, has assessed residency training quality for over 30 years through the EBO Diploma (EBOD) examination, undertaken by residents and certified ophthalmologists from the 27 European Union member states as well as Norway, Switzerland, the United Kingdom, and Türkiye. Preparation for the EBOD is largely self-directed, conducted alongside demanding clinical duties, and relies mainly on asynchronous learning. This study aimed to analyse trends in the use of learning tools among European residents and ophthalmologists preparing for the EBOD and factors associated with their choice of study resources. METHODS: A 27-item online survey was distributed to past (2016 to 2024) EBOD candidates. Data collected included demographics, study habits, learning resources, meeting attendance, and financial support. Univariable and multivariable logistic regression analyses were performed to analyse associations between use of learning tools and gender, examination year, clinical workload, study time, English proficiency, and country of training. RESULTS: A total of 633 responses (response rate, 10%) from 31 countries were analysed. Book use was high (92%) and stable over time. Respondents who sat the examination before 2020 were more likely to read journal articles (p < 0.0001, OR 2.47, 95%CI 1.56-3.92) and less likely to use social media (p = 0.002, OR 0.58, 95%CI 0.41-0.82), websites (p = 0.018, OR 0.51, 95%CI 0.29-0.88), and smartphone applications (p = 0.019, OR 0.55, 95%CI 0.47-0.94). Candidates reporting fewer than the median of study hours were less likely to read journal articles (p = 0.0002, OR 0.49, 95%CI 0.34-0.72). Candidates receiving financial support attended international meetings more frequently than those without support (p < 0.0001). Differences in digital tool use and funding sources were observed among the five most represented countries (France, Germany, Spain, Switzerland, and Türkiye). CONCLUSIONS: EBOD candidates demonstrate increasing engagement with digital learning tools. Associations between learning resource use, examination year, study time, and country of training highlight the need for adaptable educational strategies reflecting evolving technologies and diverse learner profiles.