Competency-based optometry education in Nigeria: A qualitative study of the perspectives of students, lecturers, clinical leaders, and academic leaders

<title>Abstract</title> <p> Background Competency-based education (CBE) is the framework for health professions training all over the world. However, in many low- and middle-income countries, there are discrepancies in how CBE principles are implemented. Although Nigerian optometry programs officially acknowledge CBE, little insight is available into how they translate and implement genuine competency. This research focuses on the interpretation, understanding, and implementation of CBE across five Nigerian optometry schools by multiple stakeholders of interest in the field. Methods This study used an interpretive qualitative research design across five Nigerian universities with formal accreditation. A total of 53 people participated in the study: students (n = 29), lecturers (n = 11), clinical supervisors (n = 6), and academic managers (n = 7). Purposive maximum-variation sampling was used to recruit participants. The researcher conducted a series of individual in-depth, semistructured interviews from October to December 2025, and the data were analyzed through framework thematic analysis using the SFCAF as the guide. Results <bold>F</bold> ive themes were identified and analyzed: compliance with structures, with the absence of functional implementation; delay of clinical immersion, with a predominance of lecture-based teaching; lack of assessment and competency validation; lack of infrastructure to support faculty development; and lack of readiness to meet labor market expectations, with a demand for curriculum reform. Structural-functional misalignment was obvious in all signed documents; in practice, CBE was a rhetorical policy. Conclusion Nigerian optometry programs are CBE, but the practice is not. The reform priorities are pedagogy and assessment of competencies, clinical structures, and extended faculty development. The findings have extended implications for educating health professionals in sub-Saharan African countries. </p>