Background and purpose: Microsurgery demands meticulous technical precision and refined motor skills. Traditionally, these competencies were acquired through apprenticeship-based models, including live animal laboratories and operating theatre exposure. However, ethical and financial considerations, reduced training hours and increasing emphasis on patient safety have driven microsurgical education toward simulation-based training. This review aims to explore strategies in simulation-based microsurgical education, highlighting effectiveness and potential to enhance trainee competency. Methodology: This presentation reviews the historical development and contemporary advances in microsurgical training and simulation. Training modalities are categorised into low-fidelity bench models, synthetic and biological simulators, virtual reality (VR), augmented reality (AR) and robotic-assisted platforms. Educational effectiveness is evaluated in terms of skill acquisition, transferability to the operating theatre, accessibility, cost-effectiveness and assessment capability. Results: Simulation-based microsurgical training has shown to improve learning efficiency and trainee confidence prior to clinical participation. Low-cost bench and synthetic models effectively support early skill development, whilst high-fidelity VR and robotic platforms enable objective performance metrics, standardised assessment and deliberate practice without patient risk. Structured simulation curricula have demonstrated improved operative readiness and patient safety outcomes. Conclusion: Microsurgical training has evolved from traditional apprenticeship models to competency-based, simulation-enhanced education. Advances in simulation technology provide ethical, scalable and effective solutions for training and assessment. Continued innovation and validation will be essential to integrate simulation fully into surgical training pathways and to support the future microsurgical workforce.