The oxygen evolution reaction (OER) is the efficiency-determining half-reaction process of high-demand, electricity-driven water splitting due to its sluggish four-electron transfer reaction. Tremendous effects on developing OER catalysts with high activity and strong acid-tolerance at high oxidation potentials have been made for proton-conducting polymer electrolyte membrane water electrolysis (PEMWE), which is one of the most promising future hydrogen-fuel-generating technologies. This review presents recent progress in understanding OER mechanisms in PEMWE, including the adsorbate evolution mechanism (AEM) and the lattice-oxygen-mediated mechanism (LOM). We further summarize the latest strategies to improve catalytic performance, such as surface/interface modification, catalytic site coordination construction, and electronic structure regulation of catalytic centers. Finally, challenges and prospective solutions for improving OER performance are proposed.