Surgical education in Ukraine during the war - study published in World Journal of Surgery
The Global Medical Knowledge Alliance research team has presented the first study assessing the state of surgical education in Ukraine during and before the full-scale war. The article, published in the World Journal of Surgery, identifies the strengths, limitations, and opportunities for improving the training of Ukrainian surgeons.
The study was a large-scale continuation of the article “Patient Care and Surgical Training During Armed Conflict” which appeared in the 2023 edition of the Annals of Surgery. At that time, the GMKA research team first highlighted the changes affecting the surgery residency training at a medical institute in Kyiv following the outbreak of the full-scale war. The emotional response from reviewers and the social significance of the topic prompted the researchers to continue their work and conduct a larger survey.
In a new article, the authors describe the experiences of 24 residents, surgeons, and department leaders working in rural, urban, and tertiary academic medical centers across different regions and cities in Ukraine. Their study emphasizes the need to adapt curricula to better meet the needs of residents and practicing surgeons in Ukraine. It also outlines potential ways to improve surgical education in other countries facing similar challenges.
“This study is the first large-scale and comprehensive analysis of the state of surgical education in Ukraine, covering both the pre-war and war periods. Its results are an important step towards improving the training of surgeons in the country. Through thorough interviews, we have identified key areas for improvement, making our study an integral part of the reform of medical education in Ukraine,” said Ali Dzhemilev, resident surgeon at Brigham and Women’s Hospital at Harvard Medical School (Boston, USA) and one of the lead authors of the study.
Methodology
This qualitative study involved semi‐structured interviews with 24 Ukrainian surgical residents, surgeons, and program leadership from various regions. The data collection process involved questionnaires and one-on-one interviews conducted in Ukrainian via Zoom. This approach allowed researchers to uncover diverse perspectives on clinical training, didactics, mentorship, autonomy in clinical and operating room settings, resident evaluation, the impact of war, and gender disparities for women in surgical training and practice.
Results of the Study
The study highlighted several strengths of surgical education in Ukraine, including its adaptability to war conditions and increased international cooperation. However, significant gaps in the comprehensive training system were also identified:
- A general surgery residency in Ukraine lasts three years, which is considerably shorter compared to programs in the United States and Poland.
- There is no established list of skills that residents should acquire and clear guidelines for monitoring their performance.
- Residents encountered organizational barriers to learning from different surgical areas.
- Evaluation criteria for residents’ work are undefined, relying solely on subjective feedback from mentors and supervisors.
- Some interviewees reported a lack of autonomy in the operating room, hindering practical experience.
- Gender discrimination and sexism were reported by all female surgeons, who faced derogatory comments about their careers.
- Residents expressed limited access to surgical simulators.
The wartime brought challenges in the form of interruptions in surgical training, increased stress, and logistical difficulties. However, young and experienced Ukrainian surgeons also gained valuable experience in trauma care and benefited from cooperation with foreign colleagues through workshops and conferences, which enhanced their skills in treating wartime pathologies.
Opportunities to Improve Surgical Education in Ukraine
The GMKA team has outlined key recommendations to address some of the pointed limitations and enhance surgical education in Ukraine. The recommended steps include:
- Changing the residency model by introducing standardized accreditation processes where only graduates from accredited programs are recognized as qualified surgeons.
- Developing reliable tools for assessing surgical skills and knowledge and establishing an independent national certifying body akin to the United States system.
- Implementing simulation in surgical education.
- Increasing the emphasis on trauma and emergency surgical care.
- Promoting gender equality in surgery by creating a supportive environment for women surgeons, overcoming cultural stereotypes, and ensuring equal opportunities for mentoring and professional growth.
Strengthening international cooperation and mentoring programs can provide valuable support and knowledge transfer. Initiatives such as advanced trauma life support training for Ukrainian doctors by the Global Medical Knowledge Alliance are examples of efforts that should be expanded to cover a wide range of surgical skills and specialties.
Conclusions
Research by the GMKA team highlights the vulnerable state of surgical education in Ukraine amid the ongoing war. At the same time, it provides valuable conclusions and recommendations for improvement. Addressing these issues will enhance medical education in Ukraine and prepare a new generation of surgeons to tackle the challenges of both the war and post-war periods.
The findings and recommendations aim not only to help Ukraine improve its surgical education and healthcare but also to serve as a guide for other low- and middle-income countries facing similar challenges.
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