Education in Adversity: Enhancing Surgical Training Through the “Principles of Surgery” Course in Wartime Ukraine

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BACKGROUND: The full-scale Russian invasion severely disrupted Ukraine's healthcare and surgical training systems, while increasing demand for high-quality surgical care. Online education may offer a solution, but data on its effectiveness in conflict-affected settings remain scarce. We aimed to evaluate the development, implementation, and impact of the "Principles of Surgery" course designed to enhance surgical knowledge among Ukrainian surgeons during wartime. METHODS: We designed a free, 2-semester (09/2023-06/2024) online course for Ukrainian surgeons, using Kern's 6-step approach. It comprised weekly live Zoom sessions (lectures by international speakers, Q&A, case discussions), self-study materials, and post-session knowledge tests for continuous education credits. Self-assessed understanding and confidence were measured via pre- and post-session surveys using four-point Likert scales. RESULTS: Forty-two students were selected (admission rate: 20.6%), most (n = 25,59.5%) male and based in Northern (n = 16,38.1%) and Western (n = 15,35.7%) Ukraine. The course included 37 sessions; all participants maintained > 80% attendance. Significant improvements in topics understanding were observed for Enhanced Recovery After Surgery (ERAS) (p < 0.001, r = 0.95), Bleeding (p < 0.001, r = 0.97), Surgical infections (p = 0.001, r = 0.84), Shock (p < 0.001, r = 0.79), Vascular trauma (p = 0.001, r = 0.83), and Burns (p < 0.001, r = 0.83). Confidence in management improved substantially for ERAS (p < 0.001, r = 0.87), Bleeding (p = 0.001, r = 0.94), and Shock (p < 0.001, r = 0.94). Of 24 students, providing feedback, 20 (83.3%) reported a positive impact on their practice; all expressed interest in future educational initiatives. Main barriers included internet connectivity issues (n = 9, 37.5%) and electricity outages (n = 8, 33.3%). CONCLUSIONS: High-quality online surgical education can be feasible and impactful in conflict-affected settings, enhancing both knowledge and confidence in patient management.

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