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

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.

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.

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%).

High-quality online surgical education can be feasible and impactful in conflict-affected settings, enhancing both knowledge and confidence in patient management.