Strengths and opportunities for improvement in surgical education in Ukraine: A qualitative study.

BACKGROUND: The full-scale invasion of Ukraine by Russia in 2022 has significantly impacted the country's healthcare system including surgical education. To assess the current state and identify the strengths and opportunities for the improvement of Ukraine's surgical education system during the peri-war period, this study is one of the first to explore the state of surgical education across Ukraine in peri-war, providing essential insights for current and postwar healthcare reconstruction. METHODS: This qualitative study involved semi-structured interviews with 24 Ukrainian surgical residents, surgeons, and program leadership from various regions. The study focused on clinical training, didactics, mentorship, autonomy, resident evaluation, the impact of war, and gender disparities in surgical education. Data analysis was conducted using a rapid qualitative analysis technique. RESULTS: Interviews revealed strengths in surgical education such as adaptability to war conditions and international collaborations. However, opportunities for improvement were identified including a lack of structured clinical and didactic experiences, limited autonomy and access to simulators, gender discrimination, and war-time challenges. These issues highlight a need for more comprehensive training and support systems for surgical trainees in Ukraine. CONCLUSIONS: The study underscores the resilience and adaptability of Ukrainian surgical education in the face of war while also emphasizing the need for significant improvements. It calls for implementing structured training programs, enhanced mentorship, and attention to gender equality. These findings are crucial for improving surgical education in Ukraine and can be used as an example for other lower-middle-income countries, especially in conflict settings.

Factors Affecting Colorectal Cancer Screening in Primary Care Physician Practices in Ukraine.

PURPOSE: This study aims to identify the factors influencing colorectal cancer (CRC) screening practices, along with the barriers and facilitators from the perspective of primary care physicians (PCPs) in Ukraine. Considering health care system challenges, including those posed by the ongoing war, this research seeks to inform improvements in CRC screening and outcomes in Ukraine and other low- and middle-income countries (LMICs). METHODS: A survey was designed and distributed electronically to Ukrainian PCPs, focusing on CRC screening practices, beliefs, and barriers. The survey incorporated questions adapted from established cancer screening surveys and frameworks. Complete responses were collected from 740 PCPs. Sample statistics were computed, and population-level perceptions and associations with CRC screening practices were estimated by standardizing responses to national PCP demographics. RESULTS: The majority of respondents were women (91%) and specialized in family medicine (84%). Respondents believed in the effectiveness of colonoscopy for reducing CRC mortality (80%), with 75% of PCPs referring patients for this screening modality. Major barriers identified include inadequate training of PCPs in screening and lack of resources. Respondents reported high utilization of fecal occult blood test and colonoscopy for screening when these tests were said to be available in their practices. Self-reported familiarity with CRC screening guidelines and participation in educational workshops were positively associated with screening referrals. CONCLUSION: The study highlights the role of access to CRC screening tests and awareness of screening guidelines in enhancing CRC screening practices among Ukrainian PCPs. Addressing training and resource barriers, alongside public health interventions targeting patient-related barriers, is essential. These findings offer valuable insights for LMICs facing similar challenges, emphasizing the need for tailored strategies to improve cancer screening in these health care settings.