The largest war in Europe since World War 2: impact on the final year Ukrainian resident’s competence acquisition
Authors: Bielka Kateryna , Kuchyn Iurii , Kashchii Uliana 
Published: January 2023

Abstract
Introduction. The war affects access to all ordinary civil activities, including healthcare and education, due to multiple factors: physical injury and mental health consequences in students and teachers; the educational, healthcare, and non-healthcare critical facilities destruction; the safety issues while attending the classes. All these factors could have a negative impact on medical education. It is especially crucial, since the necessities of the population in receiving health care only increase in war-affected countries. Therefore, it is essential to be able to continue providing medical education. The goal of the study was to identify if the full-scale ongoing war have an impact on final year residents-anaesthesiologists’ competence acquisition and their ability to work independently.
Methods. This retrospective study started in 2021 to assess the competence acquisition and readiness for independent work in residents-anaesthesiologists after two years of residency. When Russia invasion have started in February 2022, the residency program also was changed - most live classes were replaced by online sessions, with increasing time of self-dependent work on the online platform, as well as time of practical work in the hospitals. Study was prolonged to investigate the war impact on 2022 final year residents. At first, we investigate if the war had an impact on OSCE results, comparing 2021 and 2022 years. Secondly, questionnaires were sent to all final year residents to reflect on the education quality, competence acquisition and readiness to work as an independent anaesthesiologist. Other questionnaires were sent to all teachers to assess the educational outcomes and war impact.
Results. 38 residents in 2021 and 36 residents in 2022 were included in the study. All of them have passed the OSCE.
The number of residents, who didn’t pass the OSCE did not differ significantly (p = 0,9). The number of residents who had 70–80% competence acquisition were a significant lower in 2022 year (p = 0,039, OR 0,36 95% CI 0,1 − 0,9), although the number of resident, who had 80–90% and more than 90% competence acquisition had a tendency to increase (p > 0,05). The number of residents, who feel absolutely confident to provide anaesthesia for ASA 1–2 patients, ASA 3–4 patients and to work independently in the ICU, did not change significantly, although tended to increase in the 2022-year residents (p > 0,05). When it comes to competence acquisition assessed by teachers: 44% accordingly stated that it was higher in 2022 residents comparing to previous years, while 63% answered that it remained the same. The readiness for independent practice teachers evaluate at the same level in residents-2022 comparing with residents-2021. Teachers and residents had similar reflection about the most effective type of learning, choosing the simulation training, live master classes and seminars in small groups, self-directed learning.
Conclusion. Anaesthesiology and intensive care residents could get all necessary competences and become ready for independent work during on-going full-scale war, with increasing part of practical work in the hospital, introduction flexible hospital practice places (temporary moving to safe country regions) and sparing more time to online sessions and self-directed study.
Study registration: NCT05559593, 29/09/2022, clinicaltrials.gov.