Impact of conflict on medical education: a cross-sectional survey of students and institutions in Iraq

Abstract

Objective: This study surveyed all Iraqi medical schools and a cross-section of Iraqi medical students regarding their institutional and student experiences of medical education amidst ongoing conflict. The objective was to better understand the current resources and challenges facing medical schools, and the impacts of conflict on the training landscape and student experience, to provide evidence for further research and policy development.

Setting: Deans of all Iraqi medical schools registered in the World Directory of Medical Schools were invited to participate in a survey electronically. Medical students from three Iraqi medical schools were invited to participate in a survey electronically.

Outcomes: Primary: Student enrolment and graduation statistics; human resources of medical schools; dean perspectives on impact of conflict. Secondary: Medical student perspectives on quality of teaching, welfare and future career intentions.

Findings: Of 24 medical schools listed in the World Directory of Medical Schools, 15 replied to an initial email sent to confirm their contact details, and 8 medical schools responded to our survey, giving a response rate from contactable medical schools of 53% and overall of 33%. Five (63%) medical schools reported medical student educational attainment being impaired or significantly impaired; 4 (50%) felt the quality of training medical schools could offer had been impaired or significantly impaired due to conflict. A total of 197 medical students responded, 62% of whom felt their safety had been threatened due to violent insecurity. The majority (56%) of medical students intended to leave Iraq after graduating.

Conclusions: Medical schools are facing challenges in staff recruitment and adequate resource provision; the majority believe quality of training has suffered as a result. Medical students are experiencing added psychological stress and lower quality of teaching; the majority intend to leave Iraq after graduation.

Keywords: Conflict; Medical education; Training; War; healthcare.

Figure 1

Geographical location of participating medical schools. Image generated using GoogleMaps. (1) Jabir Ibn Hayyan Medical University; (2) University of Tikrit College of Medicine; (3) University of Wasit; (4) Hawler Medical University; (5) University of Diyala College of Medicine; (6) Sulaimani College of Medicine; (7) University of Al-Muthana College of Medicine; (8) Kufa University.

Figure 2

Deans’ perspectives on the impact of conflict on medical student attainment (academic achievement/success) (A) and quality of training (B). Numbers (n) refer to total respondents for each option.

Figure 3

Geographical location of medical student participants’ medical school. Image generated using GoogleMaps. (1) University of Baghdad; (2)University of Basrah; (3) University of Wasit.

Figure 4

Student perceptions on the impact of conflict on quality of medical training (A); main concerns, psychological and other impacts of conflict on the student experience (B). Where numbers (n) refer to total respondents for each option; % of students refers to the proportion of students selecting the option of total student participants across medical schools.

Figure 5

Student perspectives on mitigating educational impact. Student subjective comments were thematically analysed, grouped and subgrouped. Numbers (n) refer to total respondents for each option. Themes were subgrouped according to personal, educational or other external factors.