Urology education under fire: Quantitative benchmarking of trainer adaptation and competency preservation in wartime Sudan

Abstract

BACKGROUND: International competency frameworks for surgical training, such as CanMEDS, are typically implemented within stable educational systems. Their applicability under conditions of severe system disruption remains unclear. This study examined how urology trainers in Sudan adapted these frameworks to sustain training during ongoing conflict. METHODS: We conducted a national cross-sectional census of all urology trainers affiliated with the Sudan Medical Specialisation Board (SMSB) between September and December 2024. A structured online questionnaire assessed institutional functionality, adaptation strategies mapped to the seven CanMEDS roles and psychological impact. Data were analysed using descriptive statistics, Chi-square tests and one-sample proportion tests to examine associations and compare competency preservation against a predefined reference threshold of 80%. RESULTS: Among 60 respondents (response rate 86%), 88% reported their primary teaching hospital as non-functional. Several competencies were maintained at or above the reference threshold, including medical expert (85%), scholar (88%) and professional (91%) (p > 0.05 for medical expert and scholar; p = 0.02 for professional). In contrast, lower levels of preservation were observed for roles such as collaborator (38%) and leader (65%) (p < 0.01). Trainer displacement was associated with reduced preservation of the collaborator role (29.3% vs. 63.2%, p = 0.01), whereas non-functional institutions were associated with higher reported levels of severe burnout (81.1% vs. 42.9%, p = 0.03). CONCLUSION: Urology trainers in Sudan were able to sustain elements of competency-based training through adaptive educational strategies. However, competencies that depend on functioning clinical systems were more difficult to maintain. These findings highlight the need to develop context-responsive approaches to training and accreditation that support continuity while maintaining recognised educational standards in crisis-affected settings.