Peer Tutoring in Ukrainian Medical Education during Wartime: Implementation and Evaluation of a Learning-by-Teaching Program

In the high-stakes world of medical training, educators have long sought ways to turn students into active participants rather than passive listeners. One approach that has gained traction is the idea of "near-peer" teaching, where senior students, having recently mastered a subject themselves, return to guide those just starting out. This method relies on two simple but powerful human dynamics. First, because the teacher and the learner are close in age and experience, the teacher can often predict exactly where the learner will get stuck, having just navigated those same hurdles. Second, the gap in authority between them is smaller than it is with a professor, making the learner feel safer asking questions or admitting confusion. When combined with the psychological principle that teaching a concept forces the teacher to organize and deepen their own understanding, this creates a cycle where both parties grow. In stable times, this is a useful tool for learning; in times of crisis, it can become a lifeline for keeping education alive when resources are scarce and the future is uncertain.

In Ukraine, where the ongoing war has disrupted daily life and strained educational systems, a researcher at the Ivano-Frankivsk National Medical University decided to test whether this model could work under extreme pressure. Between 2022 and 2025, they launched a program where senior nursing students, after completing a rigorous twenty-four-hour certification course in pre-hospital emergency care, took on the role of instructors for younger students. The curriculum focused on life-saving skills: how to stop severe bleeding using tourniquets and hemostatic agents, and how to perform cardiopulmonary resuscitation, including chest compressions and the use of automated external defibrillators. The goal was not just to see if the younger students could learn these skills, but to determine if a peer-led system could function effectively when the country was at war, and if the senior students could grow into capable teachers through the experience.

The results of this initiative were striking in their clarity and consistency. Over the course of three academic years, the program reached 350 students across nursing, dentistry, and pharmacy specialties. When the researcher surveyed 146 of these participants at the end of the year, nearly every single one, 99.3 percent, reported that the training was beneficial. The vast majority felt that the two main modules, hemorrhage control and resuscitation, were equally valuable. Perhaps most telling was the reaction to the instructors themselves. The students did not view the senior peers as inferior substitutes for faculty; instead, they described them as approachable and patient. The younger students noted that because their teachers had just learned the material, they could explain complex ideas in accessible language and anticipated points of confusion that a distant expert might miss. The reduced hierarchy made the learning environment feel safer, encouraging more questions and engagement.

The program also revealed a transformation in the senior students who served as teachers. Initially, these peer instructors possessed strong medical knowledge but varied in their ability to teach. As the academic year progressed, faculty observers noted a clear evolution in their skills. By the second semester, and especially when the program expanded to teach school-aged children in the local community, these young instructors demonstrated organized explanations, effective pacing, and the ability to adapt their teaching to different audiences. They moved from simply reciting instructions to genuinely guiding learners. This expansion into community education, where they taught local youth alongside their college peers, showed that the skills they developed were robust enough to transfer beyond the medical college walls. The program survived the specific challenges of wartime, including periodic security interruptions and psychological stress, and in fact, many participants cited the sense of purpose and civic contribution as a motivating factor that deepened their engagement.

Despite the success, the researcher was careful to define the limits of their findings. The study was a descriptive evaluation, meaning it documented what happened and how people felt, but it did not include a control group of students taught only by faculty to prove that peer teaching was objectively superior. The data relied heavily on self-reported surveys and observations rather than long-term testing of skill retention. The response rate for the survey was 42 percent, which is respectable for a voluntary study but leaves room for the possibility that those who did not respond might have had different views. Furthermore, the unique context of a war zone means that while the program proved resilient and adaptable in Ukraine, its results might look different in other settings. The author did not claim to have solved the problem of medical education in conflict zones, but rather provided evidence that a structured, certified peer-tutoring model is a feasible and highly accepted way to maintain educational continuity and build practical skills when traditional resources are stretched thin.

Ultimately, the study suggests that investing in formal training for student teachers is a critical step. The twenty-four-hour certification course, which covered both clinical skills and basic teaching techniques, gave the program credibility and ensured that the peer instructors were not just guessing. This approach allowed the institution to stretch its limited faculty capacity while giving senior students a structured, meaningful role during a period of high stress. The program's ability to extend into the community, teaching local school students alongside medical trainees, hints at a broader potential for peer-led education to serve as a resource-efficient tool in crisis contexts. The findings indicate that when students are given the right support and training, they can effectively teach each other, preserving the continuity of essential medical education even when the world around them is in turmoil.