Strengthening health professions education during war: a multi-institutional case study of physical therapy programs in Ukraine

Recent assessments of Ukraine’s wartime health and rehabilitation systems highlight critical shortages in trained rehabilitation personnel. In response, Ukraine has undergone rapid expansion of rehabilitation services through health system reform. These changes created an urgent need to strengthen physical therapy education and align curricula with national and international competency standards. Despite urgent workforce needs, limited evidence exists describing structured, competency-based program reform models for health professions education in active conflict settings. This study provides a feasible framework for reflective educational reform in crisis-affected contexts. This multiple-case design with cross-case synthesis describes implementation of the Academic Program Reflection Tool (APRT) across four Ukrainian universities offering physical therapy education. Program leadership teams engaged in a two-year reflective review process involving self-assessment, curriculum mapping, mentoring, and in-person workshops. Two members of each leadership team attended the in-person workshops. Data sources included institutional self-assessments, revised program documents, worksheets, and workshop transcripts. Findings were analyzed descriptively to identify themes related to curriculum development, assessment practices, faculty capacity, student progression, and resource constraints. Institutions reported improved clarity in program philosophy, learning outcomes, and alignment with competency frameworks. Curriculum mapping revealed gaps in areas such as treatment for conflict-related injuries, global health, and continuing professional development. Participants identified limitations in assessment validity, reliance on lecture-based teaching, variability in clinical education practices, faculty shortages, and constrained institutional resources. The APRT process supported development of quality improvement plans and strengthened local leadership capacity for ongoing program reform. This case study demonstrates the feasibility and educational value of structured program review in strengthening physical therapy education within a low-resource, conflict-affected setting. The APRT provided a framework for aligning curricula with competency-based education principles while supporting local ownership of reform. Findings may inform efforts in rehabilitation and health professions education in other low resource countries.