Challenge of virtual medical emergency education in conflict zone in low and middle-income countries: A protocol for systematic review and meta-analysis

Abstract

Introduction: Healthcare training in conflict‑affected low‑ and middle‑income countries is repeatedly disrupted by insecurity, displacement, and damaged infrastructure. Virtual education offers a practical route to sustain emergency care training when classrooms and clinical placements are curtailed, but the effectiveness of such programmes and the feasibility of delivery under conflict conditions remain uncertain. This protocol sets out methods to evaluate educational outcomes and implementation barriers for online emergency medical education in these settings.

Methods: This will be a systematic review and, where appropriate, meta‑analysis registered prospectively with PROSPERO and aligned with PRISMA 2020. We will include randomised, quasi‑experimental, observational, qualitative, and mixed‑methods studies that evaluate virtual or online emergency education for healthcare professionals, trainees, students, or first responders in conflict‑affected low‑ and middle‑income countries. Primary outcomes will be knowledge and skill gain; secondary outcomes will include learner satisfaction and implementation barriers spanning technical, infrastructural, pedagogical, security, and cost domains. We will search PubMed, Embase, Scopus, and Web of Science for records from October 2022 to May 2025 with no language restrictions. Two reviewers will screen and extract data independently with third‑party adjudication, contacting authors for missing information. Risk of bias will be assessed using RoB 2, the Newcastle–Ottawa Scale, CASP, and MMAT as appropriate, and certainty of evidence with GRADE. When at least three comparable studies with quantitive outcomes are available, we will conduct random‑effects meta‑analysis using standardised mean differences with 95% confidence intervals; otherwise a SWiM‑guided narrative synthesis will be undertaken. Heterogeneity will be examined with I² alongside prespecified subgroup and sensitivity analyses.

Discussion: The review will clarify the educational impact of virtual emergency training in conflict settings and identify context‑specific barriers, informing programme design, equitable access, and integration with resilient blended learning models.

Registration: This protocol had been prospectively registered with PROSPERO (ID: CRD420251083001)