Syrian medical residents value palliative care but lack the knowledge to deliver it

Medical residents at Damascus University hospitals overwhelmingly agree that palliative care matters, yet most cannot answer basic questions about how it is actually delivered, according to a cross-sectional study published in BMC Medical Education. Among 224 residents surveyed in April 2026, 98.2 percent considered palliative care an important subject and 90.6 percent expressed interest in learning more about it. Despite this enthusiasm, 62 percent of respondents fell into the low and very low performance categories on a validated knowledge test, exposing a wide gap between attitude and technical competency in a health system still operating under the pressures of a conflict-affected country.

The study assessed residents across five specialties: surgery, internal medicine, anesthesia, oncology, and psychology. Participants had a mean age of 27.32 years, and women made up 52.7 percent of the sample. Most respondents were in their second year of residency and came from internal medicine. The researchers used the Palliative Care Knowledge Test to measure objective knowledge, alongside questions covering demographic characteristics, previous training, and attitudes toward the field. Only 23.2 percent of participants reported any prior training in palliative care, and among those who had received it, the majority, 63.4 percent, obtained it during residency rather than during undergraduate medical education.

Knowledge varied sharply across the domains of the scale. Residents performed best on the philosophy of palliative care, with a correct response rate of 93.6 percent, suggesting that most understand the field’s patient-centered aim of improving quality of life for people with incurable illnesses by addressing physical symptoms, psychological distress, social challenges, and spiritual concerns. Performance dropped steeply on clinical content: pain management questions were answered correctly 44.5 percent of the time, gastrointestinal issues 42.9 percent, psychiatric aspects 50.1 percent, and dyspnea, or breathing difficulty, only 36 percent. These are precisely the domains that determine whether a dying patient’s symptoms are recognized and relieved, and the authors note that the concentration of respondents in the lower performance categories highlights significant gaps in technical palliative care competency.

The statistical analysis revealed a telling pattern about what does and does not drive knowledge. Academic seniority, medical specialty, and previous training were significant factors associated with knowledge levels. In contrast, subjective factors, including the perceived importance of the field, interest in further learning, self-reported preparedness, and having prior clinical experience with terminally ill patients, did not correlate with objective knowledge. In other words, caring about palliative care and feeling ready for it did not translate into knowing it. This dissociation matters for training design, because it implies that motivation alone, however widespread among residents, will not close the competency gap without structured instruction.

The authors frame the issue as a cornerstone problem with consequences beyond individual test scores. Deficiencies in palliative care knowledge can affect patients’ quality of life, the satisfaction of patients’ families, and doctors’ own self-estimation. Palliative care demand has been increasing, and numerous studies have shown that healthcare professionals often possess insufficient knowledge in this field, a finding this study extends to a residency workforce trained inside Damascus University hospitals. The researchers conclude that formal, diligent steps toward establishing a palliative care curriculum in both undergraduate programs and residency training are important, positioning medical education reform as the practical route from the residents’ near-universal interest to the clinical competence that interest currently lacks.

Subject of Research: Palliative care knowledge and attitudes among medical residents in Syria

Article Title: Palliative care attitude and knowledge among Syrian residents: a cross-sectional study from a conflict-affected country

Article References: Almawaz, M. Y., Tawashi, K., Burkhoush, R., Zayton, N. M., Kheirbek, A., Alsweleh, H., & Manachi, M. (2026). Palliative care attitude and knowledge among Syrian residents: a cross-sectional study from a conflict-affected country. BMC Medical Education. https://doi.org/10.1186/s12909-026-10665-1

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10665-1

Keywords: palliative care, medical residents, Syria, Damascus University, cross-sectional study, knowledge gaps, pain management, medical education, residency training, curriculum reform, BMC Medical Education, conflict-affected health systems