Emergency Care Competence and Resource Gaps Among Resident Physicians in Selected Syrian Governmental Hospitals: Implications for Health System Recovery.

INTRODUCTION: Syria's health system is rebuilding after prolonged conflict, workforce attrition, and disruption of emergency care. Evidence on emergency preparedness among hospital-based resident physicians remains limited. This study assessed emergency exposure, self-perceived procedural competence, resource availability, and factors associated with competence among resident physicians in selected Syrian governmental hospitals. METHODS: A cross-sectional survey was conducted from 1 to 23 April 2026 among 368 resident physicians working in governmental hospitals, mainly in Damascus and Rif Damascus, Homs, and Lattakia. A structured Arabic questionnaire adapted from a previously published instrument assessed professional characteristics, emergency training and exposure, self-perceived competence, resource availability, and satisfaction. Multivariable linear regression identified factors independently associated with the total competence score. RESULTS: Emergency exposure was frequent, while self-perceived competence varied by procedure. Confidence was highest for nebulization and oxygen therapy, cardiac compression, and bag-and-mask ventilation, and lowest for defibrillation. Basic resources such as cannulas, oxygen masks, laboratory services, and X-ray services were widely available, whereas glucagon, equipped ambulances, Ventolin, morphine, and Ambu bags were less consistently available. Male sex, prior Advanced Trauma Life Support (ATLS) attendance, and 1-2 years of emergency department experience were independently associated with higher competence scores, while surgical/anesthesiology and pediatrics/obstetrics and gynecology/other specialty groups had lower scores than medical specialties. Ministry of Health hospitals had significantly higher resource availability scores than university teaching hospitals across all three resource domains. CONCLUSION: Among resident physicians in the studied governmental hospitals, emergency exposure was frequent but preparedness was uneven. Strengthening emergency readiness will require standardized practical training, objective skill assessment, and more consistent availability of essential emergency resources and referral support.