Building virtual real-time trauma care learning during armed conflict: the case of ECHO in Ukraine

BACKGROUND: Armed conflicts threaten the resilience of health systems and the continuity of medical education. The war in Ukraine has impacted the health infrastructure and depleted the workforce, highlighting the need for trauma care training to strengthen healthcare professionals' capacity to provide care. Sustaining training remotely may offer a practical way to overcome limitations of in-person courses. In response, the Harvard Humanitarian Initiative (HHI), in collaboration with Project ECHO (Extension for Community Healthcare Outcomes) at the University of New Mexico, piloted a virtual case-based community of practice (VCoP) to strengthen the delivery of trauma care in Ukraine and bridge initial in-person training. METHODS: Ten VCoP sessions were implemented between October and December. Participation was offered to all Ukrainian trauma care trainers who participated in prior in-person training. The assessment survey was sent to all VCoP session participants and evaluated program feasibility, reach, engagement, and perceived impact. Highly engaged participants were invited to an additional virtual interview to provide additional feedback. Implementation and outcomes were measured with a mixed-methods formative evaluation. Analysis included attendance data, post-session and end-of-series surveys, and semi-structured interviews. RESULTS: Forty-four Ukrainian trauma trainers who participated in earlier in-person education participated in at least one session, representing 10 oblasts (administrative regions) in Ukraine. Post-session survey response rate averaged 74%. 94% of participants indicated applying knowledge from the sessions in their practice or teaching and 89% reported changes in their practice and innovation in their teaching methods. 94% of participants reported that the program helped them increase professional connectedness. All participants expressed interest in participating in future VCoP sessions with 77% expressing interest in leading future sessions. CONCLUSION: The Ukraine Trauma Care VCoP demonstrated that virtual education can be feasible and effective in bridging initial training and capacity strengthening of healthcare providers in conflict settings, providing sustainability. Future efforts should evaluate the ability of this model to adapt and scale in similar contexts.