David Mills ^1,2,3* Alexis Schmid ^2,3 David Lewander ² Michelle Gonnet ⁴ Oleksii Lopatniuk ⁴ Oleksandra Demetska ⁴ Olena Sorokina ⁵ Anna Bolonska ⁵ Ramona Sunderwirth ⁶ Kathleen Murray ³ Sean Kivlehan ^3,7 Michelle Niescierenko ^2,3,8

• ¹ School of Medicine, University of California San Diego, La Jolla, California, United States
• ² Global Health Program, Boston Children's Hospital, Boston, United States
• ³ Harvard Humanitarian Initiative (HHI), Cambridge, Massachusetts, United States
• ⁴ International Medical Corps, Los Angeles, California, United States
• ⁵ Dnipro State Medical University, Dnipro, Dnipropetrovsk Oblast, Ukraine
• ⁶ Icahn School of Medicine at Mount Sinai, New York, New York, United States
• ⁷ Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
• ⁸ Harvard Medical School, Boston, Massachusetts, United States

Abstract: Introduction:On 24 February 2022, Russia launched a large-scale offensive in Ukraine, resulting in significant casualties to civilians, including children. As part of a seven-stream trauma education initiative, a novel pediatric trauma fundamentals course (PTF) was developed to provide standalone pediatric trauma education by our academic/NGO partnership. The objective of the program was to develop, implement, and evaluate a novel PTF educational course in the active armed conflict zone of Ukraine. Methods: A novel two-day PTF course was internally developed, translated into Ukrainian, and implemented across five oblasts in Ukraine from November 2022 to December 2023. Participants completed pre- and post-assessments in knowledge and self-confidence, and critical skills were assessed against objective skill checklists. Change in knowledge and self-confidence were analyzed, respectively, with the nonparametric Wilcoxon matched-pairs signed-rank test and McNemar’s test for paired data. Anonymous course evaluations were solicited after each course. Six to eight-week follow-up surveys were conducted to assess skill utilization and stewardship. Results: 446 Ukrainian health care providers were trained during 30 courses across 8 Oblasts (regions) in Ukraine during the intervention period. Aggregated knowledge and self-confidence significantly improved across all measures. Ukrainian instructors of courses received higher raw scores across all evaluation points on instructor feedback surveys as compared to international instructors. Six to eight-week follow-up surveys demonstrated participants had positive views of the training, have used the training on patients, and have taught the material to other health care providers. Discussion: Our novel PTF intervention demonstrates a successful partnership-based model for implementing pediatric trauma education in an active conflict zone in Ukraine. Challenges to implementing such programs can be mitigated through strategic partnership-based models between academic institutions and organizations with local knowledge and expertise. Ukrainian instructors provide course experiences similar or superior to international instructors, likely due to multiple factors related to language, culture, and context.