The Medical Planning Course: A Quality Improvement Project to Train Ukrainian Military Medical Personnel

INTRODUCTION: The evolution of warfare as seen in Ukraine has transformed frontline combat casualty care, forcing medical teams to operate under persistent threat up to 50 km from the line of contact. NATO medical planning doctrine currently lacks granularity for small-unit operations at the "tactical" level (company level and below). The authors previously developed the Medical Planning Process (MPP), mirroring the Troop Leading Procedures (TLP), to address this doctrinal gap. Embedded in the MPP is the CMPEC3 mission analysis framework (Casualty Estimation, Materiel, Personnel, Environment, Command, Control & Communications), which allows for comprehensive analysis of medical and tactical mission factors. The current paper reports on development and deployment of the Medical Planning Course (MPC) in Ukraine to teach the MPP to Ukrainian military medical personnel. MATERIALS AND METHODS: The MPC was developed jointly with Ukrainian partners and was part of a pilot quality improvement project initiated by request of Ukrainian military leadership. The main goal of the course was to provide small-unit medical leaders with actionable tools to begin medical mission planning and to develop a basic but complete medical plan within an acceptable timeframe. Secondary goals included increased familiarity with U.S. and NATO planning doctrine, fostering a culture of analytical and creative thinking, and empowering medical personnel to become more proactive leaders. Feedback was gathered through anonymous surveys, classroom observations, and expert consultations. The content of the course was adapted to local demands and constraints. The course reinforced basic knowledge of military planning methodologies (Military Decision-Making Process and TLP) before detailing the structure of the MPP and the separate components of the CMPEC3 mission analysis framework. Theoretical discourse further included discussion of patient triage categories, assessment of limitations and constraints, and the formulation of contingency plans. These factors were then applied to fictional and real-life case scenarios to draft a medical evacuation scheme from point-of-injury to higher levels of care with discussion of outlined medical courses of action. RESULTS: The MPC was delivered to 66 participants, including recent combat medic graduates, senior enlisted personnel, and officers. Students unanimously recognized the benefits of structured planning for team effectiveness. The practical exercise of constructing evacuation schemes proved most valuable, with groups developing basic medical concepts of operations within one hour. A notable mindset shift occurred regarding planning feasibility. Challenges included limited time allotted by command and limited applicability of the NATO Roles of Care model. Experts emphasized the need for ongoing medical reconnaissance and integration with combat operations. The MPP and MPC were later included in the Ukrainian Combat Medic Military Occupational Specialty curriculum. CONCLUSIONS: The MPC introduced structured medical planning to Ukrainian small-unit leaders, demonstrating proof of concept. Key lessons include the ability to construct plans within short timeframes, the importance of medical reconnaissance, and patient-to treatment matching beyond the standard NATO roles. Integration of the MPP into NATO doctrine could help mitigate doctrinal gaps and enhance coalition interoperability for dispersed operations in modern warfare environments.