Primary trauma care curriculum: A qualitative analysis of impediments to improvement

Objectives In 2014, the primary trauma care curriculum was delivered at a national trauma center in San Salvador, El Salvador. A quantitative analysis demonstrated that subsequent incorporation of primary trauma care algorithms did not occur. The purpose of this qualitative analysis is to explore why the delivery of the primary trauma care curriculum did not have a measurable effect on provider observance of primary trauma care algorithms. Methods Key informant interviews of primary trauma care instructors and students, trauma care observers, and hospital administrators involved in the delivery of the primary trauma care curriculum were conducted in February 2015. Interview transcripts were analyzed qualitatively using a grounded-theory approach and thematic analysis for insights and common themes. Results Four common themes emerged to explain why adherence to primary trauma care algorithms did not improve: Primary Trauma Care course delivery problems, insufficient equipment, insufficient nurse training, and unsystematic team response. Conclusions Despite the delivery of the primary trauma care curriculum, adherence to the primary trauma care algorithms did not improve as a result of problems integral to the primary trauma care model - including the teach-the-teachers method of curriculum dissemination - as well as local conditions at this hospital. These findings suggest that an isolated educational intervention may not be successful unless the host institution is able to commit to the implementation of the educational material in an ongoing and comprehensive fashion.