The development of continuing education for trauma care in an African nation.

BACKGROUND: A trauma continuing education course was developed to meet the needs of rural hospitals in Ghana.
METHODS: The course's effectiveness was evaluated by pre-course and post-course test scores; and by interviews with course participants 1 year afterwards.
RESULTS: Mean test scores improved from 69% (% correct) to 80%. There were improvements in all major categories: initial management, torso, plastic surgery, orthopaedics, and X-ray interpretation. Follow-up interviews revealed high level of utilisation of basic airway manoeuvres (93% of participants utilising at least once) and chest tube insertion (67%), but limited utilisation of advanced airway manoeuvres (20%). Participants reported that their provision of most categories of care had improved. Categories with less improvement were: management of open fractures (33% not improved), closed fractures (20%), and diagnosis of abdominal injury (20%). DISCUSSION: This locally developed course improved the participants' knowledge and their self-reported process of trauma care. Aspects of trauma care with low test scores indicate areas needing reinforcement. Aspects with low subsequent utilisation, such as advanced airway management, indicate areas that might need attention to other components of care, such as equipment availability and training of ancillary staff. These findings provide lessons for efforts to improve trauma care in other low-income countries.