Simulation-based education can be used to teach technical and non-technical skills, especially in acute care. Simulation is safe for patients and can be used throughout the education continuum, from undergraduate to postgraduate training to continuing professional learning. Simulation skills can be transferred to clinical settings and may increase team performance. This could lead to improved patient outcomes.
Hyperbaric oxygen therapy (HBOT), is widely used around the globe to treat patients of all ages, with both urgent and non-urgent conditions. To effectively manage HBOT, both individuals and teams must have the necessary clinical skills. This is especially true in situations where complications arise or when there are emergencies. HBOT may involve complex cases, such as patients who require mechanical ventilation, hyperbaric chamber fires or acute respiratory failure, seizure, or other safety events. For effective collaboration and technical skills to be used in providing HBOT, healthcare providers must have both interprofessional collaboration and technical knowledge.
In many countries, the only way to become a certified hyperbaric health professional is through didactic lectures. The initial certification process does not include simulation-based education.
There is also no formal recognized hyperbaric medicine simulation course. We believe that simulation practice can have a positive impact on provider performance in hyperbaric medicine. This is supported by evidence in other healthcare areas. It is important to review the evidence regarding simulation-based education in hyperbaric medicine before we can create a curriculum. Although this has not been completed yet, it is a good starting point to develop a future curriculum.
The eligibility criteria were established in advance. Any healthcare provider regardless of profession or specialty, who provides care in hyperbaric medicine as an individual or team member or for patients undergoing hyperbaric oxygen treatment was eligible. Studies on simulation-based education were included. We used a broad definition of simulation in this review. This included screen simulators, simulation-based education, simulation with a human avatar, and simulation with part-task trainers. The simulation intervention could have either formative or summative goals. If a comparator was present it could be no education, education with and without a simulator component, didactic teaching, or any other comparative educational intervention. Learning was the outcome of interest. It was classified according to the modified Kirkpatrick model of educational results, as modified and revised by Phillips. All outcomes across the Kirkpatrick levels were included. However, studies that rely only on self-reported outcomes (level 2b and higher) were excluded. This is because self-assessments by healthcare workers are often inaccurate and unreliable. We included self-assessed outcomes for levels 1 and 2a because this is the only way to explore these Kirkpatrick levels. All study designs (e.g. observational, case-series, experimental) were eligible for inclusion. Only studies published in English in peer-reviewed journals were eligible for inclusion. Conference abstracts weren't included.
We created a data extraction form and planned to have two independent reviewers extract the relevant information from DistillerSR. We wanted to extract data such as publication details (e.g. first author name, country of publication, funding, trial registration), study characteristics (e.g. study design, sample size, and inclusion/exclusion criteria), patient demographics and intervention details, comparator details, type of surgical procedure, anesthesia and the effect of intervention upon reported clinical outcomes.
This search returned 277 publications. Seven additional references were found from book chapters. One duplicate was also removed. This left 283 references that could be used for title or abstract screening. 17 of these studies were subject to full-text screening. All 17 articles were screened for errors after reading the entire text. One was in German, one was a conference abstract and fifteen did not describe simulation-based education. This systematic review did not identify any article that evaluated the impact of hyperbaric medicine simulation-based education and was published in English.
Although publication in English was not required by our inclusion criteria, we found one article in German that could be relevant to hyperbaric medicine and simulation-based education. This study, according to an abstract published in English describes the impact and implementation of in situ simulation training in hyperbaric medicine for emergencies. All hyperbaric medicine staff must undergo in situ simulation training every year (Kirkpatrick Level 3).
This systematic review is unique in its ability to evaluate the current state of simulation-based education for hyperbaric medicine. There was no English-language article that evaluated the impact of simulation education in hyperbaric medicine. One paper in German that could be relevant was published.
These findings are not surprising, given the widespread adoption of simulation-based education over the past two decades in many healthcare fields, including interprofessional education for acute care. Hyperbaric medicine requires close collaboration between multiple professions because it involves several professionals, such as physicians from different specialties, chamber operators and technicians, nurses, respiratory therapists, and/or respiratory therapists.
Although teamwork skills are essential in routine hyperbaric oxygen treatment, they are even more important for life-threatening situations (e.g., crisis management (CRM) situations), where coordinated and urgent actions are required between different professions to ensure safe patient care. If a hyperbaric patient experiences a pneumothorax while being treated in a multi-place chamber, the doctor, chamber operator, and nurse must effectively communicate and coordinate to identify the problem and make the necessary treatment decisions. Seizure, cardiac arrest, and fire are all examples of crises in hyperbaric medicine. These situations can occur in the operating or intensive care department, or in hyperbaric medicine. Positive patient outcomes require optimal collaboration between interprofessional teams.
Simulator-based education, which includes interprofessional simulation, is being widely adopted in many other fields. Interprofessional education, as defined by the World Health Organization, is " where two or more professionals learn from, and with, each other to facilitate effective collaboration and improve healthcare outcomes. An interprofessional simulation is a group of professionals who practice a case together and then debrief. Participants can learn from and with each other during the simulation practice and debriefing. Simulated practices for interprofessional operating room teams have shown long-term positive communication and teamwork behaviors. Simulated practice in multidisciplinary critical care unit teams resulted in improved teamwork, patient management, and other benefits. The evidence seems to show that simulation-based education results in better behaviors among healthcare professionals and a positive impact on patient outcomes. The evidence is strong that simulation-based education has a positive impact on the skills and competencies of CRM teams. Hyperbaric medicine is an exception to interprofessional simulation-based learning, even though it requires teamwork to manage life-threatening situations and respond to them.
This systematic review demonstrates the need for hyperbaric medicine to take concrete steps to join the evidence-based simulating education movement in other healthcare fields. Teaching in hyperbaric medicine is limited to didactic teaching. No certification program includes simulation-based education. Simultaneous training is rarely offered at hyperbaric conferences like the Canadian Undersea and Hyperbaric Medical Association's hyperbaric emergency team simulator course. A standardized simulation curriculum could be developed, implemented, and evaluated across hyperbaric centers to improve simulation-based education in hyperbaric medicine.
While this systematic review identified an important knowledge gap in hyperbaric medicine, there are some limitations. We included only English-language published studies. Only one non-English study was found to be relevant. Our focus was also on hyperbaric medicine, not diving medicine. However, our inclusion criteria were quite broad since we considered all Kirkpatrick levels as well as most study designs.
The systematic review did not find any English-language publication that evaluated the impact of simulation-based education on hyperbaric medicine. To optimize patient care and practice, more research is required to understand how simulation-based education can benefit the hyperbaric medicine community.
Sources:
https://pubmed.ncbi.nlm.nih.gov/31523796/
https://academictree.org/education/publications.php?pid=693039
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