Teaching Modalities for Hyperbaric Oxygen Therapy Education: A Systematic Review and Narrative Synthesis

Objective: To systematically identify and synthesise the available evidence on teaching modalities for hyperbaric oxygen therapy (HBOT) education across all learner levels. Methods: We searched PubMed, Scopus, Web of Science, CNKI, Wanfang, SinoMed, EMBASE, and the Cochrane Library from inception to 15 June 2026 for studies evaluating any HBOT teaching or training intervention against traditional instruction or another comparator, with knowledge, skills, or learner satisfaction as outcomes. Risk of bias was assessed using the Cochrane RoB 2 tool for randomised trials, ROBINS-I for comparative non-randomised studies, and MMAT/JBI checklists for descriptive and survey designs. Because of marked design heterogeneity, findings were synthesised narratively following the SWiM guideline. An exploratory synthesis of extractable effect sizes was undertaken to characterise the direction and magnitude of reported effects. The protocol was retrospectively registered in PROSPERO (CRD420261462169). Results: Thirty studies met the inclusion criteria (nine English-language, 21 Chinese-language). The evidence base was dominated by single-group pre–post evaluations, descriptive curriculum reports, and cross-sectional surveys; only four randomised controlled trials were identified. Technology-enhanced modalities—simulation-based education, blended/online learning, and Web-based simulation—were generally associated with promising improvements in knowledge and skills, although most studies lacked an active comparator. The exploratory synthesis identified only two studies with extractable knowledge outcome effect sizes, both implausibly large (g > 2.0), likely reflecting small-sample bias, absence of blinding, and practice effects. Conclusions: The available evidence suggests that technology-enhanced teaching modalities are promising for HBOT education, but the field lacks methodologically rigorous comparative studies and no study yet demonstrates consistent superiority over traditional didactic teaching. The anomalously large effect sizes in the few quantitative studies signal a high risk of bias and an urgent need for adequately powered randomised trials with blinded outcome assessment, standardised outcome measures, and a consensus-derived competency framework.