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Curriculum of the Undersea & Hyperbaric Medicine Fellowship

Program Curriculum Goals 

At the completion of the fellowship, the hyperbaric fellow will:
  1. Develop the knowledge base and clinical skills necessary to:
    • Evaluate and prescribe appropriate HBO therapy for all the medical conditions currently accepted by the UHMS as amenable to hyperbaric oxygenation.
    • Manage patients during hyperbaric treatments.
    • Evaluate and treat diving related illnesses.
  2. Discuss investigational indications for the use of HBO and areas of future research.
  3. Develop requisite academic skills to be an effective researcher and teacher in diving and hyperbaric oxygen therapy.

Fellowship Experiences 

The HBO fellowship will provide the following experiences to achieve curriculum goals: 

  1. HBO clinical service 
  • HBO clinic 
  • Supervision of daily chamber operation and treatments 
  • HBO emergency call 
  • HBO consultation service 
  • Participation in diving medicine clinic once per week 
  1. Didactic curriculum and HBO core lecture series. 
  2. Development of HBO lectures for core curriculum, community hospitals
  3. Monthly HBO journal club 
  4. Monthly HBO case conference 
  5. Required HBO research project to be completed within the one year term
  6. Participation in UHMS 
  7. Submission of research for presentation at the annual UHMS meeting 
  8. Participation in the San Diego Diver Death Committee for the investigation of diving fatalities. 
  9. Participation in the Scripps Institute of Oceanography Diving Program. 
  10. Rotation at UCSD Hillcrest and Encinitas Wound Centers 
  11. Opportunities for clinical elective experience with the US Navy, NOAA Aquarius Habitat, UCSD Center for Diving Excellence, etc 
  12. Participation in UHMS Physician Training in Diving Medicine 

Instructional Objectives for Fellowship Training 

  1. List the approved indications for hyperbaric oxygen therapy 
  2. Cite the contraindications and side effects of HBO 
  3. Describe the physiologic effects of HBO by providing a one hour lecture for students/residents
  4. Provide a brief description of the history of hyperbaric medicine 
  5. Evaluate patients and decide whether HBO therapy is appropriate 
  6. Prescribe the correct HBO treatment protocol for a given indication 
  7. Perform noninvasive measurements of tissue oxygenation and use the results to predict which patients might respond to HBO 
  8. Obtain informed consent following discussion with patients regarding risks and benefits associated with HBO therapy. 
  9. Demonstrate operation of all equipment commonly used in the multiplace HBO chamber 
  10. Discuss monoplace operation and emergency procedures 
  11. Describe the care of critically ill and injured patients in the chamber, and perform appropriate management including patient monitoring, use of medications under pressure, airway, ventilatory, and cardiovascular support 
  12. Discuss factors that will enhance outcome of chamber resuscitations 
  13. Cite methods of psychological preparation and support for pediatric and adults undergoing HBO treatments 
  14. Discuss investigational areas for the use of hyperbaric medicine 
  15. Design a research project that can be completed within the one year fellowship in one of the investigational areas for HBO 
  16. Identify potential health hazards in recreational divers by performing dive physicals in weekly dive clinics. 
  17. Describe the physiologic effects of pressure and immersion 
  18. Discuss decompression theory 
  19. Describe the pathophysiology and treatment of decompression illness
  20. Demonstrate knowledge of diving tables and historical features of dive history 
  21. Demonstrate proficiency in a comprehensive neurologic exam 
  22. Demonstrate proficiency in myringotomy and chest tube placement 
  23. Demonstrate appropriate professional conduct, humanistic qualities, and teamwork .
  24. Surface decompression 
    • Bubble detection 
    • Mixed gas diving 
    • Altitude diving, flying after diving 
  25. Pathophysiology and Treatment of Decompression Illnesses. Signs and symptoms of decompression sickness and AGE 
    • Mechanisms of gas entry and distribution
    • Effects of bubbles 
    • Dysbaric osteonecrosis 
    • Barotrauma 
    • Treatment of decompression illnesses 
  26. Health hazards in divers 
    • Medical examination and standards for hyperbaric exposure: military, commercial, recreational, scientific, hyperbaric personnel.
    • Recognition and treatment of hazardous marine life injuries