title: Exploring Mechanisms for Effective Technology-Enhanced Simulation-based Education in Wilderness Medicine: A Systematic Review.
abstract: BACKGROUND
  Technology-enhanced simulation is well-established in healthcare teaching curricula, including those regarding wilderness medicine. Compellingly, the evidence base for the value of this educational modality to improve learner competencies and patient outcomes are increasing.
  
  
  OBJECTIVE
  The aim was to systematically review the characteristics of technology-enhanced simulation presented in the wilderness medicine literature to date. Then, the secondary aim was to explore how this technology has been used and if the use of this technology has been associated with improved learner or patient outcomes.
  
  
  METHODS
  EMBASE and MEDLINE were systematically searched from 1946 to 2014, for articles on the provision of technology-enhanced simulation to teach wilderness medicine. Working independently, the team evaluated the information on the criteria of learners, setting, instructional design, content, and outcomes.
  
  
  RESULTS
  From a pool of 37 articles, 11 publications were eligible for systematic review. The majority of learners in the included publications were medical students, settings included both indoors and outdoors, and the main focus clinical content was initial trauma management with some including leadership skills. The most prevalent instructional design components were clinical variation and cognitive interactivity, with learner satisfaction as the main outcome.
  
  
  CONCLUSIONS
  The results confirm that the current provision of wilderness medicine utilizing technology-enhanced simulation is aligned with instructional design characteristics that have been used to achieve effective learning. Future research should aim to demonstrate the translation of learning into the clinical field to produce improved learner outcomes and create improved patient outcomes.
authors.affiliation: Department of Paediatric Anaesthesia & North West and North Wales Paediatric Transport Service, Royal Manchester Children's Hospital, UK.
authors.forename: Ralph
authors.initials: R
authors.lastname: MacKinnon
authors.affiliation: Research and Innovation, Royal Manchester Children's Hospital, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Aitken
authors.affiliation: Royal Preston Hospital, Preston, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Humphries
keywords: education; learner outcomes; medical simulation; systematic review; technology; wilderness medicine
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