Is It All in the Delivery? Comparing Hybrid and Traditional ATLS Courses

The Advanced Trauma Life Support (ATLS) course is the global standard for trauma education, delivered primarily in a traditional multi-day in-person format requiring trained faculty and resources that may limit access in low-resource settings. Hybrid delivery has expanded availability, but comparative effectiveness data are lacking. We sought to determine whether hybrid ATLS courses were noninferior to traditional ATLS by comparing pass rate and learner satisfaction rate at the course level.

We analyzed 7,387 ATLS courses (April 2022-June 2025) from the ACS COT learning management system with complete pass rate and learner survey data: 4,808 traditional (65%) 2,579 hybrid (35%). Primary outcome was course pass rate and co-primary outcome was participant satisfaction with educational format. Mixed-effects regression clustered courses within course sites, adjusting for year, class size, physician composition, instructor-to-student ratio, and region. Non-inferiority (NI) was pre-specified at a 5 percentage-point (pp) margin (distribution-based MCID).

Hybrid courses are non-inferior to traditional courses on both outcomes. Adjusted pass rates were 92.9% (traditional) vs 93.3% (hybrid); the 95% CI for the difference (-0.6 to +1.3pp) excluded the ±5pp NI margin. Composite satisfaction with course format was 95.9% vs. 94.9%); the 95% CI for the difference (-1.7 to -0.4pp) likewise excluded NI margin. Effect sizes were small across all analyses (Cohen's d < 0.25). Findings were robust across multiple pre-specified sensitivity analyses.

Hybrid ATLS delivery is non-inferior to traditional formats for both pass rate and learner satisfaction and may expand access to high-quality trauma education without compromising effectiveness.