Psychomotor Performance in Blended Versus In-Person Emergency Medical Technician Training: Retrospective Cohort Study

Blended learning is common in health professions education, but aggregate comparisons may obscure differences among knowledge, procedural skill, and integrated performance. Whether these domains differ after program-level changes under a common assessment system remains uncertain.

We aimed to compare knowledge, psychomotor performance, and integrated scenario competence between blended and traditional in-person emergency medical technician level 1 certification training, and, as an exploratory secondary aim, to describe digital engagement and technology acceptance among blended-cohort participants who completed the survey.

We compared routinely collected certification records from traditional in-person (2020; n=603) and blended (2023; n=581) emergency medical technician level 1 cohorts. The primary outcome was psychomotor performance; secondary outcomes were knowledge, integrated scenario performance, and competency-threshold attainment. We estimated between-cohort differences with 95% CIs and adjusted linear regression. Equivalence was assessed using two 1-sided tests with expert-derived educational importance margins established through an instructor consensus exercise before the panel was provided with the between-cohort results (±5 points for knowledge, ±3 points for psychomotor performance, and ±4 points for integrated scenario performance). These margins represent educational consensus thresholds rather than externally validated clinical thresholds. Blended-cohort trainees were additionally offered a questionnaire on digital engagement and technology acceptance, analyzed by multiple linear regression on intention to use e-learning again.

Psychomotor performance was lower in the blended cohort (80.60, SD 9.70, vs 84.44, SD 10.80; mean difference 3.84, in-person minus blended, 95% CI 2.67-5.01; d=0.37; P<.001); the adjusted coefficient was -4.04 (95% CI -5.15 to -2.92; P<.001). Equivalence within the prespecified ±3-point margin was not demonstrated. Knowledge (difference -0.30, 95% CI -1.68 to 1.08) and integrated scenario performance (-0.94, 95% CI -1.89 to 0.00) fell within the prespecified ±5- and ±4-point margins, respectively. Psychomotor-threshold (521/581, 89.7%, vs 557/603, 92.4%; P=.10) and overall-certification rates (459/581, 79%, vs 474/603, 78.6%; P=.87) did not differ detectably. Knowledge-threshold attainment was higher in the blended cohort (516/581, 88.8%, vs 503/603, 83.4%; P=.007). Among the 236 blended-cohort participants who completed the survey, perceived benefits and positive attitudes toward digital learning were positively associated with intention to use e-learning again.

The blended cohort had lower early psychomotor scores, whereas knowledge and integrated scenario differences fell within the prespecified margins. Programs adopting comparable models should assess psychomotor outcomes directly rather than infer them from knowledge or overall certification outcomes.