Comparison of classroom-based vs. distributive learning-based 12-lead ECG training

Introduction: Providing emergency medical services (EMS) requires significant resources, including the cost of paramedic training, certification, and maintenance of competencies. Currently, no published research examines the cost and performance effectiveness of Web-based training vs. video teleconferencing-based training vs. traditional classroom-based training methods for paramedics. Hypothesis: Paramedics trained in local, remote, and Web-based groups will have similar rates of successful completion of 12-lead electrocardiogram (ECG) training. The Web-based training group will be the most cost-effective method of conducting 12-lead ECG training. Methods: The 12-lead ECG course was taught to all paramedics (N = 63) employed by a county EMS system in southwestern Ontario, Canada. The paramedics were placed into one of three groups: local, remote, and Web-based. The local group (n = 17) received all training in a direct-teaching classroom format. The remote group (n = 18) received training (lecture and skills) via video teleconferencing technology. The Web-based group (n = 21) received training via Web-based learning. The three groups followed the same course schedule, material, slides/presentations, and practice cases. A pilot group of paramedics (n = 7) was used to gauge material's depth and teaching times. Independent-samples t-test was used to compare the rates of completion (dependent variable) of the three groups (local, remote, and Web). Results: The local (n = 17) and remote (n = 18) groups had a 100% successful completion of the 12-lead training program. The Web-based group (n = 21) had a non-completion rate of 19% (n = 4; p = 0.042). The mean costs per student were $300 in the local group, $238 in the remote group, and $200 in the Web-based group. However, after adjusting for retraining, the mean cost per student in the Web-based group was $250. Conclusion: The cost of paramedic training, certification, and maintenance of competence requires a significant amount of resources. Each of the three methods used in this study has distinctive strengths and limitations. In this study, we identified a limitation of the Web-based training method for the introduction of a new procedure.