JMIR Publications

ABSTRACT

Background:

Blended learning has become a dominant instructional model in health professions education, yet its effects on different domains of competence remain incompletely explored. In particular, evidence regarding psychomotor skill acquisition under digitally mediated instructional restructuring is limited. Pandemic-related disruptions created natural quasi-experimental variation in teaching modalities, enabling examination of domain-specific learning outcomes.

Objective:

To compare the effectiveness of blended versus traditional in-person emergency medical technician (EMT-1) training on cognitive knowledge, psychomotor performance, and integrated scenario competence, and to examine predictors of technology acceptance within a blended learning context.

Methods:

We conducted a retrospective quasi-experimental study using standardized certification data from an accredited EMT-1 training center. Outcomes were compared between a traditional in-person cohort (2020; n = 604) and a blended learning cohort (2023; n = 581). The primary outcome was psychomotor performance (TR2). Secondary outcomes included knowledge (TR1), integrated scenario competence (TR3), digital engagement, and technology acceptance. Multivariable regression adjusted for age, sex, and education level.

Results:

Cognitive knowledge was similar between cohorts (TR1: 69.20 ± 13.32 vs. 69.53 ± 10.75; P=.64; d = 0.03). Psychomotor performance was significantly lower in the blended cohort (TR2: 84.44 ± 10.80 vs. 80.60 ± 9.70; mean difference = 3.84, P<.001; d = 0.37), exceeding the predefined minimum clinically important difference. This association remained robust after covariate adjustment (β = −4.04, 95% CI [−5.15, −2.92], P<.001). Integrated scenario performance showed a nominal between-group difference that did not meet predefined clinical significance thresholds (TR3: P=.03; d = 0.13). Within the blended cohort, perceived benefits and positive attitudes toward digital learning were the strongest predictors of future e-learning intentions.

Conclusions:

Blended learning demonstrated domain-differential effects across competency areas: cognitive and integrated competencies were preserved, whereas early psychomotor performance was modestly reduced. These findings support a domain-differential sensitivity model and suggest that blended curricula should incorporate strategies grounded in cognitive load theory and mastery learning to safeguard psychomotor development.