Emergency medical conditions such as cardiac arrest, airway obstruction, and acute respiratory compromise require immediate recognition and prompt intervention. Basic Life Support (BLS), cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and choking management are therefore essential competencies for medical and nursing students. Although these skills are included in health-professional curricula, students may have limited exposure to real emergencies, and theoretical knowledge alone may not translate into effective performance. Structured training introduced early in medical education has been shown to improve both CPR knowledge and confidence. In an Indian study among first-year medical students, Manuel et al. reported a marked improvement in knowledge and self-confidence after lecture-based and practical BLS training [1]. Similarly, Rajaram et al. demonstrated significant improvement in BLS knowledge among Indian medical students following structured training, including increased use of audio-visual teaching methods [2]. The method used to deliver emergency-care education may influence learning, engagement, confidence, and skill acquisition. Conventional didactic lectures provide an efficient means of delivering core concepts, whereas PowerPoint presentations and audio-visual resources can improve visualization and standardization of teaching. Practical and simulation-based training additionally allows learners to practice psychomotor skills in a controlled environment. George et al. found that an online video-based BLS intervention significantly improved both knowledge and confidence among nursing students [3]. A systematic review by Abuejheisheh et al. reported that blended BLS learning combining technology-based and conventional approaches may improve knowledge and skill retention compared with traditional instruction alone [4]. These findings support the increasing use of multimodal teaching rather than dependence on a single instructional strategy. Recent Indian evidence has also emphasized the importance of practical exposure. Agarwal et al. demonstrated significant improvement in CPR knowledge after simulation-based training among doctors and nurses, although some decline was observed at six months [5]. Kochhar et al. similarly found significant improvement in BLS knowledge and practical skills among first-year MBBS students, but reported progressive deterioration in skills at six months and one year, highlighting the importance of reinforcement and repeated training [6]. More recently, Gupta et al. directly compared online content-based teaching with mannequin-based training in medical students and found superior knowledge and CPR performance with hands-on mannequin training, particularly for compression depth and rate [7]. Virtual-reality and conventional simulation approaches have also both produced significant improvements in CPR performance among nursing students, suggesting that technology-assisted instruction may complement conventional training [8]. Despite these advances, most recent studies have evaluated a single educational intervention or compared only two teaching approaches, frequently focusing solely on CPR or BLS. Direct comparisons of multiple commonly available instructional methods, such as didactic lecture, PowerPoint-based teaching, audio-visual instruction, and hands-on skill training, across different emergency topics among both medical and nursing students remain limited, particularly in the Indian setting. Identifying an effective and feasible instructional strategy is important for institutions with varying resources and training capacity. Therefore, the present study aimed to compare different teaching strategies for emergency medical care skills training among medical and nursing students and to evaluate their effectiveness in improving participants knowledge

This explanatory mixed-methods, quasi-experimental study was conducted among second-year MBBS and BSc Nursing students at Mamata Academy of Medical Sciences, Bachupally, Hyderabad, Telangana. The study aimed to compare the effectiveness of different instructional methods for teaching emergency medical care skills. A total of 247 students registered for the training programme, of whom 214 completed the training and both pre- and post-test assessments and were included in the final analysis. Participants were allocated into four instructional groups and underwent training over four sessions conducted on separate days. The instructional modalities were: • Group 1: didactic lecture, • Group 2: audio-visual teaching, • Group 3: simulation/mock practice using case-based discussions supported by PowerPoint presentations, and • Group 4: hands-on skill training using mannequins. The training programme covered the essential components of Basic Life Support (BLS), including recognition of cardiac arrest, activation of the emergency response system, high-quality cardiopulmonary resuscitation (CPR), chest compressions, airway and breathing management, automated external defibrillator (AED) use, and management of choking and other common life-threatening emergencies. A structured pre-test was administered before training, followed by a post-test immediately after completion of the respective instructional session to assess improvement in knowledge. Inclusion Criteria • Second-year MBBS students enrolled at the institution. • BSc Nursing students eligible during the study period. • Students willing to participate in the emergency medical care training programme. • Students who attended the assigned training session. • Students who completed both pre-test and post-test assessments. Exclusion Criteria • Students absent on the scheduled day of training. • Students unwilling to participate. • Students who did not complete either the pre-test or post-test. • Participants with incomplete questionnaire or assessment data. Study Tools • Structured and validated pre-test and post-test questionnaires for assessing knowledge of BLS and emergency medical care. • A self-designed validated feedback questionnaire containing Likert-scale and open-ended questions. • Adult BLS half-body mannequins, including the Laerdal® Little Anne manikin. • BLS infant mannequins for infant resuscitation training. • Laerdal AED Trainer (945090) for AED demonstration and practice. • Laerdal® pocket mask for airway and ventilation training. • PowerPoint presentations, audio-visual materials, clinical case scenarios, and simulation-based teaching aids. • Focus-group discussion guide for collecting faculty perspectives regarding the training programme. Data Collection • A total of 247 students registered for participation in the emergency medical care training programme. • Participants were allocated to one of four instructional modalities: didactic lecture, audio-visual teaching, simulation/mock practice with case-based PowerPoint discussion, or hands-on mannequin-based training. • A structured pre-test was administered before commencement of the respective training session to determine baseline knowledge. • All groups were trained using standardized emergency medical care and BLS content to maintain comparability of the subject matter. • Participants underwent their assigned instructional intervention during the scheduled training session. • A structured post-test was administered immediately after training to assess improvement in knowledge. • Student feedback regarding clarity, usefulness, engagement, and perceived effectiveness of the teaching methodology was obtained using a validated questionnaire. • Qualitative feedback was collected through open-ended questions, while faculty perspectives were explored through focus-group discussions. • Of the 247 registered participants, 214 completed the required training and assessments and were included in the final statistical analysis. Statistical Analysis Data were entered and analysed using GraphPad Prism version 10.4.1. Continuous variables were expressed as mean ± standard deviation (SD), standard error of the mean (SEM), and 95% confidence intervals (CI), wherever appropriate. Pre- and post-training knowledge scores were analysed using a mixed-effects model, followed by Tukeys multiple-comparisons test for relevant within- and between-group comparisons. Overall differences among groups were assessed using analysis of variance, including BrownForsythe and Welchs ANOVA where appropriate. The BlandAltman method was used where assessment of agreement and systematic bias was required. Statistical significance was defined as p < 0.05, with a 95% confidence level and 80% statistical power.

Table 1. Distribution of Students Across Instructional Methods According to Training Topic Training topic Didactic Lecture (DL) PowerPoint (PPT) Audio-Visual (AV) Skills Training Adult BLS 51 51 51 51 Child BLS 51 51 51 51 AED 55 56 55 56 Choking 55 56 56 56 Abbreviations: BLS, Basic Life Support; AED, Automated External Defibrillator; DL, Didactic Lecture; PPT, PowerPoint-based teaching; AV, Audio-Visual teaching. Table 1 shows the distribution of students participating in the different emergency medical care training topics according to instructional method. For Adult BLS and Child BLS, 51 students participated in each of the four teaching groups. Participation was slightly higher for AED and choking training, ranging from 55 to 56 students across the instructional modalities. Overall, the number of participants was comparable among the four teaching methods, allowing a reasonably balanced comparison of learning outcomes across the different instructional approaches. Table 2. Group-wise Schedule and Instructional Modalities Used for Emergency Medical Care Training S. No. Training Topic Group 1 Group 2 Group 3 Group 4 1 Adult BLS Skills Training DL A/V PPT 2 Child and Infant BLS DL A/V PPT Skills Training 3 Automated External Defibrillator (AED) PPT Skills Training DL A/V 4 Choking Management A/V PPT Skills Training DL Abbreviations: BLS, Basic Life Support; AED, Automated External Defibrillator; DL, Didactic Lecture; A/V, Audio-Visual teaching; PPT, PowerPoint Presentation. Table 2 presents the distribution of instructional modalities used for each emergency medical care topic across the four study groups. Each group received all four training topics, but the teaching method was systematically rotated between didactic lecture, audio-visual teaching, PowerPoint presentation, and hands-on skills training. This crossover of instructional approaches ensured that each group was exposed to every teaching modality across different topics. Such a structured allocation enabled comparison of learning outcomes associated with the different instructional methods while maintaining similar emergency-care content across the study groups. Table 3. Comparison of Pre- and Post-training Knowledge Scores Across Instructional Modalities Comparison Mean Difference Adjusted p-value Interpretation Pre-DL vs Post-DL −3.189 <0.0001 Highly significant improvement Pre-PPT vs Post-PPT −2.750 <0.0001 Highly significant improvement Pre-AV vs Post-AV −2.907 <0.0001 Highly significant improvement Pre-Skill vs Post-Skill −2.825 <0.0001 Highly significant improvement Abbreviations: DL, Didactic Lecture; PPT, PowerPoint Presentation; AV, Audio-Visual teaching; Skill, Skill-based training. Table 3 demonstrates a statistically significant improvement in knowledge scores following training across all four instructional modalities. The greatest mean improvement was observed with didactic lecture training (mean difference = −3.189), followed by audio-visual teaching (−2.907), skill-based training (−2.825), and PowerPoint-based teaching (−2.750). All pre- versus post-training comparisons were highly significant (p < 0.0001). Brown–Forsythe and Welch’s ANOVA also confirmed significant overall differences among the eight pre- and post-training score groups. These findings indicate that each instructional method was effective in improving participants’ knowledge after emergency medical care training.

The present study compared didactic lecture (DL), PowerPoint presentation (PPT), audio-visual (AV) teaching, and skill-based training for emergency medical care education among medical and nursing students. A significant improvement in knowledge was observed with all four instructional modalities. The mean pre-to-post differences were 3.189 for DL, 2.750 for PPT, 2.907 for AV, and 2.825 for skill-based training, with all comparisons being highly significant (p < 0.0001). Although DL showed the largest numerical improvement, no statistically significant superiority of one modality was demonstrated in post-training comparisons. These findings indicate that structured emergency-care training can improve immediate knowledge irrespective of the teaching approach used. Requena-Mullor et al. in 2021 evaluated a clinical simulation BLS course among 479 nursing students and reported a significant increase in theoretical knowledge from 12.61 ± 2.30 to 15.60 ± 2.06 (p < 0.001), together with improvement in practical CPR skills [9]. This is consistent with the present study and supports the effectiveness of structured BLS training in improving learners' knowledge. In 2022, Takhdat et al. compared high-fidelity simulation with case-based learning among undergraduate nursing students. High-fidelity simulation produced better CPR knowledge retention and self-efficacy at one month [10]. While the present study did not demonstrate superiority of skill-based training for immediate knowledge gain, this difference may be explained by the outcome measured, as simulation may provide greater benefits for confidence, retention, and psychomotor performance than for immediate written-test scores alone. Hassan and Elsaman subsequently reported in 2023 that a simulation-based flipped classroom resulted in significantly higher CPR skill checklist scores and greater learner satisfaction compared with traditional simulation [11]. Their findings suggest that combining visual preparation with active practical participation may offer advantages beyond knowledge acquisition. In the present study, both AV and skill-based approaches produced significant improvement, supporting the usefulness of interactive and practical methods in emergency-care education. Ranjbar et al. in 2024 found that both massed and spaced e-learning improved BLS knowledge among nursing students, although spaced e-learning resulted in better knowledge scores and retention over one month [12]. This supports the present observation that technology-assisted methods such as PPT and AV teaching can effectively improve short-term knowledge. It also emphasizes that the frequency and spacing of training, rather than teaching modality alone, may influence retention. In the same year, Abbasi et al. compared mannequin-based simulation with virtual CPR training. Both approaches significantly improved knowledge, attitude, and CPR performance (p < 0.001), demonstrating that different instructional methods can achieve meaningful learning outcomes [13]. This closely parallels the current finding that all four modalities were effective despite the absence of a clearly superior approach. More recent studies reinforce this concept. Barlocco De La Vega et al. in 2025 demonstrated that mixed-reality BLS training was non-inferior to traditional mannequin-based simulation for overall BLS performance at one month [14]. Nasiri et al. also found that flipped classroom-based simulation significantly improved CPR knowledge, skills, confidence, and satisfaction among nursing students [15]. These results indicate that modern digital approaches can complement conventional practical teaching and may be particularly useful when faculty time or simulation resources are limited. Most importantly, Telli et al. in 2026 compared facilitated interactive video with simulation-based BLS training in medical students. Both groups showed significant improvement in knowledge (p < 0.001), while differences in post-test knowledge, knowledge gain, and subsequent OSCE performance were not statistically significant [16]. This finding closely resembles the present study and supports the conclusion that well-structured instruction may be effective through multiple delivery formats without one method necessarily outperforming all others. The present study is strengthened by its comparison of four commonly used teaching methods across multiple emergency-care topics. However, immediate post-training knowledge was the principal outcome; therefore, the results cannot establish long-term retention or actual performance during emergencies. Future studies should include delayed assessments, OSCE-based evaluation, mannequin-generated CPR quality indicators, confidence scores, and repeated refresher training.

All four instructional modalities significantly improved emergency medical care knowledge among medical and nursing students. Although minor numerical differences were observed, no single teaching method demonstrated clear superiority in immediate post-training knowledge. A multimodal approach combining didactic instruction, audio-visual resources, digital presentations, and hands-on practice may therefore provide a practical and comprehensive strategy for emergency medical care education. Regular reinforcement and objective assessment of practical skills should be incorporated to ensure long-term competence.

1. Manuel SA, Tanna DB, Patel HK, Bose N. Preparing future Indian medical graduates for emergencies at the Foundation Course: Do the knowledge and self-confidence increase after basic cardiac life support training? Indian J Anaesth. 2022;66(5):358-367. doi:10.4103/ija.ija_72_22. 2. Rajaram N, Krishna H, Singh R, Narayan AK. Impact of COVID-19 on Basic Life Support Training Among Medical Students: An Experimental Study. Cureus. 2022;14(4):e23775. doi:10.7759/cureus.23775. 3. George B, Hampton K, Elliott M. Effectiveness of an educational intervention on first-year nursing students' knowledge and confidence to perform basic life support: a quasi-experimental study. Contemp Nurse. 2023;59(6):478-490. doi:10.1080/10376178.2023.2287075. 4. Abuejheisheh AJ, Alshraideh JA, Amro N, Bani Hani S, Darawad MW. Effectiveness of blended learning basic life support module on knowledge and skills: A systematic review of randomized controlled trials. Heliyon. 2023;9(11):e21680. doi:10.1016/j.heliyon.2023.e21680. 5. Agarwal A, Baitha U, Ranjan P, Swarnkar NK, Singh GP, Baidya DK, et al. Knowledge and Skills in Cardiopulmonary Resuscitation and Effect of Simulation Training on it among Healthcare Workers in a Tertiary Care Center in India. Indian J Crit Care Med. 2024;28(4):336-342. doi:10.5005/jp-journals-10071-24670. 6. Kochhar S, Samagh N, Sharma J, Kaur A, Verma M. Knowledge and Skill Retention in First-Year MBBS Students After Basic Life Support Training: A One-Year Longitudinal Study. BMC Med Educ. 2024;24(1):971. doi:10.1186/s12909-024-05922-0. 7. Gupta N, Bansal B, Gupta A, Jindal D, Singhal M, Grewal A, et al. Comparison of online content-based training with hands-on mannequin-based skill training on basic life support knowledge and skills among medical students. J Educ Health Promot. 2025;14:55. doi:10.4103/jehp.jehp_565_24. 8. Bodur G, Turhan Z, Altun YE, Kilicaslan K, Alikan B, Özer F, et al. Evaluating the effectiveness of virtual reality simulation in CPR training for nursing students: A randomized controlled trial. Nurse Educ Pract. 2025;87:104486. doi:10.1016/j.nepr.2025.104486 9. Requena-Mullor MDM, Alarcón-Rodríguez R, Ventura-Miranda MI, García-González J. Effects of a clinical simulation course about basic life support on undergraduate nursing students' learning. Int J Environ Res Public Health. 2021;18(4):1409. doi: 10.3390/ijerph18041409. 10. Takhdat K, Eddabbah M, El Hamzaoui H, Lamtali S, El Adib AR. High-fidelity simulation effects on cardiopulmonary resuscitation self-efficacy and knowledge retention in undergraduate nursing students: a two-group, experimental, longitudinal pilot study. Nurs Educ Perspect. 2022;43(6):E118-E120. doi: 10.1097/01.NEP.0000000000000984. 11. Hassan EA, Elsaman SEA. The effect of simulation-based flipped classroom on acquisition of cardiopulmonary resuscitation skills: a simulation-based randomized trial. Nurs Crit Care. 2023;28(3):344-352. doi: 10.1111/nicc.12816. 12. Ranjbar F, Sharif-Nia H, Shiri M, Rahmatpour P. The effect of spaced E-learning on knowledge of basic life support and satisfaction of nursing students: a quasi-experimental study. BMC Med Educ. 2024;24(1):537. 13. Abbasi M, Asadoola Y, Ebrahimi H, Bahonar E, Dabirian Z, Esmaeili SM, et al. Comparison of mannequin-based simulation training method with virtual training method on nursing students' learning cardiopulmonary resuscitation: a controlled randomized parallel trial. Iran J Nurs Midwifery Res. 2024;29(4):438-445. 14. Barlocco De La Vega S, Guerif-Dubreucq E, Bouaoud J, Awad M, Mathon L, Beauvais A, et al. Mixed reality versus manikins in basic life support simulation-based training for medical students in France: the mixed reality non-inferiority randomized controlled trial. J Educ Eval Health Prof. 2025;22:15. 15. Nasiri S, Hosseinabadi R, Mokhayeri Y, Beiranvand S. Impact of flipped classroom-based simulation of CPR on nursing students' self-confidence, satisfaction, knowledge and skill: a quasi-experimental study. BMC Med Educ. 2025;25(1):980. doi: 10.1186/s12909-025-07525-9. 16. Telli S, Camgöz S, Yaman M, Arslan SF. Facilitated interactive video versus simulation-based training after a standardized lecture for basic life support in medical students: a randomized trial. BMC Med Educ. 2026;26(1):753. doi: 10.1186/s12909-026-09128-4.