Skip to main content

Performance outcomes of an online first aid and CPR course


In his behavior engineering model, Thomas Gilbert advises against adopting training interventions until knowledge gaps are determined to be the true cause of an undesirable performance outcome. Even then, managers may be hard-pressed to justify releasing personnel to a traditional live instructor-led training program. Research shows how self-directed digital training solutions could mitigate training time (and cost) concerns via a more easily accessed online course that yields comparable results to courses delivered live.


Cason, C., & Stiller, J. (2010). Performance outcomes of an online first aid and CPR course for laypersons. Health Education Journal, 70(4), 458-467. doi: 


National health advisory boards and associations strongly support broad-based cardiopulmonary resuscitation (CPR), first aid, and automated external defibrillator (AED) training.  However, scheduling conflicts, time constraints, and learner discomfort performing procedures in groups limit participation in sponsored education programs. Health educators created an alternative training delivery method, self-directed video-based instruction, which has been employed with good success, providing an easily accessible, simplified, and personally tailored learning experience. Not only is participation in programs using this method greater, skills acquisition and retention are comparable to that of students enrolled in traditional classroom instruction.

Online or internet-based CPR training shares some of the attributes of video self-instruction (VSI), but its efficacy has not been thoroughly investigated. The researchers in this study evaluated the effectiveness of an online first aid CPR and AED training course by comparing learner performance with that of students in a traditional, instructor-led course.


The study focused on two research questions:

  1. What difference are there in first aid and CPR and AED skills when instruction Is delivered using an online computer-based approach and the traditional instructor-led classroom approach?
  2. Is learner satisfaction differentially associated with the mode of course delivery?

Participants were a convenience sample of 71 volunteer laypersons recruited specifically for this study. Participant ages ranged from 17 to 75 years, with a mean of 42 and a median age of 43 (SD = 13). Female participants totaled 55 per cent. Most (75 per cent) identified themselves as white.  Participants consisted of university faculty and staff, municipal employees, clinic volunteers, and social service employees. Of this sample, 87 per cent reported no recent CPR experience and 77 percent stated they had not had CPR training within the past five years.

Participants self-selected to one of two instructional groups: 25 selected a traditional instructor-led course (TRAD) and 46 selected an online computer-based course (ONLINE). Online learners could opt to complete the course at home, at work, on campus, or in a private area at the same facility where TRAD group instruction took place. Online learners were asked to track the amount of time they spent on computer-based instruction.

Eight instructors (five males, three females) were hired to teach the TRAD course, to staff skills practice opportunities for ONLINE participants, and to conduct skills tests. The male instructors were trained EMTs, while the female instructors were RNs. All had performed CPR in real emergency situations and within the past five years.  The ratio of learners to instructors was 6:1.

Key differences between the two instructional groups were:

  1. how the cognitive portion was taught (classroom lecture and DVD for TRAD and Web-based computer-accessed for ONLINE;
  2. how cognitive knowledge was assessed (instructor administered paper-and-pencil test for TRAD and web-based, computer accessed test for ONLINE); and
  3. how skills were taught (integrated into the classroom content for TRAD and instructor-guided practice after completion of computer-accessed instruction for ONLINE).

Researchers gathered both subjective data (instructor checklists) and objective data (from software linked to resuscitation mannequins) on learner performance. Course satisfaction and learner self-confidence was assessed via a post-instruction survey administered to participants. Skills assessment was monitored by members of the research team.

Findings and Implications

Descriptive statistics were computed on demographic data, instructor checklists, mannequin data, and survey data. Personal characteristics of the two groups were found to be similar, except regarding education. Participants in the online course (94 per cent) had more post-secondary education than those in the traditional course (72 per cent). Participants in the online course self-reported taking one to nine hours to complete the course (median = 3 hours).The researchers did not clearly report the length of the instructor-led course for this study, but did mention that the typical length of  instructor-led classes (eight or more hours) has been a factor in low course enrollment.

Multivariate analysis of variance was used to compare overall outcomes associated with course format. Chi-square was used to evaluate differences in checklist performance, learner satisfaction, and confidence items by class format. All tests used a criterion of p ≤.05.

All learners in both groups passed the first aid skills test. Instructors assessed all participants as having met the criteria for pass in CPR; data obtained from the mannequin software revealed that none of the participants had met objective pass criteria. However, those data indicated that participants in the online course outperformed students in traditional course even though neither passed. There were no differences between groups in terms of satisfaction or confidence in their ability to correctly administer first aid and CPR procedures. The findings suggest that online learning could be used to overcome convenience barriers for learners without compromising performance outcomes.  In addition, online instruction could reduce other factors, such as instructor variability, that could impede learner performance.

Questions for OPWL-N Members

How has online learning been utilized in your workplace? If online learning is as effective as traditional instructor-led learning, would you adopt online learning over instructor-led learning to overcome ‘convenience barriers’ or are there other factors to consider?

Workplace Oriented Research Central (WORC)
Prepared by OPWL Graduate Assistant, Susan Virgilio
Directed by OPWL Professor, Yonnie Chyung
Posted on September 18, 2013