Comparing flipped classroom and lecture-based education on clinical competency in electrocardiogram interpretation among prehospital emergency personnel

Cardiovascular diseases are among the most prevalent health conditions worldwide. One of the fastest methods for assessing cardiac rhythm and electrical activity is the electrocardiogram (ECG). Prehospital emergency personnel are usually the first healthcare providers to encounter cardiac patients outside the hospital setting. Since prehospital interventions performed by emergency medical personnel can influence factors such as ischemic time, clinical competency in ECG interpretation among prehospital providers is vital. Currently, various educational methods are available. One such approach is the flipped (or inverted) classroom model. In contrast, the traditional lecture-based method remains widely used. Lecturing is the most common instructional strategy in which all learners receive the same education regardless of individual differences. With advances in technology and widespread access to modern communication tools, education can increasingly be delivered through these platforms, allowing the utilization of innovative methods such as the flipped classroom in educational settings. This quasi-experimental interventional study with a pretest–posttest design was conducted to compare the effects of flipped classroom and lecture-based educational methods on clinical competency in ECG interpretation among prehospital emergency personnel in Iran in 2025. To compare competency scores before the intervention, two weeks after, and one month after the intervention, independent t-tests were performed. The results showed no statistically significant difference in clinical competency scores between the two groups before the intervention (p = 0.10). However, at the two subsequent time points—two weeks and one month after the intervention—significant differences were observed in the flipped classroom group. Specifically, the mean competency score in this group significantly increased, to 6.84(p = 0.002). two weeks after the intervention, and to 7.73 one month after the intervention. The results demonstrated that clinical competency in ECG interpretation among prehospital emergency personnel in the flipped classroom group was higher than that of the lecture-based group at both two weeks and one month after the intervention. The findings of this study may be useful in designing educational programs aimed at strengthening clinical competency in this group. Furthermore, considering the critical role of ECG interpretation competency in the management of cardiac patients—particularly during the prehospital phase prior to transfer to advanced medical facilities—it is recommended that ECG interpretation training be incorporated into continuing and in-service education programs for prehospital emergency personnel.