Application of the BOPPPS-CBL model in pre-employment training for emergency ancillary staff: a pilot study during the COVID-19 pandemic

Application of the BOPPPS-CBL model in pre-employment training for emergency ancillary staff: a pilot study during the COVID-19 pandemic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Application of the BOPPPS-CBL model in pre-employment training for emergency ancillary staff: a pilot study during the COVID-19 pandemic Pingeng Wu, Yun Yang, Lin Yang, Siyi Qin, Binda Han, Zheng Hou, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8400931/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Our emergency response team needed to quickly train newly recruited stretcher bearers and ambulance drivers to join the workforce during the COVID-19 pandemic. In our country, the absence of standardized pre-employment training programs for them has created an urgent need to develop an effective training method. We evaluated the efficacy of the bridge-in, objective, pre-assessment, participatory learning, post-assessment, and summary model combined with case-based learning (BOPPPS -CBL) and traditional lecture-based learning (LBL) by comparing the theoretical knowledge scores, operational skill scores, and satisfaction levels between the two training sessions in April 2022 and January 2023, which were designated as the LBL group and the BOPPPS-CBL group, respectively. Statistical comparisons confirmed BOPPPS-CBL enhanced theoretical knowledge and fostered competencies including problem-solving, analytical thinking, teamwork, confidence in handling unfamiliar problems, and written communication skills for stretcher bearers and ambulance drivers. It sharpened learning objective clarity and reduced cognitive load. For operational skill acquisition, it is no worse than LBL. Health sciences/Health care Health sciences/Health occupations Biological sciences/Psychology Social science/Psychology BOPPPS model Case-based learning Stretcher bearer Ambulance driver Pre-employment training Prehospital emergency care Figures Figure 1 Introduction Emergency medical services (EMS), as a vital part of modern health care systems, plays a critical role in enhancing clinical outcomes and survival rates ( 1 ). The principles of Chinese EMS have been adapted from foreign models referred to as Emergency Medical Services Systems (EMSS), introduced by the Chinese Association for Emergency Medicine, which includes out-of-hospital EMS, hospital EMS, and intensive care units ( 2 ). Out-of-hospital EMS provides prehospital emergency care and critical patient transportation in the case of medical emergent events ( 3 ). With the aging of Chinese population, the demand for out-of-hospital EMS is progressively increasing leading to a growing staff shortage. Therefore, the scarcity and uneven distribution of EMS resources persist as a societal challenge with an urgent need for optimized usage of resources ( 4 ). In most cities of China, the task of out-of-hospital EMS is typically carried out by a team comprising medical professionals including doctors and nurses, as well as emergency ancillary staff consisting of stretcher bearers and ambulance drivers. Evidence pointed out that the ancillary staff of the hospital trained to perform patient care tasks historically assigned to emergency nurses could alleviate the mounting pressure on them ( 5 ). The first-aid knowledge and skill training for stretcher bearers was helpful to improve the cooperation ability of the team and the efficiency of out-of-hospital EMS ( 6 ). However, emergency ancillary staff typically have limited medical education and practical skills. Consequently, we believed that the targeted pre-employment training curricula about EMS enabled rapid skill acquisition and optimizing workforce readiness. The lecture-based learning (LBL) approach is often used in the traditional pre-employment training for prehospital emergency care ( 7 ). Characterized by its teacher-centered framework and learner-passive orientation, LBL adopts an instructional paradigm of didactic knowledge transmission through full-process lecturing ( 8 ). LBL often lacks classroom interaction, causing students to find the content monotonous and lack motivation to learn ( 9 , 10 ). The BOPPPS model was initially developed by Douglas Kerr at the University of British Columbia, Canada, comprising six essential components: bridge-in (B), objective (O), pre-assessment (P), participatory learning (P), post-assessment (P), and summary (S) ( 11 ). Empirical studies suggest that BOPPPS, a learner-centered pedagogical framework, demonstrates significant potential for enhancing various dimensions of clinical and health education, including academic performance, student engagement, and satisfaction ( 12 ). Case-based learning (CBL), developed at Harvard University in the 20th century, improves learning by using cases to help students apply theory to practice, strengthening problem-solving, critical thinking, and knowledge transfer ( 13 ). In recent years, combining BOPPPS with CBL (BOPPPS-CBL) has proven effective in medical education, but rarely been applied in pre-employment training ( 14 – 17 ). This study is a preliminary investigation into the effectiveness of the BOPPPS-CBL model on pre-employment training for the stretcher bearers and ambulance drivers engaged in prehospital emergency care. Methods Participants The participants comprised 96 newly recruited ancillary staff (stretcher bearers and ambulance drivers) of the prehospital emergency department at Dandong Central Hospital, recruited through two separate recruitment rounds in April 2022 and January 2023. All the applicants were male. The inclusion criteria included (i) no medical education background; (ii) no experience in emergency work or emergency-related training programs; and(iii) voluntary agreement to undergo the training. The exclusion criteria included withdrawal midway from the training. A total of 84 participants met the conditions and were enrolled in this study (Table1). The 44 persons from the 2022 cohort served as the control group and received the teaching mode of LBL (LBL group). The 40 persons from the 2023 cohort served as the experimental group and received the teaching method of BOPPPS combined with CBL (BOPPPS-CBL group). Ethical approval This study was conducted in accordance with the Helsinki Declaration. Informed consent was obtained from all participants. The experimental protocol was approved by the Institutional Review Board of Dandong Central Hospital. It complied with the “Ethical Review Measures for Life Sciences and Medical Research Involving Human Beings” (Order No. 4 of the National Health Commission, Ministry of Education, Ministry of Science and Technology, State Administration of Traditional Chinese Medicine, China, 2023). Design The research was a non-randomized control trial. The training session encompassed 6 class hours (12 hours) in two days for each group. The training material was the “Chinese Prehospital Emergency Care Management Regulations ” and the “International First Aid, Resuscitation, And Education Guidelines 2020 ”. The training content covered some basic theoretical knowledge and operational skills about emergency and disaster medicine. The instructor cohort was comprised of eleven seasoned staff members with domain-specific expertise, including two doctors, three nurses, one ambulance driver, four stretcher bearers, and one administrator. To control for variability, both groups were exposed to identical instructional content, instructors and assessment protocols. The flowchart is as shown in Figure 1. LBL group The participants were explained the theoretical knowledge using slides and videos. They listened and took notes. Then, the instructors demonstrated the operational skills for them, and they practiced in turns. A post-assessment was administered to measure knowledge retention and skill acquisition outcomes as described below. BOPPPS-CPBL group We developed a case-based tutorial . Five typical scenario-based cases encountered in our work were selected (Table2). These cases were narrated as stories following the process of receiving a distress call, preparing equipment, proceeding to the scene, providing on-site first aid, and transporting to the hospital. Each case had learning objectives and questions without answers. We chose the case of traffic accident as an example to demonstrate the teaching approach. Bridge-in: One day prior to the training, the case-based tutorial was distributed to the participants. They were encouraged to engage in self-directed learning based on the questions and learning objectives. They searched online for texts, images, and videos about the management regulations of prehospital emergency care and treatment of trauma, such as bandaging and hemostasis of the wound. Through resource exploration, they developed a general understanding of the case. The materials were saved for classroom discussions. Objectives : At the onset of the training, the instructors emphasized the learning objectives again. Through this case, the participants were required to acquire proficiency in the Chinese management regulations of prehospital emergency care, standard first aid procedures, patient assessment, treatment of trauma, and ensuring order at the first aid scene. Pre-assessment : Conducted classroom questioning to evaluate the effectiveness of the participants ' self-directed learning to guide follow-up teaching. Participatory Learning : As the central element of BOPPPS, participatory learning constituted the pivotal interface enabling the convergence of CBL and BOPPPS. The participants were divided into five teams of eight members randomly. Participatory learning was structured through question-guided discussions in the following five parts, receiving a distress call, preparing equipment, proceeding to the scene, providing on-site first aid, and transporting to the hospital (Part1-5). Following the questions of the tutorial, each team was facilitated by two instructors through group discussions within strict time constraints. After a segment concluded, the instructors displayed key answers via slides or video demonstrations. For skill-based components, the instructors demonstrated procedures first, followed by trainee practicing. Part1 The trainees were required to master institutional guidelines and statutory requirements about prehospital emergency care. When there was an emergency rescue mission, the EMS dispatch center electronically distributed the mission to the emergency team. They need ed to learn how to accept the order via computer and identify critical details such as the accident location, number of casualties, and injury severity. Part2 The trainees must learn to identify medical equipment and medications in the ambulances. For example, stretcher-bearers studied the management of oxygen delivery systems, while drivers practiced operating vehicle alarm systems. Part3 The trainees were required to master telephone communication skills with callers, methods to use the navigation system, and techniques to clear obstacles on the emergency passage. Part4 The trainees need ed to acquire proficiency in primary trauma triage and competency in hemorrhage control, bandaging wounds, and transporting patients safely. Part5 The trainees learned the methods of psychological first aid for trauma victims and handing over tasks to hospital staff upon arrival at the medical facility. Post-assessment : Upon completion of all case analyses, a theoretical test consisting of 50 multiple-choice and 20 fill-in-the-blank questions with 1 point for each one and 5 short answer questions with 6 points for each one were taken to pinpoint how well the trainees had mastered the knowledge and skills. Summary : A representative was designated by each team to present case-specific highlights, with one case allocated per presenter. The instructor augmented the summaries and delivered a synthesized conclusion. Evaluation After the training, all the participants were required to anonymously complete a questionnaire. The questionnaire was a simplified version of the course evaluation questionnaire (CEQ) (18). The Cronbach’s coefficient α of the scale was 0.951 indicating good reliability. The 5-Point Likert Scale ranging from a score of 1 for strong disagreement to a score of 5 for strong agreement was used to evaluate the participants’ perspectives of the courses. Statistical analysis Data analysis was performed using SPSS statistics software (version 29.0, IBM Corp., Armonk, NY, USA). The Shapiro-Wilk normality test was used to assess continuous variables . Continuous variables with normal distribution were expressed as mean ± standard deviation, conducted using the t-test. Non-normally distributed variables were expressed as median and 25 – 75% interquartile range, analyzed with the Mann–Whitney U test. Categorical variables were presented as counts (%) and analyzed using the chi-square test. Statistical significance was set at p< 0.05(two-tailed). Results Demographic information of participants Upon comparison of the factors such as age, education level, and job position, there was no significant difference in general data between the two groups (p > 0.05) (Table1). Comparison of theoretical and practical test scores The total theoretical scores of the BOPPPS-CBL group were significantly higher than those of the LBL group ( 81.70 ± 6.36 vs. 76.09 ± 7.51, p< 0.01 ) . The BOPPPS-CBL group outperformed the LBL group in multiple-choice ( 44.78 ± 3.27 vs. 42.70 ± 4.09, p<0.05 ) , fill-in-the-blank ( 14.68 ± 3.25 vs. 12.75 ± 2.71, p<0.01 ) , and short-answer questions ( 22.25 ± 1.81 vs. 20.64 ± 2.36, p<0.01) (Table3). There was no significant difference in overall skill scores between the two groups [39.8(38.0 - 41.3) vs. 40.0(37.6 - 42.4), p=0.475] . Compared with the LBL model, the BOPPPS-CBL model failed to demonstrate significant improvement in cardiopulmonary resuscitation (CPR) [7.3(6.5 - 8.0) vs. 7.5(6.5 - 8.4), p=0.655] , hemostasis [8.0(7.5 - 8.5) vs. 8.5(8.0 - 9.0), p=0.055] , bandaging [8.0(7.5 - 8.5) vs. 8.0(7.5 - 8.9), p=0.813] , limb immobilization [8.0(7.5 - 9.0) vs. 8.0(7.5 - 8.5), p=0.179] , and patient transfer [8.0(7.5 - 8.5) vs. 8.0(7.5 - 8.5), p=0.367] (Table4). Comparison of training evaluation questionnaire All participants (n=84) successfully completed the CEQ (100% response rate). The CEQ consisted of five scales, good teaching, generic skills, clear goals and standard, appropriate workload, and overall satisfaction. There was no statistically significant difference in ratings between the BOPPPS-CBL and LBL groups for the following three items in good teaching: "the instructors of this course motivated me to do my best work" [4(4 - 4) vs. 4(4 - 4), p=0.118] , "the instructors spent a lot of time evaluating my learning" [4(4 - 4) vs. 4(4 - 4), p=0.086], "the instructors were extremely good at explaining things in this training" [4(4 - 5) vs. 4(4 - 5), p=0.282]. For all other items besides these three, the BOPPPS-CBL group scored significantly higher than the LBL group (p < 0.05). For trainee satisfaction scores in each dimension, see Table 5. Discussion COVID-19 began spreading through our city in early 2022, resulting in significant pressure on health care capacity. Our municipality was experiencing severe population aging, accompanied by a high prevalence of chronic conditions among the elderly demographic. The COVID-19 pandemic aggravated chronic diseases in geriatric patients, overwhelming EMS and creating severe staffing deficits in prehospital emergency care service. Therefore, there was an urgent need to recruit additional health care workers, including stretcher bearers and ambulance drivers. During emergency medical operations, stretcher bearers and ambulance drivers were required to assist medical personnel with ancillary tasks beyond their primary duties of vehicle operation and patient transport, necessitating fundamental emergency care knowledge and technical competencies. However, the vast majority of them lack ed prior emergency experience. To enable them to quickly become competent in their new roles, short-term intensive training programs must be implemented. We reviewed the medical teaching methodologies that had garnered significant attention in recent years, with the CBL and the BOPPPS models particularly capturing our interest. CBL is an active learning approach centered on clinical cases that has been widely employed by medical schools internationally (16). CBL is particularly effective for small-group learning where students acquire new concepts and information by analyzing clinical cases. The benefits include acquisition of knowledge, improvement in social and communication skills, enhancement of problem-solving capabilities, and development of self-directed learning techniques (19,20). The BOPPPS model constitutes an evidence-based instructional design approach aimed at maximizing both teaching effectiveness and learner engagement (12). It disrupts conventional education paradigms by prioritizing learner-centered design. It emphasizes integrating new concepts with prior knowledge through active learning and contextualized environments to enhance comprehension and retention. In this learning paradigm, the role of instructors shifts from knowledge provider to facilitator, fostering critical thinking and practical application skills (21,22). The synergistic integration of BOPPPS' structured lesson design and CBL's clinical reasoning framework shows untapped potential for competency-based training programs outside traditional medical curricula, particularly in layperson emergency response education. During the preparation phase, we meticulously developed training materials and slides to ensure both groups received identical core content. The cases used for the BOPPPS-CBL group were authentic and clinically representative. The LBL group received all instructional content in a centralized classroom environment. The BOPPPS-CBL group completed the Bridge-in, Objectives, Pre-assessment, Post-assessment, and Summary components of the BOPPPS model in a centralized format. During the participatory learning phase, the BOPPPS-CBL group was divided across five separate classrooms for case-based discussions, with each classroom focusing on distinct clinical scenarios. The classrooms were minimally adapted to simulate emergency care environments and equipped with skill-training materials according to their respective case scenarios. Additionally, we prepared two ambulances of different models outdoors for training. The theoretical test comprised three question types: multiple-choice questions, fill-in-the-blank questions, and short answer questions. Foundational knowledge was primarily assessed through multiple-choice , fill-in-the-blank items, and short-answer questions, while comprehensive competencies including clinical reasoning, communication skills, and expressive abilities were also evaluated by short-answer questions. The BOPPPS-CBL group demonstrated significantly higher scores than the LBL group in both total scores and individual question type categories, with statistically significant differences. This suggested that knowledge mastery was significantly stronger among the BOPPPS-CBL group learners. This enhanced learning outcome might be attributed to the more engaging case-based and simulated scenario teaching format, which effectively stimulated active learning motivation and substantially improved learning efficiency. The BOPPPS model employed a stepwise approach that not only enhanced active learner engagement but also facilitated iterative knowledge reinforcement. Furthermore, independent thinking and knowledge application skills were cultivated by the instructors during discussion sessions. The skills training programs included CPR, hemostasis, bandaging, limb immobilization and patient transfer. No statistically significant difference was observed in skill assessment scores between the BOPPPS-CBL and LBL groups. This outcome might be attributed to the limited scope of skills, which were likely to reach proficiency thresholds within the brief training period. The CEQ, a validated medical education tool, systematically connects student evaluations to teaching improvements through student-centric curriculum refinement (23). In " generic skills" of the questionnaire, the BOPPPS-CBL group participants were more likely to believe that the training improved their problem-solving skills, analytical abilities, teamwork skills, confidence in tackling unfamiliar problems, and written communication skills. In " clear goals and standard, they also agreed more strongly that the BOPPPS-CBL model provided clear learning objectives, making it easier to grasp key points. Additionally, they were more inclined to perceive the training as stress-free and without undue burden, in “appropriate workload”. In “good teaching”, no statistically significant differences were observed between the two groups in their ratings of the three items. We hypothesized that this might be because the instructors in both groups encouraged the trainees to perform their best during the training. The instructors consistently engaged with students by asking questions while teaching or interacting, aiming to assess their grasp of learning. All instructors were fully prepared for the course delivery and extremely good at explaining things in this training. The limitations of this study include the following points. First, the training was re latively short in duration and covered basic content. If time permits, extending the duration and expanding the content could enhance the depth of the training. For example, adding more operational elements. To compensate for this shortcoming, advanced training can be conducted by combining other effective teaching methods and equipment, after the emergency ancillary staff have worked for a period of time. Second, due to objective constraints, this study was designed as a non-randomized controlled trial. Future randomized controlled trials are recommended to confirm these results. Third, the current study involved a relatively small sample size. Future research could include a larger participant pool to enhance generalizability. Conclusion This study pioneers the application of the BOPPPS-CBL hybrid instructional model in the pre-employment training for stretcher bearers and ambulance drivers. Compared to LBL, BOPPPS-CBL significantly enhanced stretcher-bearers' and drivers' theoretical knowledge and fostered critical competencies including problem-solving, analytical thinking, teamwork, confidence in handling unfamiliar problems, and written communication skills. The structured approach significantly sharpened learning objective clarity and reduced cognitive load. BOPPPS-CBL is no worse than LBL for operational skill acquisition. These findings provide an evidence-based framework for pre-employment trainings of non-clinical EMS personnel and demonstrate transferability to first responder training programs. Declarations Author contribution ： Conception and design: PGW, YY, WLM; data collection: LY, BDH; data analysis: YY, SIQ; project administration: ZH, WLM; manuscript writing: PGW, YY, WLM. Funding: This work was supported by the Philosophy and Social Sciences Project of Dandong (2024DDSK077). Acknowledgments: The authors would like to thank Jiongdi Luan and Han Sun with the medical education department for their help in this study. Data availability: Our research involves in the personal identity information. If the data sets analyzed during the study are publicly available, there is a risk of revealing personal privacy. 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Baseline characteristics of the participants (n=84) LBL group (n=44) BOPPPS-CBL group (n=40) t/χ2 p-Value Age, years, (mean ±SD) 35.89 ±5.11 36.25 ±4.76 -0.336 0.737 Education level, n (%) 1.015 0.602 Meddle school 13（29.5） 10（25.0） High school 21（47.8） 17（42.5） Junior college 10（22.7） 13（32.5） Job position, n (%) 0.012 0.914 Stretcher bear 28（63.6） 25（62.5） Ambulance driver 16（36.4） 15（37.5） SD: standard deviation Table2. The key information of the cases. Item Scenes Patients Symptoms Inducing factors Key learning points 1 A traffic accident involving a collision between a bus and a taxi. Male, 70 years old, bus passenger Female, 67 years old, bus passenger Male, 28 years old, taxi passenger Male, 46 years old, taxi driver Low back pain Left thigh pain Facial hemorrhage Chest and neck pain Accidental fall Accidental fall Broken glass Seatbelt Sudden braking Trauma 2 A family suffered toxic gas exposure. Female, 62 years old, healthy person Male, 63 years old, COVID-19 patient Dizziness Coma Carbon Carbon COVID-19 Toxic gas poisoning Respiratory infectious disease Neurological diseases 3 A group of young people went on an outing to the countryside. Female, 22 years old, college student Female, 21 years old, college student Apnea Thirst and palpitations Slipping from the riverbank High temperature Humidity Drowning Heat stroke Cardiovascular diseases 4 An out-of-town tourist couple were in the hotel after dining with friends. Male, 38 years old, husband Female, 37 years old, wife/pregnant woman Vomiting and coma Abdominal pain and diarrhea Excess alcohol Contaminated food Alcoholism Acute food poisoning Digestive diseases 5 An electric wheelchair caught fire in a nursing home. Female, 79 years old, resident Female, 82 years old, resident Dyspnea Cough and skin burn Harmful gases Harmful gases Burning electric blanket Inhalation injury Burn injury Respiratory diseases Table3. Comparison of theoretical test scores. Score weights LBL group (n=44) BOPPPS-CBL group (n=40) t p-Value Multiple choice 50 42.70 ± 4.09 44.78 ± 3.27 -2.546 0.013 Fill-in-the-blank 20 12.75 ± 2.71 14.68 ± 3.25 -2.959 0.004 Short answer 30 20.64 ± 2.36 22.25 ± 1.81 -3.488 0.000 Total score 100 76.09 ± 7.51 81.70 ± 6.36 -3.673 0.000 Table4. Comparison of operational test scores. Score weights LBL group (n=44) BOPPPS-CBL group (n=40) Z p- Value Cardiopulmonary resuscitation 10 7.5 (6.5-8.4) 7.3 (6.5-8.0) -0.447 0.655 Hemostasis 10 8.5 (8.0-9.0) 8.0 (7.5-8.5) -1.921 0.055 Bandaging 10 8.0 (7.5-8.9) 8.0 (7.5-8.5) -0.237 0.813 Limb immobilization 10 8.0 (7.5-8.5) 8.0 (7.5-9.0) -1.344 0.179 Patient transfer 10 8.0 (7.5-8.5) 8.0 (7.5-8.5) -0.903 0.367 Total score 50 40.0 (37.6-42.4) 39.8 (38.0-41.3) -0.714 0.475 Table5. Training course experience questionnaire. Questions Scales LBL group (n=44) BOPPPS-CBL group (n=40) Z p-Value The instructors of this course motivated me to do my best work. Good teaching 4 (4-4) 4 (4-4) -1.563 0.118 The instructors spent a lot of time evaluating my learning. Good teaching 4 (4-4) 4 (4-4) -1.714 0.086 The instructors always made effort to understand the difficulties I might encounter in my learning. Good teaching 4 (4-4) 4 (4-5) -3.633 ＜0.001 The instructors usually gave me helpful feedback during the learning process. Good teaching 4 (4-4) 4 (4-5) -3.043 0.002 The instructors were extremely good at explaining things in this training. Good teaching 4 (4-5) 4 (4-5) -1.076 0.282 The instructors worked hard to make the training content enjoyable. Good teaching 4 (4-4) 4.5 (4-5) -4.216 ＜0.001 This training sharpened my problem-solving skills. Generic skills 4(4-4) 5(5-5) -6.580 ＜0.001 This training honed my analytical skills. Generic skills 4(4-4) 5(5-5) -6.993 ＜0.001 This training enhanced my teamwork skills. Generic skills 4(4-4) 5(5-5) -6.567 ＜0.001 This training gave me the assurance to handle unfamiliar problems. Generic skills 4(4-4) 5(5-5) -6.111 ＜0.001 This training has improved my written communication skills. Generic skills 4(4-4) 5(5-5) -6.287 ＜0.001 This training helped me to develop the ability to plan my own work. Generic skills 4(4-4) 5(5-5) -6.327 ＜0.001 The training standards were clear and straightforward. Clear Goals and Standard 4(4-4) 5(5-5) -7.288 ＜0.001 The training expectations and goals were perfectly clear to me. Clear Goals and Standard 4(3.25-4) 5(5-5) -7.072 ＜0.001 It was easy to understand this training 's requirements. Clear Goals and Standard 4(4-4) 5(5-5) -7.467 ＜0.001 Right from the start, the instructors made it clear what they expected from us. Clear Goals and Standard 4(4-4) 5(5-5) -7.276 ＜0.001 This training didn't have an overwhelming amount of work. Appropriate Workload 3(3-3) 5(5-5) -8.463 ＜0.001 The instructors usually gave me enough time to grasp what I need to learn. Appropriate Workload 3(3-3) 5(5-5) -8.513 ＜0.001 I didn't feel much pressure to excel in this course. Appropriate Workload 3(3-3) 5(5-5) -8.513 ＜0.001 The workload in this course was quite manageable, which meant I could fully grasp all the content. Appropriate Workload 3(3-3) 5(5-5) -8.620 ＜0.001 Overall, I was satisfied with the quality of this training. Overall Satisfaction 4(4-4) 5(4.25-5) -5.989 ＜0.001 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 23 Apr, 2026 Reviews received at journal 09 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers invited by journal 28 Jan, 2026 Editor assigned by journal 02 Jan, 2026 Submission checks completed at journal 29 Dec, 2025 First submitted to journal 29 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8400931","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":582349594,"identity":"21ddfd81-7de8-4bf4-abff-a264a55e90e3","order_by":0,"name":"Pingeng Wu","email":"","orcid":"","institution":"Dandong Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pingeng","middleName":"","lastName":"Wu","suffix":""},{"id":582349597,"identity":"318e7ecd-f84d-4a43-a798-6627f0ca374f","order_by":1,"name":"Yun Yang","email":"","orcid":"","institution":"Dandong Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yun","middleName":"","lastName":"Yang","suffix":""},{"id":582349602,"identity":"d2ed9325-00a6-4514-bf8d-fc65e6d9affe","order_by":2,"name":"Lin Yang","email":"","orcid":"","institution":"Dandong Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Yang","suffix":""},{"id":582349604,"identity":"bb4f0671-6748-44a0-b776-f871c57e78e7","order_by":3,"name":"Siyi Qin","email":"","orcid":"","institution":"The Second Affiliated Hospital of Qiqihar Medical University","correspondingAuthor":false,"prefix":"","firstName":"Siyi","middleName":"","lastName":"Qin","suffix":""},{"id":582349607,"identity":"8e4ad974-c348-4fb4-9516-b3ce69d825e4","order_by":4,"name":"Binda Han","email":"","orcid":"","institution":"Dandong Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Binda","middleName":"","lastName":"Han","suffix":""},{"id":582349608,"identity":"96068ca7-780a-4990-b30c-a3f8a88af90c","order_by":5,"name":"Zheng Hou","email":"","orcid":"","institution":"Dandong Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zheng","middleName":"","lastName":"Hou","suffix":""},{"id":582349609,"identity":"de9c7e04-9b5f-43c7-89b2-6625327d44dc","order_by":6,"name":"Weili Miao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYDCCAwlgioefmfnAgQ8VJGiRkWxvSzw44wwJWmwMzpwxPszbQoQOvuPpjz/zth3mYbiR8+EAbwODPL/YAfxaJM+8MTCcCdTCOCN3wwHJHQyGM2cn4NdicCOHIeEjUAuzBFCL4RmGBIPbBLWkPziQCNTCJpEDYhClJcGwAWQLD88ZhgMHidEC9Isx44xz6TwS7G0GBxvOSBD2CzjEeMqs7e0PMz/+/KfCRp5fmoAWMGBka4YxJYhQDgZ/6ohVOQpGwSgYBSMRAACugU9tCt5gtwAAAABJRU5ErkJggg==","orcid":"","institution":"Dandong Central Hospital","correspondingAuthor":true,"prefix":"","firstName":"Weili","middleName":"","lastName":"Miao","suffix":""}],"badges":[],"createdAt":"2025-12-19 05:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8400931/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8400931/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101497972,"identity":"b8675d6e-5eb3-4186-9bee-74fdfc8f186f","added_by":"auto","created_at":"2026-01-30 12:59:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45318,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of training design of the BOPPPS-CBL and LBL group\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8400931/v1/b3ef1b126cabf9276f089903.png"},{"id":101880819,"identity":"6b62d95d-d94a-46ff-b7a2-7929875360ce","added_by":"auto","created_at":"2026-02-04 15:06:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":721229,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8400931/v1/115b993c-ee9f-42b8-9095-f8519aff2bb1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application of the BOPPPS-CBL model in pre-employment training for emergency ancillary staff: a pilot study during the COVID-19 pandemic","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cem\u003eEmergency medical services (EMS), as a vital part of modern health care systems, plays a critical role in enhancing clinical outcomes and survival rates\u003c/em\u003e (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). \u003cem\u003eThe principles of Chinese EMS have been adapted from foreign models referred to as Emergency Medical Services Systems (EMSS), introduced by the Chinese Association for Emergency Medicine, which includes out-of-hospital EMS, hospital EMS, and intensive care units\u003c/em\u003e (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). \u003cem\u003eOut-of-hospital EMS provides prehospital emergency care and critical patient transportation in the case of medical emergent events\u003c/em\u003e (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). \u003cem\u003eWith the aging of Chinese population, the demand for out-of-hospital EMS is progressively increasing leading to a growing staff shortage. Therefore, the scarcity and uneven distribution of EMS resources persist as a societal challenge with an urgent need for optimized usage of resources\u003c/em\u003e (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eIn most cities of China, the task of out-of-hospital EMS is typically carried out by a team comprising medical professionals including doctors and nurses, as well as emergency ancillary staff consisting of stretcher bearers and ambulance drivers. Evidence pointed out that the ancillary staff of the hospital trained to perform patient care tasks historically assigned to emergency nurses could alleviate the mounting pressure on them\u003c/em\u003e (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). \u003cem\u003eThe first-aid knowledge and skill training for stretcher bearers was helpful to improve the cooperation ability of the team and the efficiency of out-of-hospital EMS\u003c/em\u003e (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). \u003cem\u003eHowever, emergency ancillary staff typically have limited medical education and practical skills. Consequently, we believed that the targeted pre-employment training curricula about EMS enabled rapid skill acquisition and optimizing workforce readiness.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe lecture-based learning (LBL) approach is often used in the traditional pre-employment training for prehospital emergency care\u003c/em\u003e (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). \u003cem\u003eCharacterized by its teacher-centered framework and learner-passive orientation, LBL adopts an instructional paradigm of didactic knowledge transmission through full-process lecturing\u003c/em\u003e (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). \u003cem\u003eLBL often lacks classroom interaction, causing students to find the content monotonous and lack motivation to learn\u003c/em\u003e (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003cem\u003eThe BOPPPS model was initially developed by Douglas Kerr at the University of British Columbia, Canada, comprising six essential components: bridge-in (B), objective (O), pre-assessment (P), participatory learning (P), post-assessment (P), and summary (S)\u003c/em\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). \u003cem\u003eEmpirical studies suggest that BOPPPS, a learner-centered pedagogical framework, demonstrates significant potential for enhancing various dimensions of clinical and health education, including academic performance, student engagement, and satisfaction\u003c/em\u003e (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). \u003cem\u003eCase-based learning (CBL), developed at Harvard University in the 20th century, improves learning by using cases to help students apply theory to practice, strengthening problem-solving, critical thinking, and knowledge transfer\u003c/em\u003e (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). \u003cem\u003eIn recent years, combining BOPPPS with CBL (BOPPPS-CBL) has proven effective in medical education, but rarely been applied in pre-employment training\u003c/em\u003e (\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). \u003cem\u003eThis study is a preliminary investigation into the effectiveness of the BOPPPS-CBL model on pre-employment training for the stretcher bearers and ambulance drivers engaged in prehospital emergency care.\u003c/em\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eParticipants\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe\u0026nbsp;\u003c/em\u003e\u003cem\u003eparticipants\u003c/em\u003e\u003cem\u003e\u0026nbsp;comprised 96 newly recruited ancillary staff (stretcher bearers and ambulance drivers)\u0026nbsp;of the prehospital emergency department at Dandong Central Hospital, recruited through two separate recruitment rounds in April 2022 and January 2023.\u0026nbsp;\u003c/em\u003e\u003cem\u003eAll\u0026nbsp;\u003c/em\u003e\u003cem\u003ethe\u0026nbsp;\u003c/em\u003e\u003cem\u003eapplicants\u0026nbsp;\u003c/em\u003e\u003cem\u003ewere\u003c/em\u003e\u003cem\u003e\u0026nbsp;male.\u003c/em\u003e\u003cem\u003eThe inclusion criteria\u0026nbsp;included (i) no medical education background; (ii) no experience in emergency work or emergency-related training programs; and(iii) voluntary agreement to undergo the training. The exclusion criteria included withdrawal midway from the training. A total of 84 participants met the conditions and were enrolled in this study (Table1).\u0026nbsp;\u003c/em\u003e\u003cem\u003eThe 44 persons from the 2022 cohort served as the control group and received the teaching mode of LBL (LBL group). The 40 persons from the 2023 cohort served as the experimental group and received the teaching method of BOPPPS combined with CBL (BOPPPS-CBL group).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical approval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThis study was conducted in accordance with the Helsinki Declaration. Informed consent was obtained from all participants. The experimental protocol was approved by the Institutional Review Board of Dandong Central Hospital. It complied with the “Ethical Review Measures for Life Sciences and Medical Research Involving Human Beings” (Order No. 4 of the National Health Commission, Ministry of Education, Ministry of Science and Technology, State Administration of Traditional Chinese Medicine, China, 2023).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDesign\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe research was a non-randomized control trial. The training session\u0026nbsp;encompassed 6 class hours (12 hours) in two days for each group. The training material was the “Chinese Prehospital Emergency Care Management Regulations\u003c/em\u003e\u003cem\u003e”\u003c/em\u003e\u003cem\u003e\u0026nbsp;and the “International First Aid, Resuscitation, And Education Guidelines 2020\u003c/em\u003e\u003cem\u003e”. The training content covered some basic theoretical knowledge and operational skills about emergency and disaster medicine. The instructor cohort was comprised of eleven seasoned staff members with domain-specific expertise, including two doctors, three nurses, one ambulance driver, four stretcher bearers, and one administrator. To control for variability, both groups were exposed to identical instructional content, instructors and assessment protocols. The flowchart is as shown in Figure 1.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLBL group\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe participants were explained the theoretical knowledge using slides and videos. They listened and took notes. Then, the instructors demonstrated the operational skills for them, and they practiced in turns. A post-assessment was administered to measure knowledge retention and skill acquisition outcomes as described below.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBOPPPS-CPBL group\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWe developed a case-based\u0026nbsp;\u003c/em\u003e\u003cem\u003etutorial\u003c/em\u003e\u003cem\u003e. Five typical scenario-based cases encountered in our work were selected (Table2). These cases were narrated as stories following the process of receiving a distress call, preparing equipment, proceeding to the scene, providing on-site first aid, and transporting to the hospital. Each case had learning objectives and questions without answers. We chose the case of traffic accident as an example to demonstrate the teaching approach.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBridge-in: One day prior to the training, the case-based tutorial was distributed to the participants. They were encouraged to engage in self-directed learning based on the questions and learning objectives. They searched online for texts, images, and videos about the management regulations of prehospital emergency care and treatment of trauma, such as bandaging and hemostasis of the wound. Through resource exploration, they developed a general understanding of the case. The materials were saved for classroom discussions.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eObjectives\u003c/em\u003e\u003cem\u003e: At the onset of the training, the instructors emphasized the learning objectives again. Through this case, the participants were required to acquire proficiency in the Chinese management regulations of prehospital emergency care, standard first aid procedures, patient assessment, treatment of trauma, and ensuring order at the first aid scene.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePre-assessment\u003c/em\u003e\u003cem\u003e: Conducted classroom questioning to evaluate the effectiveness of the participants ' self-directed learning to guide follow-up teaching.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipatory Learning\u003c/em\u003e\u003cem\u003e: As the central element of BOPPPS, participatory learning constituted the pivotal interface enabling the convergence of CBL and BOPPPS.\u0026nbsp;The participants were divided into five teams of eight members randomly. Participatory learning was structured through question-guided discussions in the following five parts, receiving a distress call, preparing equipment, proceeding to the scene, providing on-site first aid, and transporting to the hospital (Part1-5). Following the questions of the tutorial, each team was facilitated by two instructors through group discussions within strict time constraints. After a segment concluded, the instructors displayed key answers via slides or video demonstrations. For skill-based components, the instructors demonstrated procedures first, followed by trainee practicing.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Part1 The trainees were required to master institutional guidelines and statutory requirements about prehospital emergency care. When there was an emergency rescue mission, the EMS dispatch center electronically distributed the mission to the emergency team. They need\u003c/em\u003e\u003cem\u003eed\u003c/em\u003e\u003cem\u003e\u0026nbsp;to learn how to accept the order via computer and identify critical details such as the accident location, number of casualties, and injury severity.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePart2 The trainees must learn to identify medical equipment and medications in the ambulances. For example, stretcher-bearers studied the management of oxygen delivery systems, while drivers practiced operating vehicle alarm systems.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePart3 The trainees were required to master telephone communication skills with callers, methods to use the navigation system, and techniques to clear obstacles on the emergency passage.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePart4\u0026nbsp;\u003c/em\u003e\u003cem\u003eThe trainees\u003c/em\u003e\u003cem\u003e\u0026nbsp;need\u003c/em\u003e\u003cem\u003eed\u003c/em\u003e\u003cem\u003e\u0026nbsp;to acquire proficiency in primary trauma triage and competency in hemorrhage control, bandaging wounds, and transporting patients safely.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePart5 The trainees learned the methods of psychological first aid for trauma victims and handing over tasks to hospital staff upon arrival at the medical facility. \u0026nbsp; \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePost-assessment\u003c/em\u003e\u003cem\u003e: Upon completion of all case analyses, a theoretical test consisting of 50 multiple-choice and 20 fill-in-the-blank questions with 1 point for each one and 5 short answer questions with 6 points for each one were taken to pinpoint how well the trainees had mastered the knowledge and skills.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSummary\u003c/em\u003e\u003cem\u003e:\u0026nbsp;A representative was designated by each team to present case-specific highlights, with one case allocated per presenter.\u0026nbsp;The instructor augmented the summaries and delivered a synthesized conclusion.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEvaluation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAfter the training,\u0026nbsp;\u003c/em\u003e\u003cem\u003eall the participants were required to anonymously complete a questionnaire. The questionnaire was a simplified version of the\u003c/em\u003e\u003cem\u003ecourse evaluation questionnaire\u003c/em\u003e\u003cem\u003e(CEQ) (18). The Cronbach’s coefficient α of the scale was 0.951 indicating good reliability. The 5-Point Likert Scale ranging from a score of 1 for strong disagreement to a score of 5 for strong agreement was used to evaluate the participants’ perspectives of the courses.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData analysis was performed using SPSS statistics software (version 29.0, IBM Corp., Armonk, NY, USA). The Shapiro-Wilk normality test was used to\u0026nbsp;\u003c/em\u003e\u003cem\u003eassess continuous variables\u003c/em\u003e\u003cem\u003e. Continuous variables with normal distribution were expressed as mean\u0026nbsp;\u003c/em\u003e\u003cem\u003e±\u003c/em\u003e\u003cem\u003e\u0026nbsp;standard deviation, conducted using the t-test. Non-normally distributed variables were expressed as median and 25\u003c/em\u003e\u003cem\u003e–\u003c/em\u003e\u003cem\u003e75% interquartile range, analyzed with the Mann–Whitney U test. Categorical variables were presented as counts (%) and analyzed using the chi-square test. Statistical significance was set at p\u0026lt; 0.05(two-tailed).\u003c/em\u003e\u003c/p\u003e"},{"header":"Results","content":"\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDemographic information of participants\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eUpon comparison of the factors such as age, education level, and job position, there was no significant difference in general data between the two groups (p \u0026gt; 0.05) (Table1).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eComparison of\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003etheoretical\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eand practical test scores\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe total theoretical scores of the BOPPPS-CBL group were significantly higher than those of the\u003c/em\u003e\u003cem\u003eLBL\u003c/em\u003e\u003cem\u003egroup\u003c/em\u003e\u003cem\u003e(\u003c/em\u003e\u003cem\u003e81.70\u003c/em\u003e\u003cem\u003e±\u003c/em\u003e\u003cem\u003e6.36 vs. 76.09\u003c/em\u003e\u003cem\u003e±\u003c/em\u003e\u003cem\u003e7.51, p\u0026lt; 0.01\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003cem\u003e. The BOPPPS-CBL group outperformed the LBL group in multiple-choice\u0026nbsp;\u003c/em\u003e\u003cem\u003e(\u003c/em\u003e\u003cem\u003e44.78\u003c/em\u003e\u003cem\u003e±\u003c/em\u003e\u003cem\u003e3.27 vs. 42.70\u003c/em\u003e\u003cem\u003e±\u003c/em\u003e\u003cem\u003e4.09, p\u0026lt;0.05\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003cem\u003e, fill-in-the-blank\u003c/em\u003e\u003cem\u003e\u0026nbsp;(\u003c/em\u003e\u003cem\u003e14.68\u003c/em\u003e\u003cem\u003e±\u003c/em\u003e\u003cem\u003e3.25 vs. 12.75\u003c/em\u003e\u003cem\u003e±\u003c/em\u003e\u003cem\u003e2.71, p\u0026lt;0.01\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003cem\u003e, and short-answer questions\u0026nbsp;\u003c/em\u003e\u003cem\u003e(\u003c/em\u003e\u003cem\u003e22.25\u003c/em\u003e\u003cem\u003e±\u003c/em\u003e\u003cem\u003e1.81 vs. 20.64\u003c/em\u003e\u003cem\u003e±\u003c/em\u003e\u003cem\u003e2.36, p\u0026lt;0.01)\u003c/em\u003e\u003cem\u003e(Table3).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere was no significant difference in overall skill scores between the two groups\u0026nbsp;\u003c/em\u003e\u003cem\u003e[39.8(38.0\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e41.3) vs. 40.0(37.6\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e42.4), p=0.475]\u003c/em\u003e\u003cem\u003e. Compared with the LBL model, the BOPPPS-CBL model failed to demonstrate significant improvement in cardiopulmonary resuscitation (CPR) [7.3(6.5\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e8.0) vs. 7.5(6.5\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e8.4), p=0.655]\u003c/em\u003e\u003cem\u003e, hemostasis [8.0(7.5\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e8.5) vs. 8.5(8.0\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e9.0), p=0.055]\u003c/em\u003e\u003cem\u003e, bandaging [8.0(7.5\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e8.5) vs. 8.0(7.5\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e8.9), p=0.813]\u003c/em\u003e\u003cem\u003e, limb immobilization [8.0(7.5\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e9.0) vs. 8.0(7.5\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e8.5), p=0.179]\u003c/em\u003e\u003cem\u003e, and patient transfer [8.0(7.5\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e8.5) vs. 8.0(7.5\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e8.5), p=0.367] (Table4).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eComparison of training evaluation questionnaire\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAll participants (n=84) successfully completed the CEQ (100% response rate).\u0026nbsp;\u003c/em\u003e\u003cem\u003eThe CEQ consisted of five scales, good teaching, generic skills, clear\u0026nbsp;\u003c/em\u003e\u003cem\u003egoals and\u003c/em\u003e\u003cem\u003e\u0026nbsp;standard, appropriate workload, and overall satisfaction. There was no statistically significant difference in ratings between the BOPPPS-CBL and LBL groups for the following three items\u003c/em\u003e\u003cem\u003e\u0026nbsp;in good teaching: \"the instructors of this course motivated me to do my best work\" [4(4\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e4) vs. 4(4\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e4), p=0.118]\u003c/em\u003e\u003cem\u003e, \"the instructors spent a lot of time evaluating my learning\" [4(4\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e4) vs. 4(4\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e4), p=0.086], \"the instructors were extremely good at explaining things in this training\" [4(4\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e5) vs. 4(4\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e5), p=0.282].\u003c/em\u003e\u003cem\u003e\u0026nbsp;For all other items besides these three, the BOPPPS-CBL group scored significantly higher than the LBL group (p \u0026lt; 0.05).\u003c/em\u003e\u003cem\u003e\u0026nbsp;For trainee satisfaction scores in each dimension, see Table 5.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cem\u003eCOVID-19 began spreading through our city in early 2022, resulting in significant pressure on health\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003ecare capacity. Our municipality was experiencing severe population aging, accompanied by a high prevalence of chronic conditions among the elderly demographic. The COVID-19 pandemic aggravated chronic diseases in geriatric patients, overwhelming EMS and creating severe staffing deficits in prehospital emergency care service.\u0026nbsp;Therefore, there was an urgent need to recruit additional health\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003ecare workers, including stretcher bearers and ambulance drivers. During emergency medical operations, stretcher bearers and ambulance drivers were required to assist medical personnel with ancillary tasks beyond their primary duties of vehicle operation and patient transport, necessitating fundamental emergency care knowledge and technical competencies.\u0026nbsp;\u003c/em\u003e\u003cem\u003eHowever, the vast majority of them lack\u003c/em\u003e\u003cem\u003eed\u003c/em\u003e\u003cem\u003e\u0026nbsp;prior emergency experience. To enable them to quickly become competent in their new roles, short-term intensive training programs must be implemented.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWe reviewed the medical teaching methodologies that had garnered significant attention in recent years, with the CBL and the BOPPPS models particularly capturing our interest. CBL is an active learning approach centered on clinical cases that has been widely employed by medical schools internationally (16). CBL is particularly effective for small-group learning where students acquire new concepts and information by analyzing clinical cases.\u0026nbsp;\u003c/em\u003e\u003cem\u003eThe benefits include acquisition of knowledge, improvement in social and communication skills, enhancement of problem-solving capabilities, and development of self-directed learning techniques\u003c/em\u003e\u003cem\u003e\u0026nbsp;(19,20).\u003c/em\u003e\u003cem\u003e\u0026nbsp;The BOPPPS model constitutes an evidence-based instructional design approach aimed at maximizing both teaching effectiveness and learner engagement (12). It disrupts conventional education paradigms by prioritizing learner-centered design. It emphasizes integrating new concepts with prior knowledge through active learning and contextualized environments to enhance comprehension and retention. In this learning paradigm, the role of instructors shifts from knowledge provider to facilitator, fostering critical thinking and practical application skills (21,22). The synergistic integration of BOPPPS\u0026apos; structured lesson design and CBL\u0026apos;s clinical reasoning framework shows untapped potential for competency-based training programs outside traditional medical curricula, particularly in layperson emergency response education.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDuring the preparation phase, we meticulously developed training materials and slides to ensure both groups received identical core content. The cases used for the BOPPPS-CBL group were authentic and clinically representative. The LBL group received all instructional content in a centralized classroom environment. The BOPPPS-CBL group completed the Bridge-in, Objectives, Pre-assessment, Post-assessment, and Summary components of the BOPPPS model in a centralized format. During the participatory learning phase, the BOPPPS-CBL group was divided across five separate classrooms for case-based discussions, with each classroom focusing on distinct clinical scenarios. The classrooms were minimally adapted to simulate emergency care environments and equipped with skill-training materials according to their respective case scenarios. Additionally, we prepared two ambulances of different models outdoors for training.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe theoretical test comprised three question types: multiple-choice questions, fill-in-the-blank questions, and short answer questions.\u0026nbsp;\u003c/em\u003e\u003cem\u003eFoundational knowledge was primarily assessed through\u0026nbsp;\u003c/em\u003e\u003cem\u003emultiple-choice\u003c/em\u003e\u003cem\u003e, fill-in-the-blank items, and short-answer questions, while comprehensive competencies including clinical reasoning, communication skills, and expressive abilities were also evaluated by short-answer questions.\u003c/em\u003e\u003cem\u003e\u0026nbsp;The BOPPPS-CBL group demonstrated significantly higher scores than the LBL group in both total scores and individual question type categories, with statistically significant differences.\u0026nbsp;\u003c/em\u003e\u003cem\u003eThis suggested that knowledge mastery was significantly stronger among the BOPPPS-CBL group learners.\u0026nbsp;\u003c/em\u003e\u003cem\u003eThis enhanced learning outcome might be attributed to the more engaging case-based and simulated scenario teaching format, which effectively stimulated active learning motivation and substantially improved learning efficiency.\u003c/em\u003e\u003cem\u003e\u0026nbsp;The BOPPPS model employed a stepwise approach that not only enhanced active learner engagement but also facilitated iterative knowledge reinforcement.\u0026nbsp;\u003c/em\u003e\u003cem\u003eFurthermore, independent thinking and knowledge application skills were cultivated by the instructors during discussion sessions. The skills training programs included CPR, hemostasis, bandaging, limb immobilization and patient transfer. No statistically significant difference was observed in skill assessment scores between the BOPPPS-CBL and LBL groups. This outcome might be attributed to the limited scope of skills, which were likely to reach proficiency thresholds within the brief training period.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;The CEQ, a validated medical education tool, systematically connects student evaluations to teaching improvements through student-centric curriculum refinement (23). In \u0026quot; generic skills\u0026quot; of the questionnaire, the BOPPPS-CBL group participants were more likely to believe that the training improved their problem-solving skills, analytical abilities, teamwork skills, confidence in tackling unfamiliar problems, and written communication skills. In \u0026quot; clear goals and standard, they also agreed more strongly that the BOPPPS-CBL model provided clear learning objectives, making it easier to grasp key points. Additionally, they were more inclined to perceive the training as stress-free and without undue burden, in \u0026ldquo;appropriate workload\u0026rdquo;. In \u0026ldquo;good teaching\u0026rdquo;, no statistically significant differences were observed between the two groups in their ratings of the three items. We hypothesized that this might be because the instructors in both groups encouraged the trainees to perform their best during the training. The instructors consistently engaged with students by asking questions while teaching or interacting, aiming to assess their grasp of learning. All instructors were fully prepared for the course delivery and extremely good at explaining things in this training.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe limitations of this study include the following points. First, the training was re\u003c/em\u003e\u003cem\u003elatively short in duration and covered basic content. If time permits, extending the duration and expanding the content could enhance the depth of the training. For example, adding more operational elements. To compensate for this shortcoming, advanced training can be conducted by combining other effective teaching methods and equipment, after the emergency ancillary staff have worked for a period of time. Second, due to objective constraints, this study was designed as a non-randomized controlled trial. Future randomized controlled trials are recommended to confirm these results. Third, the current study involved a relatively small sample size. Future research could include a larger participant pool to enhance generalizability.\u003c/em\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e\u003cem\u003eThis study pioneers the application of the BOPPPS-CBL hybrid instructional model in the pre-employment training for stretcher bearers and ambulance drivers. Compared to LBL, BOPPPS-CBL significantly enhanced stretcher-bearers' and drivers' theoretical knowledge and fostered critical competencies including problem-solving, analytical thinking, teamwork, confidence in handling unfamiliar problems, and written communication skills. The structured approach significantly sharpened learning objective clarity and reduced cognitive load. BOPPPS-CBL is no worse than LBL for operational skill acquisition.\u0026nbsp;These findings provide an evidence-based framework for pre-employment trainings of non-clinical EMS personnel and demonstrate transferability to first responder training programs.\u003c/em\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor contribution\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e：\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eConception and design: PGW, YY, WLM; data collection: LY, BDH; data analysis: YY, SIQ;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eproject administration: ZH, WLM; manuscript writing: PGW, YY, WLM.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;This work was supported by the Philosophy and Social Sciences Project of Dandong (2024DDSK077).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eThe authors would like to thank Jiongdi Luan and Han Sun with the medical education department for their help in this study.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData availability:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;Our research involves in the personal identity information. If the data sets analyzed during the study are publicly available, there is a risk of revealing personal privacy. Therefore, the data is not publicly available. If you have a strong demand, please contact the corresponding author.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eThe authors declare no competing interests.\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZou Y, Jia L, Chen S, Deng X, Chen Z, He Y, Wang Q, Xing D, Zhang Y. Spatial accessibility of emergency medical services in Chongqing, Southwest China. Front Public Health. 2023; 10:959314. doi: 10.3389/fpubh.2022.959314.\u003c/li\u003e\n\u003cli\u003eThomas TL, Clem KJ. Emergency medical services in China. Acad Emerg Med. 1999; 6(2):150-5. doi: 10.1111/j.1553-2712.1999.tb01054.x.\u003c/li\u003e\n\u003cli\u003eMoore L. 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Assessment of the effectiveness of the BOPPPS model combined with case-based learning on nursing residency education for newly recruited nurses in China: a mixed methods study. BMC Med Educ. 2024;24(1):215. doi: 10.1186/s12909-024-05202-x.\u003c/li\u003e\n\u003cli\u003eGao N, Fu K, Li N, He W. Research on the application of CBL combined with BOPPPS teaching mode in oral and maxillofacial surgery teaching: a randomized controlled study. Sci Rep. 2024;14(1):26510. doi: 10.1038/s41598-024-77432-4.\u003c/li\u003e\n\u003cli\u003eXu L, Lin C, Hou C, Li S. The combined BOPPPS and CBL teaching method enhances students\u0026apos; learning in pathology experimental course. Adv Physiol Educ. 2025;49(2):526-534. \u003c/li\u003e\n\u003cli\u003eWang S, Wu Z, Chen J, Zhang M, Sun L, Yan D, Zhou S, Wang Y. Application of a dual-track teaching model combining CBL and TBL based on the BOPPPS model in trauma care nursing training. Nurse Educ Pract. 2025; 84:104295. doi: 10.1016/j.nepr.2025.104295.\u003c/li\u003e\n\u003cli\u003eBroomfield D, Bligh J. An evaluation of the \u0026apos;short form\u0026apos; course experience questionnaire with medical students. Med Educ. 1998;32(4):367-9. doi: 10.1046/j.1365-2923.1998.00232.x.\u003c/li\u003e\n\u003cli\u003eMcLean SF. Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature. J Med Educ Curric Dev. 2016;3:JMECD.S20377. doi: 10.4137/JMECD.S20377.\u003c/li\u003e\n\u003cli\u003eWei H, Dai Y, Yuan K, Li KY, Hung KF, Hu EM, Lee AHC, Chang JWW, Zhang C, Li X. AI-Powered Problem- and Case-based Learning in Medical and Dental Education: A Systematic Review and Meta-analysis. Int Dent J. 2025;75(4):100858. doi: 10.1016/j.identj.2025.100858.\u003c/li\u003e\n\u003cli\u003eMa X, Ma X, Li L, Luo X, Zhang H, Liu Y. Effect of blended learning with BOPPPS model on Chinese student outcomes and perceptions in an introduction course of health services management. Adv Physiol Educ. 2021;45(2):409-417. doi: 10.1152/advan.00180.2020.\u003c/li\u003e\n\u003cli\u003eHu K, Ma RJ, Ma C, Zheng QK, Sun ZG. Comparison of the BOPPPS model and traditional instructional approaches in thoracic surgery education. BMC Med Educ. 2022;22(1):447. doi: 10.1186/s12909-022-03526-0.\u003c/li\u003e\n\u003cli\u003eScala JJ, Cha H, Shamardani K, Rashes ER, Acosta-Alvarez L, Mediratta RP. Training the next generation of community-engaged physicians: a mixed-methods evaluation of a novel course for medical service learning in the COVID-19 era. BMC Med Educ. 2024;24(1):426. doi: 10.1186/s12909-024-05372-8.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable1. Baseline characteristics of the participants (n=84)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eLBL group (n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eBOPPPS-CBL group (n=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003et/χ2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003ep-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eAge, years, (mean\u0026nbsp;\u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e35.89\u0026nbsp;\u0026plusmn;5.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e36.25\u0026nbsp;\u0026plusmn;4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-0.336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eEducation level, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eMeddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e13（29.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e10（25.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e21（47.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e17（42.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e10（22.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e13（32.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eJob position, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eStretcher bear\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e28（63.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e25（62.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eAmbulance driver\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e16（36.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e15（37.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: standard deviation\u003c/p\u003e\n\u003cp\u003eTable2. The key information of the cases.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eScenes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003ePatients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eSymptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eInducing factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eKey learning points\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA traffic accident involving a collision between a bus and a taxi.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eMale, 70 years old, bus passenger\u003c/p\u003e\n \u003cp\u003eFemale, 67 years old, bus passenger\u003c/p\u003e\n \u003cp\u003eMale, 28 years old, taxi passenger\u003c/p\u003e\n \u003cp\u003eMale, 46 years old, taxi driver\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eLow back pain\u003c/p\u003e\n \u003cp\u003eLeft thigh pain\u003c/p\u003e\n \u003cp\u003eFacial hemorrhage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eChest and neck pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eAccidental fall\u003c/p\u003e\n \u003cp\u003eAccidental fall\u003c/p\u003e\n \u003cp\u003eBroken glass\u003c/p\u003e\n \u003cp\u003eSeatbelt\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSudden braking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eTrauma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA family suffered toxic gas exposure.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eFemale, 62 years old, healthy person\u003c/p\u003e\n \u003cp\u003eMale, 63 years old, COVID-19 patient\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eDizziness\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eComa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eCarbon\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCarbon\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCOVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eToxic gas poisoning\u003c/p\u003e\n \u003cp\u003eRespiratory infectious disease\u003c/p\u003e\n \u003cp\u003eNeurological diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA group of young people went on an outing to the countryside.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eFemale, 22 years old, college student\u003c/p\u003e\n \u003cp\u003eFemale, 21 years old, college student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eApnea\u003c/p\u003e\n \u003cp\u003eThirst and palpitations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eSlipping from the riverbank\u003c/p\u003e\n \u003cp\u003eHigh temperature\u003c/p\u003e\n \u003cp\u003eHumidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eDrowning\u003c/p\u003e\n \u003cp\u003eHeat stroke\u003c/p\u003e\n \u003cp\u003eCardiovascular diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eAn out-of-town tourist couple were in the hotel\u0026nbsp;after dining with friends.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eMale, 38 years old, husband\u003c/p\u003e\n \u003cp\u003eFemale, 37 years old, wife/pregnant woman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eVomiting\u0026nbsp;and coma\u003c/p\u003e\n \u003cp\u003eAbdominal pain\u0026nbsp;and diarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eExcess alcohol\u003c/p\u003e\n \u003cp\u003eContaminated food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eAlcoholism\u003c/p\u003e\n \u003cp\u003eAcute food poisoning\u003c/p\u003e\n \u003cp\u003eDigestive diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eAn electric wheelchair caught fire in a nursing home.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eFemale, 79 years old, resident\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFemale, 82 years old, resident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eDyspnea\u003c/p\u003e\n \u003cp\u003eCough and skin burn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eHarmful gases\u003c/p\u003e\n \u003cp\u003eHarmful gases\u003c/p\u003e\n \u003cp\u003eBurning electric blanket\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eInhalation injury\u003c/p\u003e\n \u003cp\u003eBurn injury\u003c/p\u003e\n \u003cp\u003eRespiratory diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable3. Comparison of theoretical test scores.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eScore weights\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eLBL group (n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eBOPPPS-CBL group (n=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003ep-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eMultiple choice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e42.70\u0026nbsp;\u0026plusmn;\u0026nbsp;4.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e44.78\u0026nbsp;\u0026plusmn;\u0026nbsp;3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-2.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eFill-in-the-blank\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e12.75\u0026nbsp;\u0026plusmn;\u0026nbsp;2.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e14.68\u0026nbsp;\u0026plusmn;\u0026nbsp;3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-2.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eShort answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e20.64\u0026nbsp;\u0026plusmn;\u0026nbsp;2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e22.25\u0026nbsp;\u0026plusmn;\u0026nbsp;1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-3.488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eTotal score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e76.09\u0026nbsp;\u0026plusmn;\u0026nbsp;7.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e81.70\u0026nbsp;\u0026plusmn;\u0026nbsp;6.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-3.673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable4. Comparison of operational test scores.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eScore weights\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eLBL group (n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eBOPPPS-CBL group (n=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cem\u003ep-\u003c/em\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eCardiopulmonary resuscitation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e7.5 (6.5-8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e7.3 (6.5-8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-0.447\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eHemostasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e8.5 (8.0-9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e8.0 (7.5-8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-1.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eBandaging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e8.0 (7.5-8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e8.0 (7.5-8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.813\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eLimb immobilization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e8.0 (7.5-8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e8.0 (7.5-9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-1.344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003ePatient transfer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e8.0 (7.5-8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e8.0 (7.5-8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-0.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.367\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eTotal score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e40.0 (37.6-42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e39.8 (38.0-41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable5. Training course experience questionnaire.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eQuestions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eScales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eLBL group\u003c/p\u003e\n \u003cp\u003e(n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eBOPPPS-CBL group (n=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003ep-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThe instructors of this course motivated me to do my best work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGood teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (4-4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4 (4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThe instructors spent a lot of time evaluating my learning.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGood teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (4-4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4 (4-4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThe instructors always made effort to understand the difficulties I might encounter in my learning.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGood teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (4-4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-3.633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThe instructors usually gave me helpful feedback during the learning process.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGood teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-3.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThe instructors were extremely good at explaining things in this training.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGood teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThe instructors worked hard to make the training content enjoyable.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGood teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4.5 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-4.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThis training sharpened my problem-solving skills.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGeneric skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4(4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-6.580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThis training honed my analytical skills.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGeneric skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4(4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-6.993\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThis training enhanced my teamwork skills.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGeneric skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4(4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-6.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThis training gave me the assurance to handle unfamiliar problems.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGeneric skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4(4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-6.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThis training has improved my written communication skills.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGeneric skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4(4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-6.287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThis training helped me to develop the ability to plan my own work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGeneric skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4(4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-6.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThe training standards were clear and straightforward.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eClear Goals and Standard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4(4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-7.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThe training expectations and goals were perfectly clear to me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eClear Goals and Standard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4(3.25-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-7.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eIt was easy to understand this training \u0026apos;s requirements.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eClear Goals and Standard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4(4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-7.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eRight from the start, the instructors made it clear what they expected from us.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eClear Goals and Standard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4(4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-7.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThis training didn\u0026apos;t have an overwhelming amount of work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAppropriate Workload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3(3-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-8.463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThe instructors usually gave me enough time to grasp what I need to learn.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAppropriate Workload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3(3-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-8.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eI didn\u0026apos;t feel much pressure to excel in this course.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAppropriate Workload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3(3-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-8.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eThe workload in this course was quite manageable, which meant I could fully grasp all the content.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAppropriate Workload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3(3-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(5-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-8.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 501px;\"\u003e\n \u003cp\u003eOverall, I was satisfied with the quality of this training.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eOverall Satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4(4-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5(4.25-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-5.989\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"BOPPPS model, Case-based learning, Stretcher bearer, Ambulance driver, Pre-employment training, Prehospital emergency care","lastPublishedDoi":"10.21203/rs.3.rs-8400931/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8400931/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eOur emergency response team needed to quickly train newly recruited stretcher bearers and ambulance drivers to join the workforce during the COVID-19 pandemic. In our country, the absence of standardized pre-employment training programs for them has created an urgent need to develop an effective training method. We evaluated the efficacy of the bridge-in, objective, pre-assessment, participatory learning, post-assessment, and summary model combined with case-based learning (BOPPPS -CBL) and traditional lecture-based learning (LBL) by comparing the theoretical knowledge scores, operational skill scores, and satisfaction levels between the two training sessions in April 2022 and January 2023, which were designated as the LBL group and the BOPPPS-CBL group, respectively. Statistical comparisons confirmed BOPPPS-CBL enhanced theoretical knowledge and fostered competencies including problem-solving, analytical thinking, teamwork, confidence in handling unfamiliar problems, and written communication skills for stretcher bearers and ambulance drivers. It sharpened learning objective clarity and reduced cognitive load. For operational skill acquisition, it is no worse than LBL.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"Application of the BOPPPS-CBL model in pre-employment training for emergency ancillary staff: a pilot study during the COVID-19 pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 12:59:01","doi":"10.21203/rs.3.rs-8400931/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"323998185305248291166212674346729288236","date":"2026-04-23T19:10:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-09T12:43:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334948416899206042576367212909639934948","date":"2026-02-09T11:54:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-28T11:10:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-02T13:26:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-29T15:33:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-12-29T15:24:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"71a98030-ca48-4886-99c4-c6e258ce274f","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":61955004,"name":"Health sciences/Health care"},{"id":61955005,"name":"Health sciences/Health occupations"},{"id":61955006,"name":"Biological sciences/Psychology"},{"id":61955007,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-01-30T12:59:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-30 12:59:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8400931","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8400931","identity":"rs-8400931","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}