Facilitated interactive video versus simulation-based training after a standardized lecture for basic life support in medical students: a randomized trial

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • Randomization was performed at the individual student level within a single university cohort, not at the class or school level, and the intervention is not a one-to-one tutoring exception.
    • "Of 125 eligible fourth-year medical students, 121 agreed to participate and were randomly assigned in a 1:1 ratio to the Simulation Group (n=61) or the Facilitated Video Group (n=60) using Research Randomizer (randomizer.org)."
    • Relevant Quotes: 1) "Of 125 eligible fourth-year medical students, 121 agreed to participate and were randomly assigned in a 1:1 ratio to the Simulation Group (n=61) or the Facilitated Video Group (n=60) using Research Randomizer (randomizer.org). Randomization was performed by an independent individual not involved in study procedures." (p. 2) 2) "This prospective, randomized controlled trial was conducted with fourth-year medical students at a state university in October 2025 and is reported in accordance with CONSORT guidelines." (p. 2) 3) "Students were trained in the simulation laboratory in groups of five using a BLS training manikin." (p. 3) Detailed Analysis: The ERCT 'C' criterion requires that randomisation be at the class level or stronger (school level), unless the intervention is one-to-one personal tutoring. Here, individual students within a single fourth-year cohort at one university were randomly assigned in a 1:1 ratio to the two modality groups. The unit of randomisation was the individual student, not entire classes or schools. Training was delivered to small groups of five, but assignment to condition was at the student level. The intervention (BLS training delivered to groups via lecture, simulation, or video) is not a personal one-to-one tutoring intervention, so the tutoring exception does not apply. The paper even acknowledges that "the possibility of contamination in a shared academic setting cannot be completely ruled out" (p. 8), reflecting the within-cohort student-level design. Criterion C is not met because randomisation was at the individual student level within a single class cohort rather than at the class or school level, and no tutoring exception applies.
  • E

    Exam-based Assessment

    • Outcomes were measured with a study-designed 20-item MCQ and a 30-item OSCE checklist developed by the investigators, not with a widely recognized standardized exam.
    • "Knowledge was assessed using a 20-item multiple-choice test administered immediately before training (pre-test) and immediately after training (post-test)... The MCQ instrument was designed to sample core adult BLS domains covered in the course."
    • Relevant Quotes: 1) "Knowledge was assessed using a 20-item multiple-choice test administered immediately before training (pre-test) and immediately after training (post-test) (Additional file 2). Each correct response was worth 5 points (total score range 0-100)." (p. 4) 2) "The MCQ instrument was designed to sample core adult BLS domains covered in the course... Items were mapped to the ERC 2021 adult BLS guidance used for the course, and the wording and answer options were reviewed by BLScertified instructors for guideline consistency and educational appropriateness before implementation." (p. 4) 3) "Practical skills retention and algorithm sequencing were assessed three weeks after training using an Objective Structured Clinical Examination (OSCE)... Performance was scored using a 30-item dichotomous checklist (performed=1/not performed=0) ... a total OSCE score was calculated." (p. 4) 4) "A further limitation relates to measurement validity of the cognitive outcome. The same MCQ items were administered immediately before and immediately after training... Formal item-level psychometric analyses were not prespecified for this study." (p. 8) Detailed Analysis: The ERCT 'E' criterion requires a standardised, widely recognised exam-based assessment that is not custom-built for the study. The cognitive outcome here was a 20-item MCQ explicitly "designed to sample core adult BLS domains covered in the course" and mapped to the local ERC-based course content - i.e., a researcher-assembled instrument, not a national/state-wide standardised exam. The authors themselves note formal psychometric analyses were not prespecified and that the MCQ should be interpreted "as supportive but not definitive evidence." The primary outcome (OSCE) used a 30-item dichotomous checklist created by the investigators. While OSCE is a recognised assessment format, this particular checklist is a study-specific instrument, not a standardised national/state examination in the sense required by the criterion. No widely recognised standardised achievement exam was used. Criterion E is not met because the study relied on a study-designed MCQ and a custom OSCE checklist rather than a widely recognised standardised exam.
  • T

    Term Duration

    • The primary skills outcome was measured only three weeks after a single-session intervention, far short of one full academic term.
    • "Practical skills retention and algorithm sequencing were assessed three weeks after training using an Objective Structured Clinical Examination (OSCE)."
    • Relevant Quotes: 1) "This prospective, randomized controlled trial was conducted with fourth-year medical students at a state university in October 2025." (p. 2) 2) "The study was conducted over two consecutive days. The Simulation Group was trained on the first day and the Facilitated Video Group on the second day." (p. 4) 3) "Practical skills retention and algorithm sequencing were assessed three weeks after training using an Objective Structured Clinical Examination (OSCE)." (p. 4) 4) "The OSCE was conducted on a single day, exactly three weeks after training, for both groups." (p. 5) 5) "Retention was measured after three weeks, but a longer follow-up is necessary to assess long-term competence and the rate of skill decay." (p. 8) Detailed Analysis: The ERCT 'T' criterion requires that outcomes be measured at least one full academic term (approximately 3-4 months) after the intervention begins. The standard explicitly allows short interventions but insists on at least term-long follow-up tracking from the intervention start. In this study the intervention was delivered in a single session over two consecutive days in October 2025, and the primary (OSCE) and secondary (knowledge gain) outcomes were measured immediately after training and at only three weeks. Three weeks is well below one academic term. The authors themselves note that "a longer follow-up is necessary." The interval from intervention start to the latest outcome measurement is therefore about three weeks, far short of a term. Criterion T is not met because the longest follow-up was three weeks, well short of the required full academic term.
  • D

    Documented Control Group

    • The control comparator (simulation group) is documented with its size, exact intervention received, and baseline pre-test scores reported alongside the video group.
    • "A total of 121 volunteer students were randomized (video group n=60, simulation group n=61). All randomized participants completed the intervention, and n=121 completed the 3-week OSCE assessment."
    • Relevant Quotes: 1) "A total of 121 volunteer students were randomized (video group n=60, simulation group n=61). All randomized participants completed the intervention, and n=121 completed the 3-week OSCE assessment." (p. 5) 2) "Students were trained in the simulation laboratory in groups of five using a BLS training manikin. A standardized single-rescuer adult cardiac arrest scenario (adult collapse in a shopping mall) was used... The simulation intervention comprised approximately 20 min of scenario-based practice followed by a facilitator-led debriefing (20 min), for a total modality-specific duration of 40 min." (pp. 3-4) 3) "Eligible participants were fourth-year medical students entering the clinical phase... As part of the curriculum, all students had prior theoretical exposure to adult Basic Life Support (BLS)." (p. 2) 4) "Pre-test 72.50 (65.00-78.75) [video]; 75.00 (70.00-85.00) [simulation]" (Table 2, p. 6) Detailed Analysis: The ERCT 'D' criterion requires the control/ comparison group to be well documented, including size, baseline characteristics, and the conditions/ treatment it received. This is a head-to-head trial of two active modalities; the simulation group serves as the comparison group for the video intervention (and vice versa). The paper documents the comparison group's size (n=61), eligibility and baseline status (fourth-year medical students with prior theoretical BLS exposure, no prior hands-on CPR course), the exact intervention it received (standardized lecture plus 40-min simulation with debriefing), and its baseline pre-test scores in Table 2 alongside the video group. This level of documentation allows comparison of the two groups at baseline. Although demographic breakdowns (age, sex) are limited, the group's composition, eligibility criteria, size, baseline scores, and received conditions are clearly described. Criterion D is met because the comparison (simulation) group's size, eligibility, baseline pre-test scores, and exact conditions are documented.

• Level 2 Criteria

  • S

    School-level RCT

    • The trial was conducted at a single university with randomisation at the student level; no schools were randomly assigned.
    • "This prospective, randomized controlled trial was conducted with fourth-year medical students at a state university in October 2025."
    • Relevant Quotes: 1) "This prospective, randomized controlled trial was conducted with fourth-year medical students at a state university in October 2025." (p. 2) 2) "Of 125 eligible fourth-year medical students, 121 agreed to participate and were randomly assigned in a 1:1 ratio to the Simulation Group (n=61) or the Facilitated Video Group (n=60)." (p. 2) 3) "There are certain limitations, such as the study being conducted at a single center and involving a specific group of learners, which might affect the generalizability of the findings." (p. 7-8) Detailed Analysis: The ERCT 'S' criterion requires randomisation at the school (institution/site) level, with multiple schools or implementing units randomly assigned to conditions. This study was conducted at a single state university, and individual students within that one institution were randomised to the two modality groups. Only one site/institution was involved, so school-level randomisation is impossible by design. The authors explicitly cite the single-center design as a limitation. Criterion S is not met because the study involved a single institution with student-level randomisation, not randomisation across multiple schools.
  • I

    Independent Conduct

    • The same investigator team designed the interventions and assessment instruments and conducted the study; only randomisation and OSCE scoring were delegated, with no independent third-party evaluator running the trial.
    • "Concept or design of the study - ST, SC Data Collection and/or Processing - ST, SC, MY and SFT Analysis or interpretation of data - ST, SC, MY and SFT."
    • Relevant Quotes: 1) "Throughout the production process, all narrative scripts, instructional prompts, scene descriptions, and the overall design were authored entirely by the investigators." (p. 4) 2) "The intervention sessions were conducted by four faculty members with experience in BLS instruction and familiarity with the ERC-based course content." (p. 4) 3) "Randomization was performed by an independent individual not involved in study procedures." (p. 2) 4) "For the OSCE assessment, four trained assessors who were blinded to group allocation scored student performance." (p. 5) 5) "Concept or design of the study - ST, SC Data Collection and/or Processing - ST, SC, MY and SFT Analysis or interpretation of data - ST, SC, MY and SFT... Writing Manuscript - ST, SC, MY and SFT." (p. 8) Detailed Analysis: The ERCT 'I' criterion requires that the study be conducted independently from those who designed the intervention, to reduce bias in implementation, measurement, analysis, and reporting. Here, the same investigator team authored the video content and instructional design, delivered the interventions, designed the MCQ and OSCE instruments, collected the data, and performed the analysis (CRediT statement attributes data collection and analysis to the authors ST, SC, MY, SFT). Although randomisation was delegated to an independent individual and OSCE scoring was done by blinded assessors, these are partial safeguards within a study otherwise designed, run, and analysed by the intervention developers. There is no external evaluation agency or third party that conducted the trial or its analysis. This does not meet the requirement for independent conduct. Criterion I is not met because the same team that designed the interventions and instruments also conducted and analysed the study, with no independent third-party evaluator.
  • Y

    Year Duration

    • Because criterion T (term duration) is not met, the stronger year-duration criterion cannot be met; the study tracked outcomes for only three weeks.
    • "Retention was measured after three weeks, but a longer follow-up is necessary to assess long-term competence and the rate of skill decay."
    • Relevant Quotes: 1) "The OSCE was conducted on a single day, exactly three weeks after training, for both groups." (p. 5) 2) "Retention was measured after three weeks, but a longer follow-up is necessary to assess long-term competence and the rate of skill decay." (p. 8) Detailed Analysis: The ERCT 'Y' criterion requires outcomes to be measured at least 75% of a full academic year (roughly 7+ months) after the intervention begins. Per the prompt's criterion-specific instruction, if criterion T is not met then Y cannot be met. Here the longest follow-up was three weeks, which fails term duration (T) and is far below a full academic year. The authors explicitly note that a longer follow-up would be needed. Criterion Y is not met because the follow-up was only three weeks, far short of a full academic year (and T is not met).
  • B

    Balanced Control Group

    • Both groups received the identical 20-min lecture and a standardized 40-min modality-specific session, so instructional time and resources were balanced between the two active arms.
    • "Thus, the modality-specific intervention duration was standardized to 40 min in both groups."
    • Relevant Quotes: 1) "Both groups first received the same standardized instructor-led lecture (PowerPoint with visual aids) delivered by the same instructor team, in the same setting, and for the same duration (20 min)." (p. 3) 2) "The simulation intervention comprised approximately 20 min of scenario-based practice followed by a facilitator-led debriefing (20 min), for a total modality-specific duration of 40 min." (pp. 3-4) 3) "The base video duration was 4 min 45 s, but the total facilitated session lasted 40 min, including embedded pauses, learner responses, and instructor feedback. Thus, the modality-specific intervention duration was standardized to 40 min in both groups." (p. 4) 4) "To reduce instructor-related variability, the same core learning objectives and a predefined session flow were used across sessions." (p. 4) Detailed Analysis: The ERCT 'B' criterion compares the time, budget, and resources provided to the compared conditions. Applying the decision tree: this is a head-to-head comparison of two active modalities rather than an intervention-versus-business-as-usual contrast. Both arms received the identical 20-min standardized lecture, and both modality-specific sessions were deliberately standardized to exactly 40 minutes (simulation: 20 min practice + 20 min debriefing; video: facilitated session including pauses, learner responses, and instructor feedback). Both used the same core learning objectives, the same instructor team, and the same setting. Therefore the instructional time and structured engagement were equalized across groups, and any extra resources (manikins vs. video production) are integral to the specific modality being tested rather than an unbalanced add-on. There is no meaningful time/resource imbalance between the two arms. Criterion B is met because both groups received an identical lecture and a time-matched (40-min) modality-specific session with the same learning objectives, balancing instructional time and effort.

• Level 3 Criteria

  • R

    Reproduced

    • This single trial reports no independent replication of its specific intervention, and no independent reproduction of this study was identified.
    • Relevant Quotes: 1) "This study aimed to compare the short- and medium-term learning outcomes associated with two modality-specific BLS training components (facilitated interactive video and simulation based) when both were delivered after the same standardized lecture." (p. 2) 2) "Sample size was estimated a priori using G*Power... Assuming an effect size of d = 0,54 reported in prior work [19]." (p. 5) Detailed Analysis: The ERCT 'R' criterion requires that the specific study be independently replicated by a different research team in a different context and published in a peer-reviewed journal. This paper describes a novel single trial of an AI-assisted facilitated interactive video against simulation for BLS. While it cites related prior BLS-training comparison studies (e.g., reference 19, Saidkhani et al. 2024; reference 24, Hansen et al. 2020), these are background literature, not replications of this specific intervention and design. An internet search (Google Scholar, PubMed, ClinicalTrials.gov) conducted for this verification found no independent reproduction of this particular Telli et al. trial by any other research team; this is unsurprising given the paper was only published online on 01 April 2026. No replication study was found. Criterion R is not met because no independent replication of this specific study was reported in the paper or found through external search.
  • A

    All-subject Exams

    • The study measured only a single domain (basic life support) and did not use standardized exams across all main subjects; criterion E is also not met, which precludes A.
    • "The primary outcome was the between-group difference in OSCE score at the mid-term retention assessment (3 weeks). The secondary outcome was the between-group difference in knowledge gain (post-test minus pre-test)."
    • Relevant Quotes: 1) "The primary outcome was the between-group difference in OSCE score at the mid-term retention assessment (3 weeks). The secondary outcome was the between-group difference in knowledge gain (post-test minus pre-test)." (p. 4) 2) "The MCQ instrument was designed to sample core adult BLS domains covered in the course." (p. 4) Detailed Analysis: The ERCT 'A' criterion requires that the study measure impact across all main subjects using standardised exam-based assessments, and explicitly requires criterion E as a prerequisite. Here, the outcomes were confined to a single specialised domain - adult basic life support knowledge and skills - assessed with a study-designed MCQ and OSCE checklist. No other core subjects were assessed, and criterion E (standardised exam) is not met. Therefore A cannot be met. Even under the specialised-intervention exception, the requirement for standardised exam-based assessment is not satisfied. Criterion A is not met because only a single BLS domain was assessed with non-standardised instruments and criterion E is not met.
  • G

    Graduation Tracking

    • Tracking ended at the 3-week OSCE with no follow-up to graduation, and criterion Y is also not met, which precludes G.
    • "Retention was measured after three weeks, but a longer follow-up is necessary to assess long-term competence and the rate of skill decay."
    • Relevant Quotes: 1) "The OSCE was conducted on a single day, exactly three weeks after training, for both groups." (p. 5) 2) "Retention was measured after three weeks, but a longer follow-up is necessary to assess long-term competence and the rate of skill decay." (p. 8) Detailed Analysis: The ERCT 'G' criterion requires tracking participants until graduation to assess long-term impact, and per the prompt's instruction, if criterion Y is not met then G cannot be met. Here, outcome measurement stopped at the 3-week OSCE, with no follow-up to the students' graduation or any later stage. Criterion Y is not met. An internet search for subsequent publications by the same authors tracking this cohort to graduation found no such follow-up paper; this is expected as the study is newly published (online 01 April 2026). Criterion G is not met because tracking ended at three weeks with no graduation follow-up (and Y is not met).
  • P

    Pre-Registered

    • The trial registry record (ClinicalTrials.gov NCT07368452) was first submitted 18 Jan 2026 and first posted 26 Jan 2026, after the study start date of 04 Oct 2025, so registration was retrospective, not before data collection began.
    • "The trial was registered at ClinicalTrials.gov (NCT07368452)."
    • Relevant Quotes: 1) "Trial registration ClinicalTrials.gov (NCT07368452)." (p. 1) 2) "The trial was registered at ClinicalTrials.gov (NCT07368452)." (p. 2) 3) "Approval for the study was granted by the Institutional Non-Clinical Research Ethics Committee (Approval no: 2025/11-45; date: 15.09.2025)." (p. 5) 4) "This prospective, randomized controlled trial was conducted with fourth-year medical students at a state university in October 2025." (p. 2) Detailed Analysis: The ERCT 'P' criterion requires that the full study protocol be pre-registered before data collection begins, with a verifiable registration date prior to data collection and adherence to the registered plan. The paper provides a ClinicalTrials.gov registration number (NCT07368452) but states no registration date. Internet verification of the ClinicalTrials.gov record for NCT07368452 (title "Video-Based Versus Simulation-Based Basic Life Support Training in Medical Students") shows: Study First Submitted 18 January 2026, First Posted 26 January 2026, with a study Start Date of 04 October 2025 and Primary Completion Date of 26 October 2025. Registration therefore occurred roughly three months AFTER the study had begun and been completed, not before data collection. This is retrospective registration. Additionally, the authors note that some analyses (e.g., item-level psychometrics) were "not prespecified," consistent with the absence of a pre-registered analysis plan. Criterion P is not met because the trial was registered (submitted 18 Jan 2026, posted 26 Jan 2026) only after data collection in October 2025, i.e., it was registered retrospectively rather than pre-registered before the study began.