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Background: Blended learning combines online learning with face-to-face learning. Research investigating the effect of different blended learning models to teach Basic Life Support (BLS) is lacking. Objectives: To investigate the effect of a mastery learning (ML) versus a self-directed learning (SDL) blend on students' BLS performance. In ML, students learn BLS as a linear sequence meaning each step should be 'mastered' prior to advancing to the next. In SDL, students' autonomy is increased for his or her learning trajectory leading to non-linear, user driven learning paths. Methods: A randomized controlled trial. Four conditions were created by combining two learning models (SDL and ML) in two learning phases (online and face to face). Bachelor students (n = 145) were randomized over these four conditions. In all blends an online learning module was available for one week prior to a face-to-face learning component of which the duration was 45 minutes. All learners' BLS performance was assessed individually and unannounced one week following blended learning. An individual BLS score was calculated combining cardiopulmonary resuscitation (CPR) variables reported by a Laerdal ResusciAnne Manikin and qualitative observations by two trained researchers. Results: Students' CPR performance adhered to international 2015 guidelines for all groups. Median BLS-performance was 83.0% (interquartile range 13.2%). No statistical differences between groups were found for BLS performance or CPR variables. Conclusion: All blended learning models were highly time-effective since the face-toface component only took 45 minutes and learning outcomes adhered to guidelines.

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Blended learning is the thoughtful integration of classroom face-to-face learning with online learning experiences. The design of blended learning environments impacts student learning behaviour and in turn learning outcomes. Although some attributes for successful online learning are being reported, further research on what makes online learning effective is needed. This study investigated the effect of mastery learning (ML) versus self-directed learning (SDL) as instructional strategies for the online part of a blended course. ML is characterized by program controlled, linear learning paths. SDL is characterized by student controlled, non-linear learning paths. Participants for this study were 159 freshmen undergraduate nursing students. Two online learning environments were created with identical content but different instructional strategy (ML vs. SDL). Participants were assigned to a learning environment based on their campus and completed the Motivated Strategies for Learning Questionnaire (MSLQ) to measure self-reported self-regulatory learning at the beginning of the semester. All online activity was tracked from participants over the course of eight weeks prior to an online exam. Results showed that students from the ML-condition showed significantly more online actions compared to SDL students (M = 483 vs. 283 F(1,154) = 18.6, p < .001). Also this group completed more quizzes (M = 15 vs. 7 F(1,155) = 65.0 p < .001). No difference was found between conditions for exam results. No differences were found based on students self-reported self-regulation. These findings show that while the quantity of learning activity was influenced through the design of the learning environment the quality was not.