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Purpose: This study aimed to introduce active learning methods, including flipped, case-based, and team-based learning in an electrocardiography (ECG) course and to investigate outcomes and satisfaction with these methods. Methods: To identify the learning effect of active learning, pre-and post-academic self-efficacy was compared between the experimental and control groups. In the experimental group, pre-and post-knowledge and clinical performance regarding ECG were also assessed. In addition, class satisfaction was investigated after application of active learning methods in the experimental group. Data were collected from 84 paramedic students and analyzed using SPSS 22.0 (IBM, Armonk, NY, USA). Results: The experimental group showed significant improvement in post-academic self-efficacy and knowledge. The experimental group also showed high clinical performance (9.83 out of 10 in ECG checking ability and 9.63 out of 10 in ECG reading ability). The mean satisfaction score was 4.23 out of 5 (responses based on a Likert scale) in the experimental group. Conclusion: Active learning in an ECG course was found to be highly effective and satisfactory. Furthermore, paramedic students can enhance their accountability and judgement with team-based learning through free engagement in discussion.