JMIR Publications

ABSTRACT

Background:

The concept of flipped classrooms (FC) is gaining attention in medical education as it aligns with the digital age's demand for more interactive and accessible learning experiences. By shifting the delivery of instructional content outside of the classroom, FC allows students to engage with materials at their own pace, thereby maximizing in-class time for discussions, problem-solving, and other active learning activities.

Objective:

This study aimed to conduct a comprehensive meta-analysis to appraise the comparative effectiveness of FC instruction in contrast to traditional pedagogical modalities and overcome the limitations delineated in the published literature regarding FC use within the context of medical education.

Methods:

PubMed, Web of Science, and Scopus databases were systematically searched for studies comparing academic outcomes between the FC and traditional learning approaches in medical education. The primary outcome measures were knowledge assessment and students' satisfaction. The standardized mean difference (SMD) was used as a measure of the overall effect, and subgroup analysis was performed according to study design (RCTs vs. nonRCTs). Cochran's Q test and Baujat plots were used to estimate heterogeneity, coupled with I2. Highly influential studies were identified; sensitivity analyses and meta-regression were performed.

Results:

One hundred-one studies were included in the systematic review; 88 studies with 16359 participants were included in the meta-analysis of students’ knowledge assessment, of which 22 were RCTs. FC had significantly better outcomes than the traditional method in knowledge test scores, in both RCTs and nonRCT studies (SMD=0.94; 95% CI=0.65 to 1.24; p<0.0001). There was a substantial heterogeneity among included studies (I2=95%, τ2=1.949, p<0.001). The funnel plot showed high asymmetry with significant small study effects (p<0.0001). However, the effect estimate remained robust to the exclusion of highly influential studies in sensitivity analysis. Twenty studies with a total of 5190 participants, reported students’ satisfaction. Higher students’ satisfaction scores for FC were demonstrated in contrast to the control group (SMD=0.80; 95% CI=0.38-1.22; p=0.0002). There was substantial heterogeneity among the included studies (I2=98.2%, τ2=0.876, p<0.001), but no evidence for publication bias, and no studies were found to be influential.

Conclusions:

The FC method is associated with better knowledge achievement and greater students’ satisfaction than the traditional approach in medical education, thus paving the way for its broader integration into medical school curricula. However, it's essential to consider various factors such as the availability of resources, faculty readiness, and student preferences when implementing any new educational approach. Overall, this study holds promise for advancing medical education by exploring innovative teaching methodologies that leverage technology to enhance learning outcomes.