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Effectiveness of flipped classroom on module of severe acute malnutrition among undergraduate students: A randomized controlled study
Correspondence to SAROJ KUMAR TRIPATHY; doc.saroj@gmail.com
[To cite: Das S, Malik A, Tripathy SP, Venugopal V, Arya AK, Patra SR, et al. Effectiveness of flipped classroom on module of severe acute malnutrition among undergraduate students: A randomized controlled study. Natl Med J India 2025;38:298–302. DOI: 10.25259/NMJI_1041_2022]
Abstract
Background
Flipped classroom (FC) teaching is a distinctive method in which a reversal occurs between lecture and homework components. This model differs entirely from traditional classroom teaching and data regarding its effectiveness are sparse. Our primary objective was to evaluate the improvement in post-session test scores and self-acquired confidence between the FC and traditional lecture-based classroom (TLC) among undergraduate students in the clinical diagnosis and management of severe acute malnutrition (SAM) in children. Our secondary objective was to compare, among both groups, the perception regarding their assigned teaching methods.
Methods
Our study was conducted among the fourth-semester MBBS students. Fifty-nine students were included and randomly allocated into the FC/intervention (n=29) group and a traditional lecture-based classroom (TLC)/ control group (n=30). The topic of the teaching module was SAM among children. Teaching sessions were conducted in both groups at the same time. Both groups underwent pre-session and post-session tests. In addition, students were asked about their self-perceived confidence and feedback on teaching methods in a structured questionnaire.
Results
The post-session scores (20.9 [3.6], 20.6 [3.1]) were significantly higher than the pre-test scores (16.7 [3.1], 18.8 [2.1]), with p values of <0.001 and <0.004, respectively. Self-perceived confidence was, however, similar in the two groups. Concerns like feeling pressurized, drained out, and lost leisure time were more prevalent in the FC group. Regarding feedback, students strongly agreed that FC teaching helped in self-directed learning and independent learning skills.
Conclusion
The FC model encourages learning interest among students, enhances their achievement in the final assessment, and strengthens their clinical approach, communication skills, and confidence in patient management.
INTRODUCTION
The flipped classroom (FC) is a new pedagogy model in medical education and has been adopted in curricula worldwide.1 The distinct part of this teaching method is that before coming to class, students get exposed to online or offline teaching materials and utilize the class time for case discussion, debate, and improvement of problem-solving skills under the guidance of a facilitator, which is entirely reverse of the traditional lecture-based classroom (TLC), and thus its name ‘flipped classroom’.2 There are two components in the FC model. The first component involves providing course material to students online, such as videos. The students can access learning materials anytime and discuss the exercise among small groups before class. The second component is a face-to-face discussion session, where student engagement, learning, and interest in that subject are enhanced. The model is entirely different from a TLC.3 These differences produce more student satisfaction and learning and skills.4
For developing entrustable professional activities (EPAs), traditional objective-based training has evolved into competency-based training in medical education.5,6 The essential component of competency-based medical education (CBME) is acquiring the habit of self-directed learning (SDL) and lifelong learning among medical students. The FC achieves these expectations by promoting metacognitive skills.7
Although the FC is a well-known teaching method, it has not gained widespread acceptance. It has not been incorporated into our CBME curriculum in India. Although studies have shown evidence of good student satisfaction, applying the FC to all subjects/topics may not be possible and evaluation of the effectiveness of the FC is required.
Therefore, we did a randomized controlled trial (RCT) to evaluate the effectiveness of the FC in the paediatrics curriculum on the module of severe acute malnutrition (SAM). The study aimed to evaluate the effectiveness of FCs as compared to TLC among undergraduate students in clinical diagnosis and management of SAM in children.
METHODS
The study was conducted by the Department of Paediatrics among 4th semester MBBS students of All India Institute of Medical Sciences, Deoghar, in April 2022. Ethical clearance was obtained from the institutional ethical committee before the commencement of the study. All students were explained the study method and the objective of the study. Written informed consent was obtained from all participants of the study.
Study design
Of the 61 students in the batch, 59 were included and randomly assigned to either the FC (intervention) group (n=29) or the TLC (control) group (n=30). Block randomization was done, and allocation concealment was maintained prior to selecting any group. Blinding was not possible in our study.
Module description
The topic of the teaching module was SAM among children. It was divided into two sessions. The first session focused on the clinical approach, covering definitions, classifications, clinical features, and investigations, while the second session addressed management and rehabilitation. The teaching material was prepared from the standard textbook of paediatrics and the guidelines provided by the Indian Academy of Paediatrics. The best online video for the SAM module was chosen by a group of expert faculty with more than 10 years of teaching, research, and clinical experience in paediatrics. Both groups of students were provided with the same textbook, syllabus, and practical instructions. Both groups followed the same facilitator, the same teaching schedule, and the same assessment methods.
Teaching method
Pre-session assessment (Day 1): Each participant in both groups underwent a pre-session evaluation to assess the cognitive domain, primarily focusing on the higher-order aspects of SAM. The questionnaire consisted of 30 questions, each with one mark and no negative mark for a wrong response. The question bank for the topic was prepared by all paediatrics faculty members of our institution and validated by a group of students and external paediatrics faculty members.
Pre-session preparation (Day 2 to Day 8): Twenty-nine students of the FC group were divided into five small groups with 6 students in each group (except 5 in one group) to encourage collaboration among students. Two videos, each with a duration of 30 minutes, containing the study materials were shared with all students via a common WhatsApp group created by the researchers. The five small groups were instructed to prepare a presentation for 15 minutes, each with a clinical scenario, during the class. The students were asked to finish the pre-assigned exercise through group discussion. During these 7 days, the TLC group students were asked to review the textbook and finish the assigned exercise. These instructions were provided by a separate WhatsApp group made by the researchers.
During class (Days 9 and 10): Two sessions were held on two consecutive days, each for one hour. Teaching sessions were conducted for both groups simultaneously in different lecture theatres. The activities conducted for the FC group included an introductory session led by the teacher, a presentation by each team featuring clinical scenarios, a question-and-answer discussion between the student and teacher, and a summary provided by the teacher. The activities during TLC were a didactic PowerPoint presentation by the teacher, a clinical case scenario discussion, and a summary by the teacher.
Preparatory phase for post-session assessment (Days 11 to 17): Both groups of students were asked to prepare for the evaluation, with a 7-day timeframe provided. During this period, doubts raised by students were clarified by assigned teachers.
Post-session assessment (Day 18): Both groups of students were assessed individually. The 3 questionnaires were provided to evaluate the understanding of the diagnosis and management of SAM in children, self-acquired confidence in handling patients in real-life scenarios, and feedback on perceptions towards the respective teaching methods. The total duration was one hour. The first was to assess the cognitive domain and faculties of paediatrics. A group of external experts validated the questionnaire. It consisted of 30 questions, each with one mark and no negative mark for an incorrect response. This questionnaire differed from the pre-session assessment questionnaire. The second questionnaire assessed the self-acquired confidence level for managing SAM patients in each student at the end of the module. These questions were based on the specific learning objective (SLO) kept for the module. The reliability coefficients of the questionnaire were Cronbach’s alpha (a) = 0.7 and kappa (k) = 0.65. A group of experts analyzed the content validity, and the construct validity coefficient was 0.5. A 5-point Likert scale quantified the questions (Strongly Agree 2, Agree 1, Neither Agree/Nor Disagree-0, Disagree-1, Strongly Disagree-2). The third questionnaire was to assess the feedback on teaching methods. This questionnaire was developed from four pre-validated question sets.8–11. The content validity was assessed by a group of experts from our institute, and the calculated construct validity coefficient was 0.6. The questions were to be quantified by a 5-point Likert scale. The flowchart of FC and TLC is shown in Fig. 1.
- Study flow chart
RESULT
Fifty-nine students were enrolled in this study. The average age of students in the TLC group was 20.8 years, and that of the FC group was 20.7 years. In the TLC group, 60% of the students were male, and in the flipped group, 65.5% were male. There was no statistically significant difference in age and gender between the groups (Table 1).
| Parameter | Traditional lecture class (n=30) | Flipped class-room (n=29) | p value | |
|---|---|---|---|---|
| Mean (SD) age (years) | 20.8 (1.5) | 20.7 (1.3) | 0.67* | |
| Sex | Male n (%) | 8.18 (60) | 7.19 (65.5) | 0.66† |
| Female n (%) | 8.12 (40) | 8.10 (34.5) | ||
p value based on *Chi-Square test, †Independent sample t test
The average (SD) pre-test score and post-test score of the FC group were 16.7 (3.1) and 20.9 (3.6), respectively, out of the maximum score of 30. The difference was statistically significant (p<0.001). The average (SD) pre-test scores and post-test scores of the traditional groups were 18.8 (2.1) and 20.6 (3.1), respectively. When compared within the group, the post-test scores significantly improved in both groups; however, the effect size with 95% CI was higher for the FC group, which was 1.16 (0.20–1.79) against 0.57 (0.08–1.55) in the TLC group. Students were more interested in the topic in the FC group than in the TLC group; however, this difference was not statistically significant (Table 2).
| Characteristic | Assessment score | p value, Cohen d (95% CI) | |
|---|---|---|---|
| Pre-session | Post-session | ||
| Flipped classroom (n=29) | 16.7 (3.1) | 20.9 (3.6) | <0.001, 1.16 (0.20–1.79) |
| Traditional lecture class (n=30) | 18.8 (2.1) | 20.6 (3.1) | 0.004, 0.57 (0.08–1.55) |
| Level of interest | Flipped | Traditional | 0.18 |
| classroom | lecture class | ||
| Not interested | 0.0(20) | 0.0 (6.9) | |
| Somewhat interested | 0.0 (20) | 0.0 (31.0) | |
| Very much interested | 024 (80) | 0.0 (62.1) | |
At the end of the module, students’ self-perceived confidence was assessed using a Likert scale. The positive response, namely strongly agree, was more for various learning components among students in the FC group than the TLC group. However, the median total score for each element was not statistically different (Table 3).
| Question | Group | Strongly agree | Agree | Neutral | Disagree | Strongly disagree | Median (IQR) | p value* |
|---|---|---|---|---|---|---|---|---|
| Clinical approach to child with severe acute malnutrition (SAM) | Control | 5 (16.7) | 23 (76.7) | 2 (6.7) | 0 | 0 | 4 (4 – 4) | 0.56 |
| Intervention | 7 (24.1) | 20 (69). | 2 (6.9) | 0 | 0 | 4 (4 – 4) | ||
| Planning management in hospital and community-based intervention | Control | 3 (10). | 24 (80).0 | 3 (10) . | 0 | 0 | 4 (4 – 4) | 0.23 |
| Intervention | 9 (31). | 16 (55.2) | 2 (6.9) | 2 (6.9) | 0 | 4 (4 – 5) | ||
| Rehabilitation and prevention of SAM | Control | 3 (10). | 24 (80).0 | 3 (10) . | 0 | 0 | 4 (4 – 4) | 0.60 |
| Intervention | 6 (20.7) | 19 (65.5) | 4 (13.8) | 0 | 0 | 4 (4 – 4) | ||
| Counsel parents of children with SAM | Control | 8 (26.7) | 20 (66.7) | 1 (3.3) | 1 (3.3) | 0 | 4 (4 – 5) | 0.43 |
| Intervention | 11 (37.9) | 16 (55.2) | 1 (3.4) | 1 (3.4) | 0 | 4 (4 – 5) | ||
| Enumerate the role and use of locally prepared ready to use therapeutic food | Control | 7 (23.3) | 18 (60).0 | 5 (16.7) | 0 | 0 | 4 (4 – 4) | 0.93 |
| Intervention | 8 (27.6) | 20 (69).0 | 1 (3.4) | 0 | 0 | 4 (4 – 5) | ||
| Make appropriate diet chart with locally available food | Control | 3 (10). | 19 (63.3) | 4 (13.3) | 4 (13.3) | 0 | 4 (3 – 4) | 0.16 |
| Intervention | 8 (27.6) | 12 (41.4) | 6 (20.7) | 3 (10.3) | 0 | 4 (3 – 5) |
IQR inter-quartile range TLC control group FC intervention group * based on Mann-Whitney U test
At the end of the module on SAM in paediatrics, students’ feedback on teaching–learning methods was obtained using the Likert scale. The positive response, namely strongly agree, was more among students in the FC group compared to the TLC group. However, the median total score against each component was not statistically different. The positive response (strongly agree) to negative statements, namely, (I was pressured and felt burdened during the course, this teaching method hampered my leisure time, and this module drained my personal energy level), was more for the TLC than the FC groups. The median total score against these negative components was statistically significant between groups (Table 4).
| Question | Group | Strongly agree | Agree | Neutral | Disagree | Stronly disagree | Median (IQR) | p value* |
|---|---|---|---|---|---|---|---|---|
| This course stimulated my learning interest | T LC | 12 (42.9) | 14 (50) | 2 (7.1) | 0 | 0 | .04 (4–5) | 0.72 |
| FC | 13 (46.4) | 14 (50) | 0 | 1 (3.6) | 0 | .04 (4–5) | ||
| This module improved my comprehensive understanding the knowledge/concept | TLC | 12 (40).0 | 17 (56.7) | 1 (3.3) | 0 | 0 | .04 (4–5) | 0.85 |
| FC | 13 (44.8) | 14 (48.3) | 2 (6.9) | 0 | 0 | .04 (4–5) | ||
| This teaching method motivated my self-directed learning (SDL) or independent learning skill | TLC | 9 (30).0 | 19 (63.3) | 2 (6.7) | 0 | 0 | .04 (4–5) | 0.06 |
| FC | 15 (51.7) | 14 (48.3) | 0 | 0 | 0 | .05 (4–5) | ||
| My critical thinking skill was activated by this module | T L C | 7 (23.3) | 19 (63.3) | 4 (13.3) | 0 | 0 | .04 (4–4.5) | 0.18 |
| FC | 11 (37.9) | 16 (55.2) | 2 (6.9) | 0 | 0 | .04 (4–5) | ||
| During managing the real-life scenario this teaching method will be helpful | T L C | 9 (30).0 | 20 (66.7) | 1 (3.3) | 0 | 0 | .04 (4–5) | 0.07 |
| FC | 16 (55.2) | 12 (41.4) | 0 | 1 (3.4) | 0 | .05 (4–5) | ||
| I was alert throughout the session without sleeping or being bored | T L C | 9 (30) | 17 (56.7) | 3 (10) | 1 (3.3) | 0 | .04 (4–5) | 0.59 |
| FC | 13 (44.8) | 10 (34.5) | 4 (13.8) | 2 (6.9) | 0 | .04 (4–5) | ||
| This teaching method can be utilized for other courses | T L C | 9 (30) | 18 (60) | 3 (10) | 0 | 0 | .04 (4–5) | 0.61 |
| FC | 12 (41.4) | 13 (44.8) | 2 (6.9) | 1 (3.4) | 1 (3.4) | .04 (4–5) | ||
| I was pressurized and felt burdened during the course | T L C | 15 (50).0 | 9 (30) | 0 | 5 (16.7) | 1 (3.3) | .01 (1–2) | 0.03 |
| FC | 14 (13.8) | 10 (34.5) | 6 (20.7) | 3 (10.3) | 6 (20.7) | 2.5 (2–4) | ||
| This teaching method hampered my leisure time | T L C | 13 (43.3) | 13 (43.3) | 0 | 3 (10) | 1 (3.3) | .02 (1–2) | 0.001 |
| FC | 2 (6.9) | 10 (34.5) | 9 (31) | 3 (10.3) | 5 (17.2) | .03 (2–4) | ||
| My personal energy level was drained by this module | T L C | 8 (26.7) | 12 (40) | 6 (20) | 4 (13.3) | 0 | .02 (1–3) | 0.02 |
| FC | 2 (6.9) | 12 (41.4) | 4 (13.8) | 7 (24.1) | 4 (13.8) | .03 (2–4) | ||
| The content is appropriate to handle the real-life scenario | TLC | 8 (26.7) | 15 (50) | 2 (6.7) | 3 (10) | 2 (6.7) | .04 (3.5–5) | 0.33 |
| FC | 9 (31) | 17 (58.6) | 1 (3.4) | 2 (6.9) | 0 | .04 (4–5) | ||
| Well planned module | T L C | 8 (26.7) | 20 (66.7) | 2 (6.7) | 0 | 0 | .04 (4–5) | 0.99 |
| FC | 7 (24.1) | 21 (72.4) | 1 (3.4) | 0 | 0 | .04 (4–4.5) | ||
| This teaching method is very useful for final examination | T L C | 11 (36.7) | 17 (56.7) | 2 6.7 | 0 | 0 | .04 (4–4) | 0.85 |
| FC | 10 (34.5) | 17 (58.6) | 1 (3.4) | 1 (3.4) | 0 | .04 (4–5) | ||
| My communication skill was improved by this module | T L C | 3 (10) | 21 (70) | 4 (13.3) | 1 (3.3) | 1 (3.3) | .04 (4–4) | 0.002 |
| FC | 12 (41.4) | 16 (55.2) | 0 | 1 (3.4) | 0 | .04 (4–5) | ||
| Overall, I am satisfied with this module | T L C | 12 (40).0 | 17 (56.7) | 1 (3.3) | 0 | 0 | .04 (4–5) | 0.75 |
| FC | 11 (37.9) | 16 (55.2) | 2 (6.9) | 0 | 0 | .04 (4–5) |
TLC traditional classroom FC flipped classroom * based on Mann Whitney U test
DISCUSSION
In the FC group, the performance of students in the post-test score was better compared to the TLC group while assessing the higher-order cognitive domain of the SAM module. This outcome provides the effectiveness of FC in the improvement of the academic achievement and higher-order cognitive domain of students. This result establishes the hypothesis that FC teaching is better than TLC teaching, similar to various FC studies.2,8–10 This encouraging result shows that the FC technique encourages the integration of SDL, contributes perfect and group-based classroom learning, implements further student–teacher communication, and highlights the gaining of knowledge from students.8,12,13 The level of interest towards the topic among students in the FC group was higher than in the TLC group. The FC offers independent training, more opportunities, and resilience for self-paced student study. These factors are essential for increasing interest in SAM topics in the FC group.14
In the FC group, the time spent by students outside the classroom for the subject was significantly higher than in the TLC group. The students in the FC group invested more time in designated preparatory work and group discussion. Investing more time outside class yields greater learning and a deeper understanding of the topic among students in the FC group, which explains the benefit of the FC approach in terms of high post-session test scores.15,16
The positive response, specifically ‘strongly agree,’ was more prevalent for various components of self-perceived confidence, such as confidence in the clinical approach, management, rehabilitation, prevention, counselling parents, and creating appropriate diet charts after the SAM module in the FC group, compared to the TLC group. However, the difference was insignificant between the two groups, even though the post-test score was significantly higher in the FC group. There is a need for a multicentre assessment with a larger sample size.8,9,17
The FC method favours teacher–student interaction and peer partnership, enhancing students’ intellectual potential. Students in the FC group gave positive feedback on learning interest, comprehensive understanding of the concept, independent learning skills, critical thinking, and better management in life scenarios as compared to traditional lecture-based learning. Finally, FCs strengthen high-order cognitive skills like applying knowledge, critical analysis, evaluation of the problem, and problem-solving attitude.18–21
A FC approach promotes personalized study, and it offers more privilege and resilience for self-paced training and creates freedom to utilize time effectively. The FC creates an opportunity for group study with peers and teachers, which may enhance individual students’ proficiency in medical knowledge. Students can express what they have learned and exchange concepts through presentations in a FC, compared to only reading and listening in a traditional classroom.8 FCs actively involve students and facilitators in the learning process, but in traditional classrooms, students participate passively.22 In the FC method, the self-study by students outside class involves the lower level of Bloom’s taxonomy. Inside the classroom, under the guidance of facilitators, it involves higher-order thinking, such as application and analysis, promoting deeper learning. Knowledge retention is higher in FC as compared to TLC. The most crucial benefit of FC is that it improves student attendance rates as it solves the universal problem of student absenteeism.23
A few common issues can be considered before implementing the FC in teaching. First, concrete material with less abstraction is essential for the FC model of teaching. Second, there is a requirement for more time for pre-session preparation, which provides more workload for students. Third, multiple-choice questions cannot assess core competencies like communication and teamwork.8
Limitations
Our study was done among a small groups of students. The survey explored a limited amount of content in the module due to reserved teaching hours for all subjects. Therefore, the outcome cannot be generalized. A study with a larger sample size and different module content is required to assess validity of our findings. This study did not use heterogeneous grouping; therefore, we could not validate similarities in academic levels and personality traits between students in the two groups. Further, we tested acquisition of knowledge at only one time point which may be insufficient to assess the longevity of the retained knowledge. It would be worthwhile to repeat the test to identify the potential long-term benefits of this approach.
Conclusion
The FC model encourages learning interest among students, upgrades their achievement in the final assessment, and strengthens their clinical approach and communication skills. The FC technique further requires optimization for different subjects, assignment of students, and assessment methods for students. A large, controlled study on multiple subjects is needed before introducing this teaching method as a part of the standard curriculum.
Conflicts of interest
None declared
References
- Flipped classroom improves student learning in health professions education: a meta-analysis. BMC Med Educ. 2018;18:38.
- [CrossRef] [PubMed] [Google Scholar]
- Flipped classroom versus traditional lecture in training undergraduates in paediatric epilepsy. J Family Med Prim Care. 2020;9:4805-8.
- [CrossRef] [PubMed] [Google Scholar]
- Advances in medical education and practice: student perceptions of the flipped classroom. Adv Med Educ Pract. 2017;8:63-73.
- [CrossRef] [PubMed] [Google Scholar]
- Evaluation of the flipped classroom approach in a veterinary professional skills course. Adv Med Educ Pract. 2014;5:415-25.
- [CrossRef] [PubMed] [Google Scholar]
- Flipped classroom: A concept for engaging medical students in learning. Indian Paediatr. 2018;55:507-12.
- [CrossRef] [Google Scholar]
- Competency-based medical education, entrustment, and assessment. Indian Paediatr. 2015;52:413-20.
- [CrossRef] [PubMed] [Google Scholar]
- Cultivating lifelong learning skills during graduate medical training. Indian Paediatr. 2016;53:797-804.
- [CrossRef] [PubMed] [Google Scholar]
- Comparison between flipped classroom and lecture-based classroom in ophthalmology clerkship. Med Educ Online. 2017;22:1395679.
- [CrossRef] [PubMed] [Google Scholar]
- Flipped classroom approach used in the training of mass casualty triage for medical undergraduate students. Disaster Med Public Health Prep. 2022;16:94-101.
- [CrossRef] [PubMed] [Google Scholar]
- The effect of case-based teaching and flipped classroom methods in comparison with the lecture method on learning and satisfaction of internship students in surgery. J Educ Health Promot. 2020;9:256.
- [CrossRef] [PubMed] [Google Scholar]
- Introduction of interactive teaching for undergraduate students in community medicine. Indian J Community Med. 2020;45:72-6.
- [CrossRef] [PubMed] [Google Scholar]
- Learning with technology in physiotherapy education: design, implementation and evaluation of a flipped classroom teaching approach. BMC Med Educ. 2019;19(1):291.
- [CrossRef] [PubMed] [Google Scholar]
- A systematic review of the effectiveness of flipped classrooms in medical education. Med Educ. 2017;51:585-97.
- [CrossRef] [PubMed] [Google Scholar]
- Facing the challenges in ophthalmology clerkship teaching: Is flipped classroom the answer? PLoS One. 2017;12(4):e0174829.
- [CrossRef] [PubMed] [Google Scholar]
- Increased preclass preparation underlies student outcome improvement in the flipped classroom. CBE Life Sci Educ. 2015;14:ar36.
- [CrossRef] [PubMed] [Google Scholar]
- Flipped classroom as a strategy to enhance active learning. Kokubyo Gakkai Zasshi. 2015;82:1-7.
- [CrossRef] [Google Scholar]
- Friend or Foe? Flipped classroom for undergraduate electrocardiogram learning: A randomized controlled study. BMC Med Educ. 2017;17:53.
- [CrossRef] [PubMed] [Google Scholar]
- Flipped-class pedagogy enhances student metacognition and collaborative-learning strategies in higher education, but effect does not persist. CBE Life Sci Educ. 2015;14:26.
- [CrossRef] [PubMed] [Google Scholar]
- Flipping content to improve student examination performance in a pharmacogenomics course. Am J Pharm Educ. 2015;79:103.
- [CrossRef] [PubMed] [Google Scholar]
- Pharmacy student engagement, performance, and perception in a flipped satellite classroom. Am J Pharm Educ. 2013;77:196.
- [CrossRef] [PubMed] [Google Scholar]
- Flipping for success: Evaluating the effectiveness of a novel teaching approach in a graduate level setting. BMC Med Educ. 2015;15:27.
- [CrossRef] [PubMed] [Google Scholar]
- Comparison of the effectiveness of flipped classroom and traditional teaching method on the components of self-determination and class perception among university students. J Adv Med Educ Prof. 2021;9:230-7.
- [Google Scholar]
- Comparison of flipped and traditional lecture-based classrooms for Kampo (traditional Japanese medicine) education in a medical school. International J Educ Res Open. 2022;3:100156.
- [CrossRef] [Google Scholar]