The primary goal of the educational system in medical fields is to achieve deep learning among learners, ensuring that the effects of education are evident in their future professional behavior. This study aimed to determine and compare of the flipped classroom method using clinical scenarios and educational technology versus subject-based lectures in the course of gastrointestinal physiology for medical students.
In terms of learning outcomes, researchers have shown higher post-test scores for medical students using the flipped classroom method compared to those learning from the subject-based lecture method. The improvement in students’ grades demonstrates the effectiveness of flipped classroom teaching techniques, consistent with previous studies [13]. Many investigations have indicated that a flipped classroom is associated with effective learning, understanding, and retention of medical content [14, 15]. However, this study is unique because it extended the flipped classroom with clinical scenarios and the use of instructional technology.
In traditional lectures, students are often passive due to the lack of mechanisms to ensure intellectual engagement with the material. Additionally, students’ attention wanes quickly after fifteen to twenty-five minutes [16]. The results align with previous studies that have shown the implementation of flipped learning as a promising teaching method [17]. The test effect shows the positive impact of recalling information on long-term memory retention [18], which is improved in the flipped classroom method. Evaluation post-test scores for the flipped classroom method are significantly higher than those for the traditional lecture method. Afrashtehfar et al. (2022) reviewed valid publications in the field of the flipped class and reported greater effectiveness of this method than the traditional one, especially for the highly collaborative and technology-friendly population of the current student generation [19].
Students indicated that after studying the pre-presented course materials, discussing them in groups along with clinical scenarios, and solving them with the help of the teacher, they could remember the material for a long time and achieve a deeper understanding of basic and clinical science concepts. These results are consistent with the Ebbinghaus forgetting curve, which reports a direct relationship between memory and time [20]. Medical students take control and responsibility for their own learning in terms of subject mastery, study speed, and class attendance. They are also more receptive to critical thinking and are not afraid to solve their problems in such meetings. While actively participating in discussions and solving clinical scenarios in the flipped classroom, students can improve their levels in Bloom’s taxonomy, such as application, analysis, and synthesis of knowledge, and achieve the ability to lead and work in a team.
In the traditional teaching method, the focus is on the subject rather than individual needs, limiting the understanding of concepts and solving clinical scenarios for each student. However, in the flipped classroom method, individualized and differentiated learning is enhanced by solving clinical scenarios and performing practical procedures. Students can focus their efforts and time on individual learning needs and future preparation. Therefore, they are not bored by class discussions and solving clinical scenarios that move too quickly or by class time spent covering material that has already been studied. This method can be effective for active students to learn course material in a short period and use the extra time to acquire psychomotor skills related to patient care [21].
In terms of practical skills outcomes, researchers have shown better practical skills for medical students using the flipped classroom method compared to students’ skills from the subject-based lecture method in the course of gastrointestinal physiology. Practical learning is an important part of a medical student’s professional development and extends throughout their career [22]. The primary goal of medical education is to produce specialists whose most important task is to treat patients [23]. The flipped classroom method helped improve the cognitive skills, psychomotor skills, and performance attitudes of medical students by creating more time and in-depth understanding of concepts, indicating that it is a reliable teaching method with a strong capacity to improve students’ clinical performance. Moreover, students stated that in the flipped classroom method, they had more time to perform practical procedures in the skill lab, which helped promote their performance, individual needs, and self-confidence.
Laboratory courses are believed to play an important role in scientific theory courses by providing opportunities for students to acquire experimental skills and collaborative learning skills [10]. The use of technology-based learning has been a growing trend in education. A generation of medical sciences students who have come of age in the technology era are not only attracted to technology-based learning platforms but also demonstrate better objective learning compared to traditional modalities [24]. Despite better post-test scores in the intervention group, students’ satisfaction in gastrointestinal physiology in the theoretical and practical sections was higher in the control group compared to the intervention group. Additionally, most students in the flipped classroom group stated that although this method was more useful, they felt stressed during the sessions and required more time to study and prepare for the exam in each session. Christopher (2018) found that students felt the flipped classroom model compounded their time pressure, with 75% agreeing that it meant they were spending more time on self-study. Of the students, 60% agreed that they liked the flexibility in their learning [11].
Along with our study, Tang (2022) used the flipped classroom method for teaching ophthalmology. According to his results, this method enhanced the learning motivation and communication skills of the learners. The post-test score of knowledge increased after the implementation of the flipped classroom. However, they reported that students did not prefer the flipped class to a lecture-based method. A previous study reported no effect on student satisfaction regarding the learning environment in the flipped classroom method [25]. However, a recent study indicated that the implementation of the active learning curriculum with the flipped classroom teaching method for the specialized field of pediatrics was successful according to their level of satisfaction [26]. DeLozier (2017) noted that other learning activities common in the flipped classroom (e.g., quizzes or clicker questions, pair-and-share activities, student presentations, and discussions) differ both in their effectiveness and in the conditions necessary for enhancing learning performance [27]. All medical students are completely familiar with the lecture method and are more satisfied with this method than the flipped classroom method. Therefore, they feel more comfortable during the lecture method compared to the flipped classroom method.
Generally, considering the enhancement of students’ knowledge of the course, the implementation of blended learning using the flipped classroom method and group discussion with clinical scenarios and educational technology is suggested as one of the complementary methods for providing theoretical and practical lessons. Of course, this study was only conducted on a single course, and to generalize the results, more extensive studies are required. However, the flipped classroom also has its limitations. Students often prefer traditional methods and expect the teacher to explain all the details. Additionally, students may not always complete the required homework before attending class [28]. The lack of control over students’ mental and emotional conditions while completing the satisfaction questionnaire is another challenge faced in flipped classroom teaching.
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