Effectiveness of the flipped classroom in medical education: a systematic review and meta-analysis

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PURPOSE: This systematic review and meta-analysis aimed to evaluate the effectiveness of the FC approach compared to conventional teaching methods in medical education. METHODS: A comprehensive search of PubMed, Embase, and Web of Science databases was conducted. Eighteen eligible studies, involving diverse learner populations, were included in the analysis. The effectiveness of the FC model was assessed across five predefined domains: theoretical knowledge, procedural/technical skills, self-directed learning ability, case analysis/problem-solving ability, and learner satisfaction. RESULTS: Pooled analyses demonstrated significant advantages of the FC model, with moderate to large effect sizes observed across most outcomes. Notable improvements were found in self-directed learning ability and procedural/technical skills. Subgroup analyses suggested that residents showed larger benefits, particularly in procedural/technical skills and learner satisfaction. Sensitivity analyses generally supported the direction of the findings, although statistical significance was not retained in all leave-one-out analyses for some outcomes. CONCLUSIONS: Flipped classrooms were associated with improved outcomes in medical education, with larger effects in residents. Given high heterogeneity and limited evidence in some domains, benefits appear context dependent. Implementation should be tailored, and future studies should define mechanisms and optimal conditions.