Babak Saatchi, PhD Student, Sue & Bill Gross School of Nursing, University of California, Irvine

Using the flipped classroom model has become a popular approach in higher education within the past years. In contrast to traditional classrooms in which the knowledge is passively delivered to students via lectures inside the class, flipping or inverting classroom consists of providing students with content prior to the class, and then using the class time as an opportunity for applying the learned knowledge with active learning practices (Chen, Lui, & Martinelli, 2017). Despite the evidence regarding positive student perceptions toward flipped classrooms, there are mixed notions about the effectiveness of this approach in health sciences education. Accordingly, we provided a summary of the latest evidence and recommendations in the last five years regarding flipped classrooms in health sciences.

In a systematic review study, Betihavas, Bridgman, Kornhaber, and Cross (2016) found neutral to enhanced academic outcomes and mixed results in terms of student satisfaction when the flipped classrooms were used in nursing education. Flipped classrooms can provide a student-centered framework for nursing students to employ critical thinking skills and apply the learned theories to nursing practice. Explaining the aims and rationale of flipped classrooms to students were identified as a foundational factor in engaging students in the flipped classrooms approach. The authors also underlined the need for further investigation with regard to the implementation and use of flipped classrooms in nursing education.

In another systematic review, Chen et al. (2017) explored the effectiveness of using flipped classrooms in medical education. The authors reviewed nine studies and demonstrated an increase in the number and quality of research on employing flipped classrooms in medical education. It is found that flipped classrooms are popular among medical students—according to the existing positive perception among students—however, the evidence about the associations between flipped classrooms and changes in knowledge and professional practice skills is inconclusive and requires further scrutiny.
Hew and Lo (2018) examined the effect of using flipped classrooms in health professions education compared to traditional classrooms. In this meta-analysis, the authors assessed 28 comparative studies between flipped and traditional classrooms across different fields in health sciences—Medicine, Dentistry, Nursing, and Public Health. The findings showed a statistically significant effect (standardized mean difference, SMD = 0.33, 95% confidence interval, CI = 0.21–0.46, p < 0.001) in using flipped classrooms in health sciences education. Using the flipped classroom approach assisted the health sciences students to have free access to pre-recorded material, which could be watched at any time as per students’ pace and desire. At the same time, students had more time to interact with their peers during the small-group discussion in the class and to apply their learnings with active learning opportunities.


• One shared theme is for instructors to inform their students about the aims, importance, and potential benefits of flipped classrooms before applying them into their classes (Betihavas et al., 2016; Hew & Lo, 2018). For instance, instructors may want to explain to their students that it is fundamental to spend time before coming to the class watching the pre-recorded lectures to better participate in active learning strategies, engage in group discussions, and grasp the information provided during the class. Many students come from secondary education settings that active learnings might not be something they experienced, and therefore it is essential to take different educational backgrounds into account. They could also communicate to the students regarding the benefits they can obtain in flipped classrooms, such as opportunities to apply the knowledge gained in lectures and readings with class activities and improve their critical thinking and problem-solving skills, which are considered higher-order cognitive skills.
• Instructors may minimize the duration of pre-recorded lectures to shorter segments like 20-to-25-minute fragments (Hew & Lo, 2018), so students do not spend a lot of time outside of the class to watch the recordings and be able to rewatch them later without consuming a considerable amount of time. This is one of the challenging parts of using flipped classrooms as some students may not find it engaging to watch hours of recordings or simply not have the time due to their responsibilities outside of the class. This is also the case when instructors use multiple readings (8 or more) before the class to discuss those readings in the class. In such cases, assigning fewer readings or making some of the readings optional for students is better.
• Another recommendation is to set the class tone with a short quiz at the start of each session. This is identified to make flipped classrooms more effective, as instructors can have an opportunity for assessing shortfalls in prior knowledge of their students, and students could make connections between their prior knowledge and the things they learn before the class. For example, interactive polling platforms like Kahoot or Poll Everywhere are great tools to create short quizzes with approximately 5 to 10 questions to assess students’ learned material and prior knowledge at the start of a class.

Future Directions

There are some areas regarding flipped classrooms and their use in health professions education that future studies need to explore: (1) given most flipped classrooms include a pre-recorded lecture component, it is important to investigate different video lecturing styles and their effect on students learning experience (Hew & Lo, 2018) (2) health professions students are predominantly trained to work closely with patient populations and their families, and thus it is worthy of examining the potential outcomes of using flipped classrooms in relation to the application of knowledge in professional practice and patient care (Chen et al., 2017) (3) assessing the associations between employing flipped classrooms and improvements in higher-order cognitive skills like higher categories seen in the Bloom’s Taxonomy, and (4) most importantly, understanding long term impacts of flipped classrooms in students’ knowledge retention.



Betihavas, V., Bridgman, H., Kornhaber, R., & Cross, M. (2016). The evidence for ‘flipping out’: A systematic review of the flipped classroom in nursing education. Nurse education today, 38, 15-21. doi:10.1016/j.nedt.2015.12.010
Chen, F., Lui, A. M., & Martinelli, S. M. (2017). A systematic review of the effectiveness of flipped classrooms in medical education. Medical Education, 51(6), 585-597. doi:10.1111/medu.13272
Hew, K. F., & Lo, C. K. (2018). Flipped classroom improves student learning in health professions education: a meta-analysis. BMC Medical Education, 18(1). doi:10.1186/s12909-018-1144-z