Based on the preliminary study conducted, it was revealed that critical thinking skills, creativity, and student learning outcomes were low in clinical refraction courses. Whereas in 21st-century learning, students must master the skills of critical thinking, communication, collaboration, and creativity (4Cs) as recommended. Because of this phenomenon, it is critical to use the appropriate learning approach; one solution offered is CBI Flipped Learning Integrated Problem-Based and Case Method (PBL-cflip). The purpose of this study is to describe the effectiveness of the CBI Flipped Learning Integrated Problem Based and Case Method (PBL-cflip) in improving student learning outcomes in clinical refraction courses. This research is quantitative, using a quasi-experimental method. Participants in this study were 61 vocational education students who took the clinical refraction course. The results showed an increase in students' critical thinking, collaboration, communication, and creativity skills, which helped them achieve the expected learning outcomes. It can be concluded that this PBL-cflip is very useful for students to understand and solve cases in clinical refraction courses and can create an interesting learning atmosphere according to student interests, making students more enthusiastic about participating in learning. The novelty of this study is the use of problem-based CBI, which is implemented in a flipped, whereas previous studies have not focused on implementing problem-based in a flipped manner
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