Academic outcomes of flipped classroom learning: a meta-analysis

Abstract

ContextThe flipped classroom (FC), reversing lecture and homework elements of a course, is popular in medical education. The FC uses technology‐enhanced pre‐class learning to transmit knowledge, incorporating in‐class interaction to enhance higher cognitive learning. However, the FC model is expensive and research on its effectiveness remains inconclusive. The aim of this study was to compare the efficacy of the FC model over traditional lecture‐based (LB) learning by meta‐analysis.MethodsWe systematically searched MEDLINE, PubMed, ERIC, CINAHL, EMBASE, reference lists and Association for Medical Education in Europe (AMEE) conference books. Controlled trials comparing academic outcomes between the FC and LB approaches in higher education were considered eligible. The main findings were pooled using a random‐effects model when appropriate.ResultsForty‐six studies (9026 participants) were included, comprising four randomised controlled trials (RCTs), 19 quasi‐experimental studies and 23 cohort studies. Study populations were health science (n = 32) and non health science (n = 14) students. The risk of bias was high (36/37 articles). Meta‐analyses revealed that the FC had significantly better outcomes than the LB method in examination scores (post‐intervention and pre–post change) and course grades, but not in objective structured clinical examination scores. Subgroup analyses showed the advantage of the FC was not observed in RCTs, non‐USA countries, nursing and other health science disciplines and earlier publication years (2013 and 2014). Cumulative analysis and meta‐regression suggested a tendency for progressively better outcomes by year. Outcome assessments rarely focused on behaviour change.ConclusionsThe FC method is associated with greater academic achievement than the LB approach for higher‐level learning outcomes, which has become more obvious in recent years. However, results should be interpreted with caution because of the high methodological diversity, statistical heterogeneity and risk of bias in the studies used. Future studies should have high methodological rigour, a standardised FC format and utilise assessment tools evaluating higher cognitive learning and behaviour change to further examine differences between FC and LB learning.

The impact of flipped classrooms on student achievement in engineering education: A meta‐analysis of 10 years of research

“…Similarly, both the meta‐analyses for the health profession indicated statistically significant overall effect sizes in favor of the flipped classroom. The effect sizes were SMD = 0.468 in Chen et al () and Hedges' g = 0.33 in Hew and Lo (). As a side note, the difference in effect sizes in the two studies of the health profession was due to two reasons.…”

“…At the time of this article, only a few flipped classroom meta‐analyses papers had been published. For example, one was in mathematics education (Lo et al, ) and two were in the context of the health profession (Chen et al, ; Hew & Lo, ). The meta‐analysis of flipped mathematics education showed an overall positive significant effect of Hedges' g = 0.298 in favor of the flipped classroom over the traditional classroom.…”

“…As a side note, the difference in effect sizes in the two studies of the health profession was due to two reasons. First, Hew and Lo (2018) included more academic database sources than Chen et al (2018). Second, more recent articles were included and analyzed by Hew and Lo (2018).…”

“…These additional articles yielded findings that changed the overall effect size. According to Cohen (1988), the overall effect sizes in the meta-analyses of other subject disciplines (i.e., Chen et al, 2018;Hew & Lo, 2018;Lo et al, 2017) suggest that the flipped classroom results in a small positive effect on student achievement outcomes. Our quantitative result of flipped engineering courses (Hedges' g = 0.289) appears comparable to the existing metaanalytic studies.…”

Flipped learning: Turning medical education upside down

“…There is evidence that the approach may facilitate deeper learning as it encourages active, rather than passive learning, often seen with didactic lectures. [6][7][8] In published studies, flipped learning demonstrates greater student engagement and satisfaction, but does not always demonstrate higher assessment scores. A systematic review of 82 papers suggests that flipped learning is a promising approach to increasing student motivation and engagement, but that there remains a lack of evidence for its effectiveness with regards to knowledge retention and transfer.…”