Main Article Content


In a flipped classroom, class’ lecture is delivered as a video to students before the class is held, and the actual time of the class is spent on problem solving and discussions. As there is a need for further clarification of the way of using this method, in this study, we assessed the effect of the sequence of flipped and lecture-based classes on medical students’ learning and satisfaction in Emergency Medicine theoretical course. For this purpose, 59 medical students participated in this quasi-experimental study who were divided into two flipped-first and lecture-first groups. Eight topics were selected to be taught. Firstly, students took a pre-test covering these topics’ objectives. Afterward, in the lecture-first group, 4 topics were taught through lecturing while the next 4 topics were taught through flipped classroom method. Then the teaching method was shifted for the flipped-first group. Finally, students’ answered the satisfaction survey and post-test questions. Indeed, not only the final score of the flipped-based topics in both groups was significantly higher than lecture-based ones (P-value = 0.022), but also the post-test score of all topics were significantly higher in the flipped-first group (P-value = 0.032).  In addition, the satisfaction score for the flipped-based topics was higher than the lecture-based one (P-value = 0.011). As a conclusion, flipped classroom approach could increase medical students’ learning as well as their satisfaction and it is recommended that flipped classes be applied from the beginning of the course to be more effective.


Teaching Methods Learning Flipped Classroom Emergency Medicine Satisfaction

Article Details

How to Cite
Shabani, A., Mohammadi, A., Mojtahedzadeh, R., Hosseini, A., Valadkhani, S., Sistani, A., Asadzandi, S., & Rashidi, H. (2020). Does the sequence of flipped and lecture-based classes affect the academic achievement and satisfaction of medical students?. Journal of E-Learning and Knowledge Society, 16(4), 86-93.


  1. Afurobi, A, Izuagba, A, Obiefuna, C, & Ifegbo, P. (2015). Effects of the Use of Lecture Method and Wordle on the Performance of Students Taught Curriculum Studies 1: EDU222. Journal of Education and Practice, 6(18), 142-149.
  2. Alluri, R.K, Tsing, P, Lee, E, & Napolitano, J. (2016). A randomized controlled trial of high-fidelity simulation versus lecture-based education in preclinical medical students. Medical teacher, 38(4), 404-409.
  3. Bala, P, Kaur, T, & Kaur, M. (2017). Study on Effectiveness of Lecture and Smart Class Method of Teaching on Academic Achievements among Upper Primary School Students. International Letters of Social and Humanistic Sciences, 76, 25-29.
  4. Belfi, L.M, Bartolotta, R. J, Giambrone, A.E, Davi, C, & Min, R. (2015). “Flipping” the introductory clerkship in radiology: impact on medical student performance and perceptions. Academic radiology, 22(6), 794-801.
  5. Bishop, J.L, & Verleger, M.A. (2013). The flipped classroom: A survey of the research. Paper presented at the ASEE national conference proceedings, Atlanta, GA.
  6. Bove, A. (2008). Internet-Based Medical Education. Perspectives in Biology and Medicine 51(1), 61-70.
  7. Boysen-Osborn, M, Anderson, C.L, Navarro, R, Yanuck, J, Strom, S, McCoy, C.E, . . . Langdorf, M. (2016). Flipping the advanced cardiac life support classroom with team-based learning: comparison of cognitive testing performance for medical students at the University of California, Irvine, United State. Journal of educational evaluation for health professions, 13.
  8. Chen, F, Lui, A.M, Martinelli, & Chen, F. (2017). medical education in review A systematic review of the effectiveness of fl ipped classrooms in medical education.
  9. Chen, F, Lui, A.M, & Martinelli, S. (2017). A systematic review of the effectiveness of flipped classrooms in medical education. Medical education, 51(6), 585-597.
  10. Dall’Amico E., Verona S. (2015), Cross-country survey on soft skills required by companies to medium/high skilled migrants, Methodological approach for a common framework of Soft Skills at work. VHSM report retrieved from the website of VHSM project - Valorize High Skilled Migrants-, no. 2014-1-IT02-KA204-003515, co-funded by the ERASMUS+ Program of the European Union website:
  11. Della Ratta, C.B. (2015). Flipping the classroom with team-based learning in undergraduate nursing education. Nurse Educator, 40(2), 71-74.
  12. Docherty CHoy , D , Topp, H, & Trinder, K. (2005). e Learning techniques supporting problem based learning in clinical simulation. International Journal of medical informatics74(7), 527-533.
  13. Enfield, J. (2013). Looking at the impact of the flipped classroom model of instruction on undergraduate multimedia students at CSUN. TechTrends, 57(6), 14-27.
  14. Heitz, C, Prusakowski, M, Willis, G, & Franck, Ch. (2015). Does the concept of the “flipped classroom” extend to the emergency medicine clinical clerkship? Western Journal of Emergency Medicine, 16(6), 851.
  15. Kaur, G. (2011). Study and Analysis of Lecture Model of Teaching. International Journal of Educational Planning & Administration., 1(1), 9-13.
  16. Koo, C. L, Demps, E.L, Farris, Ch, Bowman, J, Panahi, L, & Boyle, P. (2016). Impact of flipped classroom design on student performance and perceptions in a pharmacotherapy course. American journal of pharmaceutical education, 80(2).
  17. Liebert, C, Lin, D, Mazer, L, Bereknyei, S, & Lau, J. (2016). Effectiveness of the surgery core clerkship flipped classroom: a prospective cohort trial. The American Journal of Surgery, 211(2), 451-457. e451.
  18. Liebert, C, Mazer, L, Merrell, S, Lin, D, & Lau, J. (2016). Student perceptions of a simulation-based flipped classroom for the surgery clerkship: A mixed-methods study. Surgery, 160(3), 591-598.
  19. Ma, X, Luo, Y, Zhang, L, Wang, J, Liang, Y, Yu, H, . . . Cao, M. (2018). A Trial and Perceptions Assessment of APP-Based Flipped Classroom Teaching Model for Medical Students in Learning Immunology in China. Education Sciences, 8(2), 45.
  20. McLaughlin, J, Griffin, L, Esserman, D, Davidson, Ch, Glatt, D, Roth, M, . . . Mumper, R. (2013). Pharmacy student engagement, performance, and perception in a flipped satellite classroom. American journal of pharmaceutical education, 77(9).
  21. Missildine, K, Fountain, R, Summers, L, & Gosselin, K. (2013). Flipping the classroom to improve student performance and satisfaction. Journal of Nursing Education, 52(10), 597-599.
  22. O'Connor, E, Fried, J, McNulty, N, Shah, P, Hogg, J, Lewis, P, Reddy, S. (2016). Flipping radiology education right side up. Academic radiology, 23(7), 810-822.
  23. OECD (2018), Preparing our youth for an inclusive and sustainabe world: The OECD PISA global competence framework,
  24. OECD (2019), OECD Future of education and skills 2030, Conceptual learning framework,
  25. Park, Sang E, & Howell, T. (2015). Implementation of a flipped classroom educational model in a predoctoral dental course. Journal of dental education, 79(5), 563-570.
  26. Pettit, R, McCoy, L, & Kinney, M. (2017). What millennial medical students say about flipped learning. Advances in medical education and practice, 8, 487.
  27. Ramnanan, Ch, & Pound, L. (2017). Advances in medical education and practice: student perceptions of the flipped classroom. Advances in medical education and practice, 8, 63.
  28. Rose, E, Jhun, P, Baluzy, M, Hauck, A, Huang, J, Wagner, J, . . . Claudius, I. (2018). Flipping the classroom in medical student education: does priming work? Western Journal of Emergency Medicine, 19(1), 93.
  29. Sawarynski, K.E, Eastwood, J, & Iyer, N. (2013). An Integrated, Flipped Classroom Model for Medical Education. FASEB J, 27, 517.511.
  30. Street, S, Gilliland, K, McNeil, Ch, & Royal, K. (2015). The flipped classroom improved medical student performance and satisfaction in a pre-clinical physiology course. Medical Science Educator, 25(1), 35-43.
  31. Tang, F, Chen, Ch, Zhu, Y, Zuo, Ch, Zhong, Y, Wang, N, Liang, D. (2017). Comparison between flipped classroom and lecture-based classroom in ophthalmology clerkship. Medical education online, 22(1), 1395679.
  32. Vieira, D.A., Meirinhos, V., Ardions, A., Araújo, M.S., Carvalho, P. (2019), Soft skills list and Mind map. ULISSE IO2 Soft Skills Report 2. Retrieved from the website of the ULISSE Project - Understanding, Learning and Improving Soft Skills for Employability-, no. 2018-1-IT01-KA203-048286, co-funded by the ERASMUS+ Program of the European Union website:
  33. Whillier, S, & Lystad, R.P. (2015). No differences in grades or level of satisfaction in a flipped classroom for neuroanatomy. Journal of Chiropractic Education, 29(2), 127-133.
  34. Wozny, N, Balser, C, & Ives, D. (2018). Evaluating the flipped classroom: A randomized controlled trial. The Journal of Economic Education, 49(2), 115-129.