Whether case-based teaching combined with the flipped classroom is more valuable than traditional lecture-based teaching methods in clinical medical education: a systematic review and meta-analysis

Abstract

Background: An increasing body of evidence suggests that both flipped classroom and case-based teaching models outperform traditional teaching methods in clinical medical education. Both teaching methods share several advantages, including a student-centered approach, enhanced understanding and mastery of knowledge, the development of comprehensive skills, and an emphasis on interactive communication. Therefore, a teaching model that integrates both methods may achieve similar or even better educational outcomes. Although previous studies have demonstrated this, they are generally limited by small sample sizes and inconsistent evaluation criteria for teaching effectiveness. This study aims to provide a high-quality assessment of this teaching method through meta-analysis and systematic review, further confirming its value in the field of clinical medical education.

Methods: This study employed a meta-analysis to systematically and quantitatively compare the educational impact of a teaching model combining flipped classroom and case-based learning (Flipped Classroom Case Learning, FCCL) with traditional lecture-based learning (LBL) for clinical medical students. An extensive literature search was conducted to identify studies on the application of FCCL and LBL in clinical medical education, covering the period from inception to November 21, 2024. Databases searched included the Cochrane Library, Web of Science, Embase, and PubMed. A total of 12 studies were included, comprising 1,857 clinical medical students or residents. The quality of each included study was assessed using RevMan (Version 5.4). The primary outcome measures were students' theoretical scores and clinical analytical skills. The extracted data were subjected to meta-analysis using Stata 18.0 software.

Results: A total of 1,857 participants from 12 studies were included in the analysis. The meta-analysis revealed that the FCCL group demonstrated significantly superior theoretical scores (Cohen's d = 0.60, 95% CI: 0.17 to 1.04, P = 0.01) and clinical analysis skills (Cohen's d = 1.53, 95% CI: 0.86 to 2.19, P = 0.00) compared to the LBL group. The Cohen's d for clinical analytical skills was 1.53 (> 0.8), indicating a large effect size between the two groups, suggesting a significant difference between the FCCL and LBL groups in improving students' clinical analytical skills. In contrast, the Cohen's d for theoretical scores was 0.60(approximately 0.5), indicating a moderate effect size, suggesting a moderate difference between the FCCL and LBL groups in improving students' theoretical knowledge. Subgroup analyses indicated that Chinese students in the FCCL group exhibited better theoretical performance (SMD = 1.03, 95% CI: 0.30 to 1.77, P = 0.01; heterogeneity, P = 0.00) and clinical analysis skills (SMD = 2.54, 95% CI: 1.06 to 4.02, P = 0.00; heterogeneity, P = 0.00) compared to their LBL counterparts. Among students from Western countries, those in the FCCL group outperformed the LBL group in clinical analysis skills (SMD = 0.45, 95% CI: 0.26 to 0.63, P = 0.00; heterogeneity, P = 0.21). However, no significant difference in theoretical scores was observed between the two teaching methods in this subgroup (SMD = 0.10, 95% CI: -0.28 to 0.48, P = 0.60; heterogeneity, P = 0.00).

Conclusion: The present study demonstrates that FCCL is more effective than LBL in enhancing clinical medical students' theoretical scores and clinical analysis skills. These findings were generally consistent across different nationalities of the study populations, with the exception of students from Western countries, where no statistically significant difference was observed in theoretical scores between the two instructional methods. However, due to the inevitable methodological differences among the included studies, heterogeneity is difficult to eliminate, and the overall sample size is relatively small. Therefore, further randomized controlled trials with rigorous experimental designs are needed to confirm these conclusions.

Keywords: Clinical medicine; Education; Flipped classroom case learning (FCCL); Lecture-based learning (LBL).