Implementation of flipped classroom combined with case-based learning: A promising and effective teaching modality in undergraduate pathology education

The popularity of flipped classroom (FC) is growing in medical education. However, the application of FC in pathology teaching has not been well explored. This study assessed the efficacy of FC combined with case-based learning (CBL) in undergraduate pathology education via comparison with a traditional lecture-based classroom (LBC). A total of 117 third-year students were enrolled and assigned to the FC group (n = 59) or LBC group (n = 58) with demographic matches. Two sections in the pathology textbook (cardiovascular and respiratory system diseases) were chosen for the teaching content. Students in the FC group were required to study the preprovided course materials pre-class, followed by clinical case-based interactive group discussion in-class. Students in the LBC group were encouraged to preview and attended a didactic lecture in class. Post-class quizzes and Likert questionnaires were performed to investigate the efficacy and possible advantages of CBL-based FC over LBC. The scores of the 2 groups in the mid-term examination of pathology before interventions were comparable. However, students in the FC group gained significantly higher scores in the post-quizzes than those in the LBC group, especially the scores regarding the questions of clinical case analysis. In the questionnaires, more students considered CBL-based FC to be beneficial to learning motivation, knowledge comprehension, critical thinking, patient management and teamwork than LBC. In addition, more students agreed that the FC model increased pre-class burden than LBC, rather than in-class pressure. CBL-based FC modality has promising effects on undergraduate pathology education and may be a better choice than traditional LBC. Further optimizations are needed to implement this novel approach in pathology and other medicine curricula.