Eight practical strategies for designing case-based flipped learning to foster clinical reasoning in preclinical medical students

BACKGROUND: Flipped learning has gained increasing attention in health professions education, demonstrating potential advantages over traditional teaching methods. However, specific guidance on how to design flipped learning to effectively support clinical reasoning development in novice learners remains limited. Clinical reasoning is a cognitively demanding and complex process that requires systematic, theory-informed instructional design-particularly for students with limited medical knowledge and clinical experience. PURPOSE: This commentary aims to provide practical recommendations for designing case-based flipped learning to foster clinical reasoning in preclinical medical students. In this approach, clinical cases serve as the primary learning content, with the overarching goal of developing clinical reasoning. DISCUSSION: Eight practical strategies are presented, drawing on established learning science theories as well as my research and teaching experience. Three key messages are:Novice learners require multiple forms of instructional support in developing clinical reasoning, as it is a cognitively complex process.Instructional supports should be grounded in learning science theories and systematically integrated into case-based flipped learning to ensure successful outcomes.Managing the cognitive load of novice learners is a critical design strategy for effective case-based flipped learning. CONCLUSION: These recommendations provide guidance for educators to create structured, supportive, and engaging flipped learning environments that facilitate the progressive development of clinical reasoning in preclinical medical students.