Synergising flipped classroom and case-based learning in resource-intensive anatomy education in China: a quasi-experimental study

OBJECTIVE: This quasi-experimental study aimed to evaluate the impact of a flipped classroom (FC) combined with case-based learning (CBL) on the academic performance of first-year clinical medicine students in a human anatomy course in China, with a specific focus on higher-order cognitive skills and self-efficacy. STUDY DESIGN: A quasi-experimental design was implemented, with participants randomly assigned to an intervention group (flipped classroom case learning (FCCL), n=64) or a control group (traditional lecture-based instruction, n=64). Learning outcomes and cognitive levels were compared between the two groups. SETTING: The study was conducted at a medical school in Meizhou, China, over an 18-week period. The curriculum covered the anatomy of nine major organ systems (excluding the nervous system). PARTICIPANTS: A total of 128 first-year clinical medicine students participated. The FCCL group (63.5% male) had a mean age of 19.13±1.351 years, and the traditional group (67.1% male) had a mean age of 19.33±1.481 years. No significant differences were found in gender (p=0.580) or age (p=0.414) between the groups. INTERVENTIONS: The FCCL group engaged in pre-class activities via the ChaoXing platform, which included instructional videos, key concept outlines and clinical cases. In-class sessions were dedicated to group discussions, specimen practice and case analysis. The control group received traditional PowerPoint-based lectures and completed post-class assignments. Both groups were taught by the same instructors, shared identical learning objectives and used the same laboratory materials. MAIN OUTCOME MEASURES: Outcomes included scores on a theoretical examination (TCE) and a laboratory examination (LCE), both designed based on Bloom's taxonomy; responses on a self-efficacy questionnaire (incorporating Likert-scale and open-ended items); and qualitative analysis of reflective journals from the FCCL group. RESULTS: No significant difference was observed in TCE scores between the FCCL and traditional groups (59.52%±15.67% vs 55.5%±14.31%, p=0.136). However, the FCCL group scored significantly higher on the LCE (65.94%±13.71% vs 57.27%±16.95%, p=0.004). Furthermore, the intervention group demonstrated superior performance on higher-order cognitive questions (application-type: +8%, p=0.036; analysis-type: +11%, p=0.009). Questionnaire results indicated that the FCCL approach enhanced students' learning motivation, critical thinking and collaborative skills (mean Likert scores >4.5). CONCLUSION: The integration of FC with CBL effectively enhanced medical students' higher-order cognitive abilities in anatomy, particularly in practical application and analytical skills, although its effect on the short-term retention of theoretical knowledge was limited. This approach offers a viable pathway for reforming anatomy education, though future studies with larger samples and longer follow-up are warranted.