Answer to "What does the literature tell us about the efficacy the flipped classroom teaching method over other forms of learning?"

Research is very mixed in terms of whether the flipped classroom or traditional lecture are more efficacious. Individual studies and systematic reviews show high variability, whereas meta-analyses show clearer patterns.

Individual studies:

  • Tune et al. (2013) examined outcomes for cardiovascular, respiratory, and renal physiology subjects delivered to first-year graduate students:

    • participants in flipped course scored significantly higher on multiple-choice exams (around 11-12 percentage points).

  • Gillipsie et al (2016) found that the flipped classroom students:

    • outperformed traditional lecture group on OSCE scores

    • MCQ scores were lower than the traditional lecture group.

  • Bonnes et al.(2017) report a flipped quality improvement (QI) classroom in residency education:

    • higher perceptions of FC associated with more engagement with online modules;

    • greater knowledge of QI. 

  • Studies with paramedical staff (McLaughlin et al., 2013, 2014) found increases in:

    • class attendance;

    • students’ learning;     

    • perceived value of the flipped classroom model.

  • Geist et al, (2015) examining flipped versus traditional instruction with Baccalaureate nursing pharmacology students (pretest-posttest nonequivalent control group quasi-experimental design):

    • no significant difference in the means for the final examination;

    • knowledge gains on tests;

    • students’ positive responses towards flipped methods.

 Systematic review: 

  • Chen, Lui and Martinelli (2017) undertook a systematic review of n=9 randomised/non-randomised control studies and n=37 ‘other’ study types (including action research, pre-post designs). Of the control studies:

    • generally positive perceptions of the FC approach;

    • knowledge and skills benefits were very inconclusive.


  • Tan, Yue and Fu (2017) undertook a meta-analysis of n=29 studies in nursing education (English and Chinese) finding significant post-intervention improvement in:

    • knowledge

    • skills

    • improvement in critical thinking and problem-solving skills

    • students' self-learning abilities

    • high rating of flipped classroom pedagogy

    • satisfaction with the flipped method

  • ​Chen et al. (2018) undertook a meta-analysis of 46 studies across healthcare (n=32) and non-healthcare (n=14) studies of the flipped classroom compared with lecture-based teaching.

    • Flipped classroom had significantly better outcomes:

  • examination scores (post-intervention and pre–post change);

  • course grades;

  • but not in objective structured clinical examination scores.

         ○  Flipped classroom did not have significant benefit for studies:

  • using randomized control trials

  • non- USA countries

  • nursing and other health science disciplines

  • earlier publication years (2013 and 2014)

○   A cumulative analysis and meta-regression suggested a tendency for progressively better outcomes by year.


Bonnes, S. L. M., Ratelle, J. T., Halvorsen, A. J. M., Carter, K. J., et al. (2017) ‘Flipping the Quality Improvement Classroom in Residency Education’, Academic Medicine, 92(1), pp. 101–107.

Chen, F., Lui, A. M. and Martinelli, S. M. (2017) ‘A systematic review of the effectiveness of flipped classrooms in medical education’, Medical Education, 51(6), pp. 585–597.

Chen, K.-S., Monrouxe, L., Lu, Y.-H., Jenq, C.-C., et al. (2018) ‘Academic outcomes of flipped classroom learning: a meta-analysis’, Medical Education, 52(9), pp. 910–924.

Geist, M. J., Larimore, D., Rawiszer, H. and Sager, A. W. A. (2015) ‘Flipped Versus Traditional Instruction and Achievement in a Baccalaureate Nursing Pharmacology Course’, Nursing Education Perspectives, 36(2), pp. 114–115.

Gillispie, V. (2016) ‘Using the Flipped Classroom to Bridge the Gap to Generation Y’, Ochsner Journal, 16(1), pp. 32–36.

McLaughlin, J. E., Griffin, L. M., Esserman, D. A., Davidson, C. A., et al. (2013) ‘Pharmacy Student Engagement, Performance, and Perception in a Flipped Satellite Classroom’, American Journal of Pharmaceutical Education, 77(9), p. 196.

McLaughlin, J. E., Roth, M. T. P., Glatt, D. M., Gharkholonarehe, N. P., et al. (2014) ‘The Flipped Classroom:  A Course Redesign to Foster Learning and Engagement in a Health Professions School’, Academic Medicine, 89(2), pp. 236–243.

Tan, C., Yue, W.-G. and Fu, Y. (2017) ‘Effectiveness of flipped classrooms in nursing education: Systematic review and meta-analysis’, Chinese Nursing Research, 4(4), pp. 192–200.

Tune, J. D., Sturek, M. and Basile, D. P. (2013) ‘Flipped classroom model improves graduate student performance in cardiovascular, respiratory, and renal physiology’, Advances in Physiology Education, 37(4), pp. 316–320.