ArticleBMC medical education2026
Enhancing diagnostic logic in high-acuity care: evidence from an online flipped classroom intervention in emergency medicine.
Article in BMC medical education, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMedical education has increasingly embraced the flipped classroom—a pedagogical model involving pre-class online instruction followed by active problem-solving. However, its effectiveness in clinical settings where knowledge application is critical, such as clinical reasoning, requires further investigation. This study evaluated whether an online flipped classroom (OFC) approach enhances clinical reasoning performance among medical students during their emergency medicine clerkship.
methodsA quasi-experimental, single-group pre-test–post-test design was employed involving 45 medical students at Jundishapur University of Medical Sciences (2022–2023. A clinical reasoning course was developed based on a modified ADDIE instructional design model. The intervention included asynchronous e-content delivered via WhatsApp and a Learning Management System, followed by 60-minute synchronous bedside think-aloud sessions. Clinical reasoning was assessed using Objective Structured Clinical Examinations and the Clinical Reasoning Indicators History Taking Scale (CRI-HT-S).
resultsA total of 45 medical students (40% male, 60% female) participated. Statistically significant differences were found between the total mean scores before and after the intervention. The total mean score increased from 25.97 ± 2.40 (average range) to 30.40 ± 3.37 (satisfactory range). The mean difference was 4.43, which was statistically significant (P < 0.0001). In all clinical cases, post-training scores significantly exceeded pre-training values (P < 0.0001). Analysis of the CRI-HT-S scale showed the highest frequency in the domains of generally the criteria are met and approximately half of the criteria are met, demonstrating the effectiveness of the training.
conclusionThe online flipped classroom offers preliminary evidence as a feasible and valuable framework for developing clinical reasoning during clerkship. These findings provide a proof-of-concept for integrating blended learning into emergency medicine curricula to enhance diagnostic skills in high-acuity clinical domains.
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