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Health Professions Education xxx (xxxx) xxx
www.elsevier.com/locate/hpe

Comparing the effects of individual versus group face-to-face class

activities in flipped classroom on student's test performances
Hawazen Rawas a,*, Nusrat Bano a, Salwa Alaidarous b
a
College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
b
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
Received 7 January 2019; revised 1 June 2019; accepted 13 June 2019

Abstract

Background: Flipped classroom is an active learning instructional design in which students are required to complete pre-class
learning assignments and participate in concept application activities during class time. There is limited evidence describing the
most appropriate type of class activity facilitating better test performance in students engaged in flipped classroom learning.
Purpose: The purpose of this study was to compare effects of individual versus group face-to-face class activities in flipped
classroom on student’s test performances.
Method: A two-group post-test only true experimental study design was used. Students were randomly assigned in group 1 and
group 2. Students in both of the groups completed identical pre-class learning assignments. Face-to-face class sessions in group 1
comprised of small group activities where as group 2 completed individualized tasks during class time. Students in both the groups
completed a test comprising of assessment items in Fink’s taxonomy learning domains. Test scores in each domain were compared
between the two groups.
Results: Test performance in Group 1 was better in learning domains of foundation of knowledge, application and integration
whereas Group 2 performed comparatively better in domains of human dimension and caring. The study revealed that the mean test
score of students in group 1 (face-to-face class activities) was better than group 2 (individual face-to-face class activities) and the
difference across Group 1and Group 2 was significant (P ¼ <0.001).
Conclusion: Flipped classroom design with group based face-to-face class activities yielded better test scores compared to the
design comprising of individual face-to-face class activities.
© 2019 King Saud bin Abdulaziz University for Health Sciences. Production and Hosting by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords: Flipped classroom; Group; Individual; Face-to-face activities; Test performance

1. Introduction

Flipped classroom (FC) is an active learning

* Corresponding author. instructional design that requires students to participate
E-mail address: rawassh@ksau.edu.sa (H. Rawas). in face-to-face class sessions after completing pre-class
Peer review under responsibility of AMEEMR: the Association learning assignments.1 It is a constructivist learner-
for Medical Education in the Eastern Mediterranean Region.

https://doi.org/10.1016/j.hpe.2019.06.002
2452-3011/© 2019 King Saud bin Abdulaziz University for Health Sciences. Production and Hosting by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article as: Rawas H et al., Comparing the effects of individual versus group face-to-face class activities in flipped classroom on
student's test performances, Health Professions Education, https://doi.org/10.1016/j.hpe.2019.06.002
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2 H. Rawas et al. / Health Professions Education xxx (xxxx) xxx
centered pedagogical model employed to improve
learning experiences in students.2 It was used to
enhance student engagement3,4 and develop critical
thinking skills.5 Improvements with flipped classroom
are considered to be the outcome of active learning.6
Students are shown to benefit from this instructional
method when the learning is adequately planned,
aligned and effectively executed.7 It is therefore
important to understand the theoretical underpinnings
of flipped classroom.
In the flipped classroom, most of the pre-class ac-
tivities are traditional but the face-to-face class ses-
sions are based on constructivist principles.8 Based on
this principle, students are not considered to be ‘empty
vessels’ in which knowledge could be poured from the
instructors, but rather knowledge is to be constructed
by students for themselves. Student input is pivotal in
constructivist classrooms as they play a three
edimensional role of a social, active and creative
learner.8,9 As per Piaget and Dewey, cognitive conflict
and experience of ‘puzzlement’ is crucially important
for the creation of knowledge. Flipped classroom is
deep rooted in the principle of active learning by Piaget
and Dewey, as knowledge dissemination occurs in pre-
class activity and the social, active and creative learner
experiences ‘puzzlement’ in an controlled learning
environment in face-to-face class sessions.8,10 Due to
its core active learning component, flipped classroom
is widely acclaimed by enthusiastic and energetic
instructors.
There is lots of excitement centered on the concept
of flipped classroom in recent years11 and a robust rise
in enthusiastic research on the subject is noted.11,12
Similarly, popularity of flipped classroom is also crit-
icized.13,14 It is mainly because of the varying reports
regarding the effectiveness and utility of the model.
Some studies have shown that flipped classroom im-
proves academic performance of the student and yields
positive outcomes15e17 at the same time, there are
mixed reports on student satisfaction with the
model.16,18 There are several kinds of evidence on
flipped classroom. Owing to the enormous difference
in the basic design and theoretical aspects between
flipped classroom and traditional classroom, these two
models are not truly comparable. However, numerous
studies based on this comparison are already
reported.19e21 Some studies found that flipped class-
room is more effective17 whilst others did not find any
significant differences in the learning outcome of stu-
dents assigned to flipped or traditional classrooms.22,23
Investigations into the reason for the conflicting
reports on the effectiveness showed that although
Please cite this article as: Rawas H et al., Comparing the effects of individual versus group face-to-face class activities in flipped classroom on
student's test performances, Health Professions Education, https://doi.org/10.1016/j.hpe.2019.06.002
flipped classroom is an effective instructional strategy,
the differences lie in how it is implemented.11 The
design of flipped classroom is of ultimate significance
because differences in the design features are directly
related to its outcomes.24 Based on this evidence,
research focus on flipped classroom has shifted from
comparing it with traditional teaching towards
comparing the different types of design in flipped
classroom. The precedence lies in selecting the most
suitable and effective flipped classroom design in a
particular context. Most of this research is based spe-
cifically on differences in the pre-class learning stra-
tegies of flipped classroom.11,25 The two major design
components of flipped classroom are; a) pre-class
assigned learning b) face-to-face class activity. There
are several studies reporting effectiveness of pre-class
assigned learning e.g. text book style reading,26 video
tutorials, and interactive tutorials.11 On the other hand
there is very little evidence on the outcomes of the
different types of face-to-face in class activities.
Although the types of face-to-face in class activities
used are described in some studies e.g. audience clicker
response, pair and share, micro lectures, student pre-
sentations and discussion and individual or paired quiz,27
there is a dearth of actual research reporting comparative
effects of the different face-to-face class strategies in
flipped classroom. Therefore, it is identified as a problem
area of the research at hand. One of the two studies
addressing the issue is by Kim (2014), who reported the
variations of face-to-face class activities, based on
comparison between problem solving in small groups,
discussion of group projects in class and recording of
small group discussion without the presence of the in-
vestigators.28 The second study is by Eryilmaz (2019),
who compared the effectiveness of individual flipped
learning with cooperative flipped learning model and
reported its effect on student performance and anxiety.29
In view of the scarcity of evidence, the present study is
designed to fill the gap in the existing bed of knowledge
and provide evidence for the differences in the outcomes
of two different types of flipped classroom designs based
on the face-to-face class strategy.
This study takes into account the constructivist
perspective of cooperative learning as an strong
active learning method in which students work in a
group resulting in better achievements.29e32 In
addition, it also takes into consideration, the
assumption that achievements in flipped classroom
are merely the fruits of cooperative (collaborative)
learning.6,33 It is therefore interesting to explore the
outcomes of flipped classroom based on individual
face-to-face class strategy and compare them with
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H. Rawas et al. / Health Professions Education xxx (xxxx) xxx
group face-to-face class strategy. The question at
hand is if flipped classroom is equally effective with
and without cooperative learning (group activity)? In
this paper, we report findings about two different
types of face-to-face class activities in support of
flipped learning outcomes on student's academic
(test) performance. Hence, the purpose of this study
was to compare effects of individual versus group
face-to-face class activities in flipped classroom on
student's test performances.
2. Method
2.1. Study design and setting
This study had a two-group post-test only true
experimental study design. It was chosen because it is
the simplest of all the experiment designs with two
groups which are randomized. But despite its
simplicity, it is considered to be a strong experimental
design. Pre-test is not required because due to random
assignment of students, it can be assumed that the two
groups are probabistically equivalent. The study was
conceptualized and conducted at College of Nursing,
in King Saud bin Abdulaziz University for Health
Sciences located in King Abdulaziz Medical City,
Jeddah.
2.2. Ethical considerations
The study was conducted after IRB approval
from the Research Office at King Abdullah Inter-
national Medical Research Center (Approval No.
IRBC/1826/18). Students were informed about the
study at the end of the study to avoid reactivity and
minimize the Hawthorne effect.34,35 Informed con-
sent was attained from each respondent and data
was excluded from final assessment for those
refusing participation.
2.3. Study respondents
Students enrolled in Medical/Surgical course in
the Fall semester (Academic year 2017/18) were
included in the study (N ¼ 100). Prior to admission in
the BSN degree program at the college they had
studied from either the Governmental Regular Sys-
tem (G1), Governmental Course System (G2) or the
Private Education System (P1). The study re-
spondents were randomly allocated to two groups by
the academic office using a computer generated
random allocation.
Please cite this article as: Rawas H et al., Comparing the effects of individual versus group face-to-face class activities in flipped classroom on
student's test performances, Health Professions Education, https://doi.org/10.1016/j.hpe.2019.06.002
3
2.4. Instructional design
The flipped classroom model was used in both
groups of students. The pre-class learning assignment
was kept identical in both the groups. The course
content and the instructors were same for both the
groups. The difference in group 1 and group 2 was
based on how the class time was used which comprised
of two different types of face-to-face activities (Fig. 1).
2.4.1. Pre-class learning assignment
The pre-class learning assignment was identical for
group 1 and group 2. The e-learning software,
‘Blackboard Learn © 1997e2018 Blackboard Inc.’ was
used to generate online learning resources and each
student had access to the same content. The student
pre-class learning activity was tracked by the facilitator
who noted the number of times the content was
accessed and reviewed by each student. This enabled
the facilitator to send reminders to passive students via
email. The learning resource comprised of online
videos and power point slides with voice over. The
discussion board was also active and the facilitators
guided discussion in both the groups. The students
were also directed to the library with book recom-
mendations for pre-class study. The instructions for
critical reading were uploaded in the ‘announcement
section’ of the Blackboard. The students was able to
communicate via email or participate in the discussion
threads anytime during the time frame dedicated for
pre-class activity.
2.4.2. Face-to-face class activity
There were two types of face-to-face class activities.
The first was a group based activity and the second was
individual student activity. The students in group 1 were
required to utilize the class time in group activities. On
the other hand, the students in group 2 were required to
utilize the class time in individual activities. The flipped
classroom model used in our study is similar to Eryilmaz
and Cigdemoglu (2019)29, who have also compared
group face-to-face class activity with individual face-to-
face class activity across two groups.
2.4.2.1. Group 1. As shown in Fig. 1, the face-to-face
class activity of group 1 comprised of students learning
in groups. In order to initiate an interactive group ac-
tivity in the students, an effective model of student-
centered learning was employed by the formation of
buzz groups.36,37 Case scenarios were uploaded on the
smart board. The students were required to participate
in a question-answer session related to the case
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Fig. 1. Flipped classroom instructional design.

scenarios. Students could discuss within their groups
and provide a single response by activating the elec-
tronic buzzer provided in each group. The entire class
time was used in this activity and the students
completed 3e6 scenarios in each class.
2.4.2.2. Group 2. As shown in Fig. 1 the face-to-face
class activity of group 2 comprised of students
learning individually. Worksheets were provided to
students to initiate individual learning activity in the
students38,39. Case scenarios were uploaded on the
smart board. The students were required to participate
in a question-answer session related to the case sce-
narios. They entered their individual responses in the
worksheets. The entire class time was used in this ac-
tivity and students completed 3e6 scenarios in each
class.
dimension, caring and learning to learn as per Fink's
taxonomy.40 The test scores were compared across the
learning domains.
2.4.4. Statistical analysis
Data was analyzed using SPSS version 20. Inde-
pendent sample t-test was used to compare differences
in the mean values of the test scores across the two
groups (Group 1 and Group 2) in each assessment
domain. ANOVA was used to test differences in student
groups with regards to educational background and
previous GPA. A p value less than 0.05 was considered
significant.
3. Results
3.1. Student demographic profile

2.4.3. Comparing test performance
Students from both the groups underwent a test
comprising of case scenarios with multiple choice
question based assessment items. The test comprised of
87 questions. Students were tested in domains of
foundation knowledge, application, integration, human
The total number of students included in the
study was 100, where Group 1 and Group 2
comprised of 51 and 49 students respectively. The
mean age of the students was 20.89 years
(SD ¼ 1.06) within a range of 19e23 years. Based
on the educational background (high-school), 71% of

Please cite this article as: Rawas H et al., Comparing the effects of individual versus group face-to-face class activities in flipped classroom on
student's test performances, Health Professions Education, https://doi.org/10.1016/j.hpe.2019.06.002
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H. Rawas et al. / Health Professions Education xxx (xxxx) xxx 5

Table 1
Test performances of Group 1 and Group 2 and compared difference (N ¼ 100).
Variables (N ¼ 100) Group I (n ¼ 51) Group II (n ¼ 49) t-test P
Mean SD Mean SD Mean SD
Assessment domains Foundation knowledge 37.3 8.89 42.2 9.38 32.2 4.37 6.885 0.001*
Application 18.5 5.37 19.8 6.37 17.0 3.66 2.705 0.008*
Integration 16.1 4.19 17.5 5.39 14.6 1.28 3.724 0.001*
Human dimension 9.7 3.47 7.0 1.27 12.6 2.64 13.350 0.001*
Caring 7.3 5.65 2.3 0.91 12.6 3.20 21.633 0.001*
Learning to learn 12.7 2.37 12.8 1.31 12.6 3.12 0.513 0.610
Overall Test Performance 56.8 10.4 63.7 7.9 49.6 7.2 9.332 0.001*
t: Student t-test, *: Statistically significant at p  0.05.

students had qualifications from the Governmental
Regular System (G1), 21% from the Governmental
Course System (G2) whereas 8% studied from the
Private Education System (P1).
3.2. Difference in test performances of group 1 and
group 2
‘human dimension’ and ‘caring’ and the difference
across the two groups was noted to be very highly
significant (p ¼ 0.001). The test results indicate that
the scores were better in the area of ‘learning to learn’
in students of Group 2 compared to the students of
Group 1 but the difference in the test scores was not
significant (p ¼ 0.610).

Table 1 shows that the difference in the overall test
performance between Group 1 and Group 2 is highly
significant (P ¼ 0.001 < 0.05). The overall test per-
formance was higher in Group 1 compared to Group 2.
The mean score for Group 1 was 63.8, and the mean
score for Group 2 was 49.6.
The difference in the domains of ‘foundation
knowledge’, ‘application’ and ‘integration’ across the
two groups was highly significant with p ¼ 0.001,
p ¼ 0.008 and p ¼ 0.001 respectively. The students in
Group 1 had a higher test score in these three areas.
Table 1 shows that the test performance of Group 2
was comparatively better than Group 1, in area of
‘human dimension’ and the difference across the two
groups was highly significant (p ¼ 0.001). The students
of Group 2 excelled in their test performance in the
area of ‘caring’ compared to Group 1 who performed
the lowest in this domain. Thus the difference across
the two groups was very highly significant in the test
performance in the domain of ‘caring’.
Table 1 shows that the test performance of Group 2
was comparatively better than Group 1 in the area of
3.3. Student test performance based on educational
background
Table 2 shows that the difference across the two
groups was statistically significant based on educa-
tional background. Higher mean test scores were noted
in Group 1 compared to Group 2 irrespective of
educational background.
3.4. Student test performance across assessment do-
mains with regard to previous GPA
The difference in the mean test scores in Group 1
and Group 2 was significantly (p ¼ 0.001) for students
within the GPA range of 3.0e3.49 in the assessment
domain ‘foundation knowledge’. A statistically sig-
nificant difference was noted in the mean test scores in
group 1 and group 2 for students from all four GPA
ranges within 2.0 and 3.99 in the assessment domains
‘human dimension’ and ‘caring’ whereas, no signifi-
cant difference was noted in the assessment domain
‘learning to learn’. There was a significant difference

Table 2
Student test performance based on educational background in Group 1 and Group 2(N ¼ 100).
Educational background Group I (n ¼ 51) Group II (n ¼ 49) t-test P
No (%) Mean SD No (%) Mean SD.
G1: Governmental regular secondary school 64.7 62.88 8.54 77.6 49.61 7.08 7.158* 0.001*
G2: Governmental course system secondary school 25.5 66.15 6.71 16.3 50.50 6.63 5.214* 0.001*
P1: Private education 9.8 63.29 7.40 6.1 46.67 11.55 2.531* 0.045*
t: Student t-test, *: Statistically significant at p  0.05.

Please cite this article as: Rawas H et al., Comparing the effects of individual versus group face-to-face class activities in flipped classroom on
student's test performances, Health Professions Education, https://doi.org/10.1016/j.hpe.2019.06.002
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6 H. Rawas et al. / Health Professions Education xxx (xxxx) xxx

Table 3
Student test performance based on previous GPA and assessment domains (N ¼ 100).
Variables GPA ranges Group 1 (n ¼ 51) Group 1 (n ¼ 49) t-test p
Mean SD Mean SD
Foundation knowledge 2.0e2.49 40.0 7.5 31.4 3.1 2.30 0.061
2.5e2.99 39.4 7.9 33.2 4.3 2.11 0.050
3.0e3.49 43.9 6.6 31.8 4.8 7.02 0.001*
3.5e3.99 38.3 13.6 30.9 1.1 0.90 0.377
4.0e5.0 46.6 4.2 e e e e
F 1.5 (0.201) 0.461 (0.711) e
Application 2.0e2.49 17.9 5.5 16.8 4.5 0.31 0.763
2.5e2.99 16.0 9.0 16.5 3.4 0.12 0.908
3.0e3.49 19.3 6.4 17.0 3.7 1.50 0.139
3.5e3.99 19.0 6.2 20.1 2.2 0.31 0.760
4.0e5.0 24.3 4.1 e e e e
F 1.871 (0.132) 0.805 (0.498) e e
Integration 2.0e2.49 22.6 4.6 14.5 1.0 3.95 0.008*
2.5e2.99 19.3 2.3 14.5 1.2 4.03 0.021*
3.0e3.49 18.6 4.8 14.6 1.4 3.42 0.003*
3.5e3.99 15.6 6.5 15.2 1.2 0.23 0.818
4.0e5.0 16.0 4.6 e e e e
F 1.694 (0.168) 0.253 (0.859) e e
Human dimension 2.0e2.49 6.5 1.0 13.2 2.8 3.90 0.008*
2.5e2.99 8.8 1.3 12.6 2.9 2.54 0.021*
3.0e3.49 7.0 1.1 12.3 2.4 9.52 0.001*
3.5e3.99 6.5 .8 13.6 3.7 7.26 0.001*
4.0e5.0 7.0 1.5 e e e e
F 3.021 (0.027) 0.375 (0.771) e
E:Caring 2.0e2.49 1.3 0.5 12.3 2.9 6.21 0.001*
2.5e2.99 2.2 0.6 12.6 3.4 11.1 0.001*
3.0e3.49 2.6 1.0 12.3 3.1 14.4 0.001*
3.5e3.99 2.3 0.7 15.2 2.8 7.82 0.015*
4.0e5.0 2.1 0.9 e e e e
F 1.635 (.182) 0.742 (0.533) e
Learning to learn 2.0e2.49 12.7 0.2 12.4 3.4 0.144 0.890
2.5e2.99 12.7 0.9 13.2 3.9 0.40 0.692
3.0e3.49 12.9 1.4 12.1 2.4 1.13 0.264
3.5e3.99 12.9 1.5 13.4 4.3 0.37 0.715
4.0e5.0 12.6 1.1 e e e
F 0.115 (0.977) 0.423 (0.737) e
t: Student t-test F ¼ ANOVA test *: Statistically significant at p  0.05.

in the mean test scores of group 1 and group 2 for
students from all three GPA ranges within 2.0 and 3.49
in the assessment domain ‘integration’ (see Table 3).
4. Discussion
The purpose of this study was to assess the difference
in two designs of flipped classroom. In specific, two
face-to-face class activities were tested and the effect on
the test outcomes of the students was compared.
The results of this study indicate that the overall test
performance in the students who were engaged in face-
to-face class activities conducted in groups (Group 1)
was better than the students who accomplished
individual tasks in the face-to-face class session (Group
2) and the difference in the mean test scores across the
two groups was highly significant (p ¼ 0.001). The mean
score in Group 1 was 63.8 whereas the mean score in
Group 2 was 49.6. This finding in the currentl study is
similar to Eryilmaz & Cigdemoglu (2019), who reported
higher test scores in group flipped classroom (70.80)
compared to individual flipped classroom (68.52), how-
ever, they did not report a statistically significant dif-
ference between the two groups (p ¼ 0.587).
Over all better test scores in Group 1 belonging to
different types of educational backgrounds indicate that
the flipped classroom design with group based face-to-
face class activities is comparatively more effective.

Please cite this article as: Rawas H et al., Comparing the effects of individual versus group face-to-face class activities in flipped classroom on
student's test performances, Health Professions Education, https://doi.org/10.1016/j.hpe.2019.06.002
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H. Rawas et al. / Health Professions Education xxx (xxxx) xxx
The class time was employed for learning conducted in
groups which enables cooperative learning.41 It is in line
with study finding by Foldnes (2016) who conducted a
randomized experiment and reported that flipped class-
room with cooperative learning in group activities yiel-
ded higher test scores compared to traditional classrooms
and the difference between them was highly significant
whereas the difference in individual flipped classroom
compared to traditional classrooms was not significantly
different.42 Cooperative learning enables students to
develop an understanding of the studied material by
‘deep learning’ through an active and constructivist
process.43 Group based student activities provide op-
portunities for development of reciprocity and coopera-
tion, using active learning techniques, building respect
for diverse talents whilst students explore ways of
learning within groups.44 . The group activity designed
in Group 1 also had a component of peer discussion.
Discussion in turn, is the most effective active learning
method if the learning outcomes are long term retention
of the information, building critical thinking skills and
enhance motivation of learning.45 This is showcased in
the student test scores (Table 1). As per Dewey ‘we never
educate directly, but indirectly by means of the envi-
ronment. Whether we permit chance environment to do
the work, or whether we design environments for the
purpose”.46 In view of this principle, we assume that the
learning environment in the flipped classroom design in
Group 1 enabled students to build knowledge with
cooperative learning.
Based on the highly significant difference in the
overall test scores of Group 1 and Group 2, it is evident
that effectiveness of flipped classroom is directly related
to cooperative learning in which students are responsible
for their own learning and learning of all group mem-
bers.47 Group team work and mutual team goals which are
critical elements in cooperative learning48 were the core
components of the flipped classroom design for Group 1
in this study. As per definition of cooperative learning by
Kagan (1989), the social interaction structure within
groups and the learning activities were also designed by
the teacher in Group 149. It is therefore concluded that a
flipped classroom design with cooperative learning
(Group 1) has better outcomes on the test performance of
the students compared to a flipped classroom design
without cooperative learning (Group 2).
The findings in this study further indicate that test
scores in Group 1 are better than Group 2 with a highly
significant difference in assessment and learning do-
mains of ‘foundation knowledge’, ‘application’ and
‘integration’ which is most probably the outcome of the
cooperative learning activities in Group 1. The structural
Please cite this article as: Rawas H et al., Comparing the effects of individual versus group face-to-face class activities in flipped classroom on
student's test performances, Health Professions Education, https://doi.org/10.1016/j.hpe.2019.06.002
7
approach in cooperative learning adheres to pre-
determined cognitive objectives and is based on crea-
tion, analysis and systematic application of knowledge
and develops critical thinking skills.49,50 More students
in Group 1 were able to solve test questions pertaining to
domains of ‘foundation knowledge’, ‘application’ and
‘integration’ which required critical thinking skills,
developed in cooperative learning in group based face-
to-face class activity and these results are congruent to
earlier studies on effectiveness of flipped class in
development of problem solving and critical thinking
skills in students.51,52
It was also observed that students in Group 2 (indi-
vidual face-to-face class activity group) had better test
scores in the domains of human dimension and caring.
This finding shows that a flipped classroom design is
effective in learning domains that require self-reflection
even without a cooperative learning component. Group 2
students spent their class time in individual learning
activities designed by the teacher. The results support
that flipped classroom improves individualized
learning53 and fosters autonomy.54 Khanova et al. (2015)
reported that flipped classroom improves ‘engagement’
of the student during the process.55 It fosters higher self-
efficacy56 and enables flexible learning.57 These skills
are directly effective in the learning domain of ‘human
dimension’ and ‘caring’, which requires students to
reflect on areas of their own strength and weakness based
on reflection as well as team feedback.
Based on the results, it can be assumed that different
types of flipped classroom designs comprising of different
face to face activities are effective on the test scores of the
students in varying learning domains. In light of the find-
ings presented in this study, a facilitator can select a more
appropriate flipped classroom design in consideration of
the specific learning objectives at hand.
Furthermore, there was no difference in the test
performance of the students with regards to their pre-
vious GPA in both the Group 1 and Group 2. This
shows that both the designs of flipped classroom in this
study are suitable for all types of students with
different previous academic achievements. It is in line
with earlier studies which have reported that flipped
classroom helps students with low GPA scores in
improving their grades and enables the teacher to reach
out to each type of student.15,58,59
4.1. Limitations
One of the study limitations was a small sample
size. Further research with a longitudinal study design
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8 H. Rawas et al. / Health Professions Education xxx (xxxx) xxx
is recommended. This study only reports the effec-
tiveness of two designs of flipped classroom on student
test performances. Future studies that may explore
student satisfaction in different designs of flipped
classroom are also recommended.
5. Conclusion
A flipped classroom design with group based face-to-
face class activities yields better overall test scores in
students compared to a flipped classroom design with
individual face-to-face class activities irrespective of
their educational background and previous academic
achievements. Flipped classroom designs with coopera-
tive learning is more effective in students academic
achievement in domains of ‘foundation knowledge’,
‘application’ and ‘integration’ whereas flipped classroom
design without cooperative learning, entirely focused on
individual face-to-face class activities is effective in
domains of ‘human dimension’ and ‘caring’. The key to
a successful flipped classroom execution is in selection
of the appropriate design in consideration of the specific
learning objectives in the course.
Disclousure
Ethical approval: Ethical approval has been granted
from King Abdullah International Medical Research
Center (KAIMRC) (15 October 2018, RYD-18-
417780-147668).
Funding
None.
Other disclosure
None.
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Hawazen Rawas is Associate Dean, Clinical Affairs and assistant
Professor Medical/Surgical Nursing at College of Nursing, King
Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi
Arabia.
Nusrat Bano is Assistant Professor Pharmacology, at College of
Nursing, King Saud bin Abdulaziz University for Health Sciences,
Jeddah, Saudi Arabia.
Salwa Al aidarous is Assistant Professor, Internal Medicine
(Endocrinology), at College of Medicine, King Saud bin Abdulaziz
University for Health Sciences, Jeddah, Saudi Arabia.