Undergraduate Perceptions of Flipped Classrooms in Medical Instrumentation Courses: Insights and the T.I.C.E.F. Framework from a Cross-Sectional Psychometric Evaluation

Undergraduate Perceptions of Flipped Classrooms in Medical Instrumentation Courses: Insights and the T.I.C.E.F. 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Framework from a Cross-Sectional Psychometric Evaluation Heba Mohtady Ali, Shimaa Elaraby, Mona Hassan, Enas Gouda This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6048897/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background The flipped classroom approach has become an innovative teaching method that reverses traditional instructional sequences, allowing students to engage with lecture content outside the classroom and use in-class time for interactive, collaborative learning. Rooted in constructivist principles, this model promotes active learning, enhances student engagement, and fosters higher-order thinking skills. Despite its growing adoption, particularly accelerated by the COVID-19 pandemic, there remains limited evidence of its long-term impact on student performance and effectiveness in specialised contexts, such as medical education and instrumentation courses. This study evaluates undergraduate students' perceptions of the flipped classroom's effectiveness in enhancing student engagement, instructor support, technological design, and the overall learning environment within medical instrumentation courses. Methods A cross-sectional study was conducted with 237 third-year undergraduate students enrolled in the Medical Laboratory Science program at Fakeeh College for Medical Sciences, Saudi Arabia. The flipped classroom model was implemented in two courses—Instrumentation and Electronic Microscope—over three 50-minute sessions per course. Pre-class materials were provided one week in advance through Blackboard, and in-class activities included quizzes, case discussions, and assignments, followed by constructive feedback. Student satisfaction was measured using a 30-item questionnaire. Exploratory factor analysis and reliability analysis were performed to assess the questionnaire's psychometric properties. Data analysis was conducted using SPSS, with statistical significance at p < 0.01. Results The findings demonstrated strong internal consistency, with Cronbach’s alpha values ranging from 0.86 to 0.94. The flipped classrooms significantly foster student engagement and collaboration, improve the role of instructors, and enhance the learning environment through technology-driven, self-paced learning. Conclusion Based on these findings, practical recommendations were developed for instructors, including the creation of high-quality pre-class materials, optimisation of in-class activities for active learning, and the redefinition of the instructor’s role as a facilitator. The study also emphasises the importance of leveraging technology, cultivating a supportive learning environment, and implementing continuous assessment and feedback mechanisms. These insights led to developing the T.I.C.E.F. Framework (Technology, Instructor, Content, Environment, and Feedback), which offers a structured guide to optimising flipped classroom implementations and improving teaching strategies and student learning experiences. Flipped Classes Student Satisfaction Medical Education Active Learning Psychometric Evaluation Saudi Arabia Figures Figure 1 1. Background The flipped classroom approach represents an innovative shift in educational delivery, fundamentally reordering traditional teaching methods. In this model, students engage with lecture materials—such as pre-recorded videos or assigned readings—outside of class, thereby freeing in-class time for interactive, problem-solving, and collaborative activities under the instructor's guidance ( 1 ). This instructional strategy is deeply rooted in constructivist principles, where learners actively construct knowledge through hands-on experiences and reflective engagement ( 2 , 3 ). The core idea of constructivism applied to learning is that the environment is learner-centred, and knowledge and understanding are socially constructed ( 3 , 4 ). A substantial body of research has demonstrated the advantages of the flipped classroom. Notably, this approach enhances student engagement and promotes active learning by transforming students from passive recipients to active constructors of knowledge ( 5 , 6 ). Additionally, flipped classrooms have been associated with improved academic performance and a deeper understanding of complex concepts, mainly by emphasising higher-order thinking skills such as analysis and problem-solving ( 7 , 8 ). Students also report increased satisfaction, mainly due to the flexibility of accessing pre-class materials at their own pace and the enriched, discussion-focused learning environment during class ( 9 , 10 ). The rapid shift toward flipped classrooms, accelerated by the challenges posed by the COVID-19 pandemic, has highlighted both the potential and the challenges of this teaching method. While many educators have adopted this approach out of necessity, the transition has underscored the importance of thoughtful planning, organisation, and integrating appropriate technological tools to maximise its benefits ( 7 , 11 ). Despite these promising outcomes, several gaps remain in our understanding of the long-term impact of flipped classrooms on student performance, retention of knowledge, and the development of lifelong learning skills. Moreover, there is limited evidence regarding the influence of flipped classrooms on clinical competencies and their effectiveness across diverse educational contexts ( 11 , 12 ). 2. Methods Aim and Research Question This study aims to evaluate undergraduate students' perceptions of the flipped classroom approach within medical instrumentation courses. Specifically, the research seeks to answer the following question: How do undergraduate students perceive the effectiveness of flipped classrooms in enhancing student engagement, instructor support, technological design, and the overall learning environment in medical instrumentation courses? By addressing this question, the study intends to contribute to a deeper understanding of how flipped classroom methodologies can be optimised to meet the evolving needs of medical and science education. 2.1. Study Design and Setting A cross-sectional study was conducted ( 13 ). It included 237 third-year undergraduate students enrolled in the Medical Laboratory Science (MLS) program at Fakeeh College for Medical Sciences (FCMS), Saudi Arabia. FCMS has consistently embraced innovative teaching strategies since its inception. This study implemented the flipped classroom model in two instrumentation courses—Instrumentation and Electronic Microscope—within the MLS curriculum. 2.2. Design and Implementation of the Flipped Classroom Each flipped classroom session lasted 50 minutes and was conducted over three class meetings per course. Students were initially oriented to the flipped classroom approach through a presentation and an accompanying infographic film outlining the process. Pre-class materials were distributed one week in advance via email and uploaded to Blackboard, the institution’s Learning Management System, ensuring that students were well-prepared for in-class activities. In-class activities included quizzes, assignments, case discussions, and other course-specific exercises, with constructive feedback provided at the end of each session ( 2 , 5 , 7 ) 2.3. Study Instrument Student satisfaction with the flipped classroom method was measured using a 30-item questionnaire adapted from Pierce and Fox ( 14 ). Content validity was established through expert review by professionals in the subject matter and medical education ( 15 ). Responses were recorded on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree), which is a standard measurement scale used in evaluating student satisfaction with flipped classrooms and medical education ( 15 , 16 ) The items were initially organised into four conceptual factors: Student Engagement and Collaboration, the Role of the Instructor, Technology Designs, and the Learning Environment. These factors align well with common themes in flipped classroom research, particularly in medical education settings ( 5 , 7 ). The use of a questionnaire to measure student satisfaction is a widely accepted approach to assessing the effectiveness of flipped classroom implementations in medical education ( 5 , 16 ). 2.4. Psychometric Evaluation The psychometric properties of the questionnaire were assessed using exploratory factor analysis (EFA) and reliability analysis ( 17 , 18 ). The planned procedures included: Sample Suitability : The sample of 237 participants was deemed adequate for factor analysis. Factorability of the Correlation Matrix : Moderate, statistically significant correlations were found among variables, confirming the appropriateness of the data. KMO and Bartlett’s Test : The Kaiser-Meyer-Olkin (KMO) measure was 0.93 (superb), indicating sampling adequacy, and Bartlett’s Test of Sphericity was statistically significant (p < 0.001), confirming that the variables were sufficiently correlated for factor analysis. Factor Extraction : Principal Component Analysis with varimax rotation identified five factors with eigenvalues > 1.00, explaining 67.5% of the total variance. A scree plot confirmed the factor structure. 2.5. Statistical Analysis Data analysis was conducted using SPSS (version 20, IBM). Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarise the findings. Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) and Bartlett's Test of Sphericity were used to conduct EFA ( 19 , 20 ). Furthermore, bivariate correlations were measured using product-moment Pearson’s coefficient . P-values less than 0.01 were considered statistically significant. Internal consistency reliability of the questionnaire was measured using Cronbach’s Alpha ( 21 ). 2.6. Synthesis: This study synthesised the findings and summarised recommendations from the data and existing literature to develop a conceptual framework. An inductive approach was used to categorise related concepts and map potential relationships relevant to flipped classroom implementation, providing a structured foundation for the framework. Diagrammatic representation enhanced clarity and illustrated the interconnected concepts and key factors ( 22 , 23 ). 3. Results 3.1. Psychometric Properties of the Questionnaire 3.1.1. Exploratory Factor Analysis Data Suitability : The KMO measure was 0.93, indicating superb sampling adequacy. Bartlett’s Test of Sphericity was statistically significant (p 1.00, collectively explaining 67.5% of the total variance. A scree plot confirmed the selection of factors, with a noticeable drop starting from the fifth factor. Based on the following criteria, three items were removed: Cross-Loadings : Item 30 was removed due to cross-loadings (≥ 0.30 on multiple factors). Insufficient Items : Items 5 and 7 were removed because they comprised a factor with only two items. Final Factor Structure consisted of 27 items distributed across four factors: Factor 1 : Student Engagement and Collaboration (12 items) Factor 2 : Role of the Instructor (6 items) Factor 3 : Technology Designs (5 items) Factor 4 : Learning Environment (4 items) Communalities for the 27 items ranged from 0.55 to 0.77, indicating that the extracted factors explained a substantial portion of the variance in the items, as presented in Supplementary Table 1 3.1.2. Reliability Analysis Cronbach’s alpha coefficients for the four factors ranged from 0.86 to 0.94, with an overall alpha of 0.96 for the entire questionnaire. No increase in alpha was observed upon deletion of any item, confirming high internal consistency, as presented in the following table (Table 1 ) . Table 1 Reliability statistics using Cronbach's Alpha: Factor Number of items per factor Cronbach's Alpha per Factor Cronbach's Alpha of all items Factor 1: Student engagement and collaboration 12 0.94 0.96 Factor 2: Role of instructor 6 0.92 Factor 3: Technology designs 5 0.86 Factor 4: Learning Environment 4 0.86 3.2. Descriptive Statistics and Inter-Factor Correlations A total of 237 completed questionnaires were analysed, with 68% (n = 161) female and 32% (n = 76) male respondents. Descriptive statistics for the four factors are summarised in Table 2 . Notably, the Technology Designs factor (Factor 3) received the highest satisfaction score (mean = 3.99). Pearson’s correlation coefficients among the factors ranged from 0.52 to 0.74, indicating moderate, significant positive correlations as presented in Table 3 . Table 2 Means and Standard deviation of the four factors of the Questionnaire (n = 237): Factors Number of Items Means Standard deviation Percentages % Factor 1: Student engagement and collaboration 12 3.97 0.72 79.4% Factor 2: Role of instructor 6 3.96 0.78 79.2% Factor 3: Technology designs 5 3.99 0.72 79.8% Factor 4: Learning Environment 4 3.98 0.78 79.6% N.B. Scales were rated out of 5 Table 3 Pearson’s correlations between different factors of the used questionnaire (n = 237): Factor 1: Student engagement and collaboration Factor 2: Role of instructor Factor 3: Technology designs Factor 4: Learning Environment Factor 1 : Student engagement and collaboration 0.74 ** 0.50 ** 0.67 ** Factor 2 : Role of instructor 0.58 ** 0.74 ** Factor 3 : Technology designs 0.52 ** Factor 4 : Learning Environment **. Correlation is significant at the 0.01 level (2-tailed). 4. Discussion Flipped classrooms encourage students to participate and engage positively in their learning experiences ( 5 , 6 ). This study implemented flipped classrooms alongside traditional teaching strategies in two courses (Instrumentation and Electronic Microscope). Learning materials were provided in advance, and scheduled training sessions facilitated interactive discussions and quizzes. A questionnaire was employed to assess students’ perceptions of this instructional method. 4.1. Psychometric Properties of the Questionnaire To evaluate the construct validity and reliability of the questionnaire, exploratory factor analysis (EFA) and reliability analysis were conducted. The EFA, performed using principal component analysis (PCA) with varimax rotation, identified four factors: Factor 1 : Student Engagement and Collaboration (12 items) Factor 2 : Role of the Instructor (6 items) Factor 3 : Technology Designs (5 items) Factor 4 : Learning Environment (4 items) The KMO measure (0.93) indicated superb sampling adequacy, and Bartlett’s Test of Sphericity was statistically significant (p < 0.001), confirming the suitability of the data for factor analysis. Initially, the 30-item questionnaire yielded five factors, but after removing three items due to cross-loadings or insufficient item representation, the final structure contained 27 items, explaining 67.5% of the total variance. Reliability analysis revealed strong internal consistency, with Cronbach’s alpha coefficients ranging from 0.86 to 0.94 for individual factors and an overall alpha of 0.96, confirming the instrument's robustness. Factor 1: Student Engagement and Collaboration The findings showed that students highly valued the flipped classroom approach in enhancing engagement and collaboration. This aligns with previous research, which suggests that flipped classrooms foster critical thinking and improve comprehension of key concepts ( 5 , 6 ). Additionally, flipped classrooms fulfil key psychological needs outlined in Self-Determination Theory by fostering autonomy, competence, and relatedness, leading to greater student motivation ( 8 ). Students found flipped classrooms more motivating than traditional lectures, echoing results from Naing, Whittaker ( 1 ), who noted that flipped classrooms improve academic performance and enhance student satisfaction. Flipped classrooms can improve cognitive learning and support higher-order skills, such as problem-solving and application of knowledge ( 7 ). Factor 2: Role of the Instructor Instructors in this study transitioned from information providers to facilitators, a shift that students found beneficial. This observation is consistent with findings from Tucker ( 24 ) where the students reported that instructors in flipped classrooms exhibited strong content expertise and were more approachable. Furthermore, research has shown that flipped classrooms strengthen instructor-student relationships and improve communication ( 25 ), ultimately contributing to a more interactive and supportive learning environment. Factor 3: Technology Designs Technology played a crucial role in the flipped classrooms, with students utilising videos, online materials, and digital tools for self-paced learning. This factor received the highest satisfaction score, indicating that students appreciated the flexibility offered by digital resources. Similar to findings by Hew and Lo ( 9 ), students valued pre-class materials, which enhanced their understanding of key concepts. Additionally, Johnson ( 26 )and Phillips and Wiesbauer ( 7 ) reported that students appreciated the ability to pause, replay, and control video lectures at their convenience, reinforcing the effectiveness of instructional videos as an alternative to traditional lectures. Factor 4: Learning Environment Students overwhelmingly agreed that flipped classrooms provided a more interactive and supportive learning environment. Consistent with previous research, flipped classrooms encouraged peer collaboration and engagement with instructors, optimising in-class time for meaningful discussions and activities( 10 ). Additionally, studies by Tang, Chen ( 27 ) and Naing, Whittaker ( 1 ) highlighted that flipped classrooms enhance motivation, improve students’ communication skills, and support independent learning. 4.2. Developing the T.I.C.E.F. Framework for Optimising Flipped Classroom Implementations Based on the existing literature on flipped classrooms and the findings from this study, several recommendations were developed to enhance flipped classroom implementations, as presented in Table 4 . These recommendations were then synthesised into the T.I.C.E.F. Framework (Technology, Instructor, Content, Environment, and Feedback), as shown in Fig. 1 . This synthesis process involved grouping related concepts into five interconnected categories, reflecting key aspects of effective flipped classroom design. The combined approach grounds the proposed strategies in established educational practices while tailoring them to the specific insights gathered from the questionnaire data. This structured framework provides educators with a comprehensive guide to optimising flipped classroom experiences, ensuring a balanced focus on technological tools, instructional roles, content delivery, learning environments, and feedback mechanisms. Table 4 Recommendations for Enhancing Flipped Classroom Implementation Recommendation Rationale Grounding 1. Develop High-Quality Pre-Class Materials Engaging, well-structured content increases student satisfaction and supports self-paced learning. Technology Designs (Factor 3), Literature ( 7 , 9 ) 2. Optimize In-Class Activities for Active Learning Focus on interactive sessions and higher-order skills to foster engagement and critical thinking. Student Engagement and Collaboration (Factor 1), Literature ( 6 , 10 ). 3. Redefine the Instructor’s Role Shift from lecture-based to facilitative teaching to enhance student interaction and promote a supportive learning environment. Role of the Instructor (Factor 2), Literature ( 24 , 25 ). 4. Leverage Technology Effectively Use digital tools that allow flexibility and self-paced learning to enhance understanding and accessibility. Technology Designs (Factor 3), Literature( 7 , 26 ). 5. Cultivate a Supportive Learning Environment Foster a collaborative, interactive environment to promote peer collaboration, motivation, and independent learning. Learning Environment (Factor 4), Literature ( 1 , 8 ). 6. Implement Continuous Assessment and Feedback Use regular low-stakes assessments and quizzes to monitor progress and gather feedback for instructional adjustments. Student Engagement and Collaboration (Factor 1), Literature ( 12 ). 4.3. Limitations and Future Directions Despite this study's strengths, some limitations should be acknowledged. The cross-sectional design limits the ability to assess long-term impacts on learning outcomes. Additionally, reliance on self-reported data introduces potential biases related to individual perceptions. Future research should consider longitudinal studies to evaluate the sustained effects of flipped classrooms on academic performance and skill acquisition. Further questionnaire validation across diverse educational settings may also strengthen its applicability. 5. Conclusion Through a cross-sectional psychometric evaluation, this study explored undergraduate students' perceptions of flipped classrooms in medical instrumentation courses. The findings indicated that flipped classrooms significantly enhanced student engagement, collaboration, and motivation, with technology playing a pivotal role in facilitating self-paced learning. The four identified factors—Student Engagement and Collaboration, Role of the Instructor, Technology Designs, and Learning Environment—demonstrated strong internal consistency (Cronbach's alpha values ranging from 0.86 to 0.94), validating the effectiveness of the flipped classroom approach. The results emphasised the importance of structured pre-class materials, interactive in-class activities, and a supportive learning environment. Students appreciated the shift from traditional lectures to a more facilitative instructor role, which fostered communication and collaboration. Technology was also highlighted for providing flexible, self-paced learning opportunities catering to diverse learning styles. Based on these findings and supported by existing literature, the study offers practical recommendations for instructors, including developing engaging pre-class materials, optimising in-class activities for higher-order skills, redefining the instructor’s role to facilitate collaboration, and leveraging technology to enhance student learning. Additionally, fostering a supportive learning environment and implementing continuous assessment and feedback mechanisms were identified as key components for maintaining engagement and improving outcomes. This study provides a structured framework, the T.I.C.E.F. Framework (Technology, Instructor, Content, Environment, and Feedback), for enhancing flipped classroom practices in medical education. The recommendations, grounded in rigorous psychometric evaluation, offer valuable insights for instructors seeking to optimise teaching strategies and improve student learning experiences. Future research should refine and validate these practices in diverse settings, ensuring their long-term effectiveness in promoting student success. Abbreviations FCMS Fakeeh College for Medical Sciences MLS Medical Laboratory Science DSFH Soliman Fakeeh Hospital Declarations Ethics approval and consent to participate The study was conducted according to the guidelines of the Declaration of Helsinki. All participants voluntarily provided informed consent to participate in the study, with no obligations or benefits from the authors. Ethical clearance was obtained from the Institutional Review Board (IRB) at DSFH (Dr Soliman Fakeeh Hospital) (approval NO:49/IRB/2019). Consent for publication Not applicable to this study Competing interest The authors declare that they have no competing interests. Funding This research received no external funding Author Contribution Conceptualisation: HMA; Study instrument and Collecting data: EG, SE, MH; Formal analysis of results: EG; Writing—original draft: HMA; Developing conceptual framework: HMA; Review and editing: EG, SE, MH.All authors have read and approved the final version of the manuscript. Acknowledgement We acknowledge all the participants, students, and experts, as well as the support provided by Fakeeh College for Medical Sciences in fostering an environment conducive to research and academic writing. Data Availability Data cannot be shared openly but are available on request from authors. References Naing C, Whittaker MA, Aung HH, Chellappan DK, Riegelman A. The effects of flipped classrooms to improve learning outcomes in undergraduate health professional education: A systematic review. Campbell Systematic Reviews. 2023;19(3):e1339. Lewis C. 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Exploratory factor analysis (EFA) in quantitative researches and practical considerations. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2022;13(2):947-65. Hadi NU, Abdullah N, Sentosa I. An easy approach to exploratory factor analysis: Marketing perspective. Journal of Educational and Social Research. 2016;6(1):215-23. Streiner DL, Norman GR, Cairney J. Health measurement scales: a practical guide to their development and use: Oxford University Press, USA; 2015. Ngulube P, Mathipa ER, Gumbo MT. Theoretical and conceptual frameworks in the social and management sciences. Addressing research challenges: Making headway in developing researchers. 2015;43:66. Botma Y, Van Rensburg GH, Coetzee IM, Heyns T. A conceptual framework for educational design at modular level to promote transfer of learning. Innovations in Education and Teaching International. 2015;52(5):499-509. Tucker B. The flipped classroom. Education next. 2012;12(1):82-3. Papachristopoulos G, Lakin E, editors. 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Supplementary Files SupplementaryTable1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 24 Apr, 2025 Reviewers invited by journal 14 Apr, 2025 Editor assigned by journal 08 Apr, 2025 Editor invited by journal 19 Mar, 2025 Submission checks completed at journal 18 Mar, 2025 First submitted to journal 18 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6048897","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":442518705,"identity":"81f78d1a-dc34-432a-8f76-25c7221df2e6","order_by":0,"name":"Heba Mohtady Ali","email":"data:image/png;base64,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","orcid":"","institution":"Zagazig University","correspondingAuthor":true,"prefix":"","firstName":"Heba","middleName":"Mohtady","lastName":"Ali","suffix":""},{"id":442518706,"identity":"129819dc-6f15-4db7-80e8-9efda5109c2f","order_by":1,"name":"Shimaa Elaraby","email":"","orcid":"","institution":"Fakeeh College for Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Shimaa","middleName":"","lastName":"Elaraby","suffix":""},{"id":442518707,"identity":"fd1c1720-e6a6-421f-9721-184a599de6a9","order_by":2,"name":"Mona Hassan","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Mona","middleName":"","lastName":"Hassan","suffix":""},{"id":442518708,"identity":"560b179b-da14-4e46-8e84-38b7bd48a063","order_by":3,"name":"Enas Gouda","email":"","orcid":"","institution":"Fakeeh College for Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Enas","middleName":"","lastName":"Gouda","suffix":""}],"badges":[],"createdAt":"2025-02-17 14:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6048897/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6048897/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80803437,"identity":"6ca54549-204d-4e3a-8732-4635016ef67f","added_by":"auto","created_at":"2025-04-17 09:02:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":152533,"visible":true,"origin":"","legend":"\u003cp\u003eThe T.I.C.E.F. Framework (Technology, Instructor, Content, Environment and Feedback).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6048897/v1/b99644e7d95d74b1f74204d4.png"},{"id":80805067,"identity":"d704b764-71b1-44a3-a20f-62cc84753f51","added_by":"auto","created_at":"2025-04-17 09:18:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1323244,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6048897/v1/8f1ec5db-2540-4cc8-9b43-a9caef7365b6.pdf"},{"id":80803434,"identity":"ee2db35f-6dd1-4e5b-b9dd-cbbde0bb5d05","added_by":"auto","created_at":"2025-04-17 09:02:26","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20507,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6048897/v1/6ba0ac8ae01e0da24e2fe44e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Undergraduate Perceptions of Flipped Classrooms in Medical Instrumentation Courses: Insights and the T.I.C.E.F. Framework from a Cross-Sectional Psychometric Evaluation","fulltext":[{"header":"1. Background","content":"\u003cp\u003eThe flipped classroom approach represents an innovative shift in educational delivery, fundamentally reordering traditional teaching methods. In this model, students engage with lecture materials\u0026mdash;such as pre-recorded videos or assigned readings\u0026mdash;outside of class, thereby freeing in-class time for interactive, problem-solving, and collaborative activities under the instructor's guidance (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This instructional strategy is deeply rooted in constructivist principles, where learners actively construct knowledge through hands-on experiences and reflective engagement (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The core idea of constructivism applied to learning is that the environment is learner-centred, and knowledge and understanding are socially constructed (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA substantial body of research has demonstrated the advantages of the flipped classroom. Notably, this approach enhances student engagement and promotes active learning by transforming students from passive recipients to active constructors of knowledge (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Additionally, flipped classrooms have been associated with improved academic performance and a deeper understanding of complex concepts, mainly by emphasising higher-order thinking skills such as analysis and problem-solving (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Students also report increased satisfaction, mainly due to the flexibility of accessing pre-class materials at their own pace and the enriched, discussion-focused learning environment during class (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe rapid shift toward flipped classrooms, accelerated by the challenges posed by the COVID-19 pandemic, has highlighted both the potential and the challenges of this teaching method. While many educators have adopted this approach out of necessity, the transition has underscored the importance of thoughtful planning, organisation, and integrating appropriate technological tools to maximise its benefits (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Despite these promising outcomes, several gaps remain in our understanding of the long-term impact of flipped classrooms on student performance, retention of knowledge, and the development of lifelong learning skills. Moreover, there is limited evidence regarding the influence of flipped classrooms on clinical competencies and their effectiveness across diverse educational contexts (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e \u003cb\u003eAim and Research Question\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study aims to evaluate undergraduate students' perceptions of the flipped classroom approach within medical instrumentation courses. Specifically, the research seeks to answer the following question:\u003c/p\u003e \u003cp\u003e \u003cem\u003eHow do undergraduate students perceive the effectiveness of flipped classrooms in enhancing student engagement, instructor support, technological design, and the overall learning environment in medical instrumentation courses?\u003c/em\u003e \u003c/p\u003e \u003cp\u003eBy addressing this question, the study intends to contribute to a deeper understanding of how flipped classroom methodologies can be optimised to meet the evolving needs of medical and science education.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study Design and Setting\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). It included 237 third-year undergraduate students enrolled in the Medical Laboratory Science (MLS) program at Fakeeh College for Medical Sciences (FCMS), Saudi Arabia. FCMS has consistently embraced innovative teaching strategies since its inception. This study implemented the flipped classroom model in two instrumentation courses\u0026mdash;Instrumentation and Electronic Microscope\u0026mdash;within the MLS curriculum.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Design and Implementation of the Flipped Classroom\u003c/h2\u003e \u003cp\u003eEach flipped classroom session lasted 50 minutes and was conducted over three class meetings per course. Students were initially oriented to the flipped classroom approach through a presentation and an accompanying infographic film outlining the process.\u003c/p\u003e \u003cp\u003ePre-class materials were distributed one week in advance via email and uploaded to Blackboard, the institution\u0026rsquo;s Learning Management System, ensuring that students were well-prepared for in-class activities. In-class activities included quizzes, assignments, case discussions, and other course-specific exercises, with constructive feedback provided at the end of each session (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Study Instrument\u003c/h2\u003e \u003cp\u003eStudent satisfaction with the flipped classroom method was measured using a 30-item questionnaire adapted from Pierce and Fox (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Content validity was established through expert review by professionals in the subject matter and medical education (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResponses were recorded on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree, 5\u0026thinsp;=\u0026thinsp;strongly agree), which is a standard measurement scale used in evaluating student satisfaction with flipped classrooms and medical education (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) The items were initially organised into four conceptual factors: Student Engagement and Collaboration, the Role of the Instructor, Technology Designs, and the \u003cem\u003eLearning Environment.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThese factors align well with common themes in flipped classroom research, particularly in medical education settings (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The use of a questionnaire to measure student satisfaction is a widely accepted approach to assessing the effectiveness of flipped classroom implementations in medical education (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Psychometric Evaluation\u003c/h2\u003e \u003cp\u003eThe psychometric properties of the questionnaire were assessed using exploratory factor analysis (EFA) and reliability analysis (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The planned procedures included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSample Suitability\u003c/b\u003e: The sample of 237 participants was deemed adequate for factor analysis.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFactorability of the Correlation Matrix\u003c/b\u003e: Moderate, statistically significant correlations were found among variables, confirming the appropriateness of the data.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eKMO and Bartlett\u0026rsquo;s Test\u003c/b\u003e: The Kaiser-Meyer-Olkin (KMO) measure was 0.93 (superb), indicating sampling adequacy, and Bartlett\u0026rsquo;s Test of Sphericity was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), confirming that the variables were sufficiently correlated for factor analysis.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFactor Extraction\u003c/b\u003e: Principal Component Analysis with varimax rotation identified five factors with eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1.00, explaining 67.5% of the total variance. A scree plot confirmed the factor structure.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Statistical Analysis\u003c/h2\u003e \u003cp\u003eData analysis was conducted using SPSS (version 20, IBM). Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarise the findings. Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) and Bartlett's Test of Sphericity were used to conduct EFA (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Furthermore, bivariate correlations were measured using \u003cem\u003eproduct-moment Pearson\u0026rsquo;s coefficient\u003c/em\u003e. P-values less than 0.01 were considered statistically significant. Internal consistency reliability of the questionnaire was measured using Cronbach\u0026rsquo;s Alpha (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Synthesis:\u003c/h2\u003e \u003cp\u003eThis study synthesised the findings and summarised recommendations from the data and existing literature to develop a conceptual framework. An inductive approach was used to categorise related concepts and map potential relationships relevant to flipped classroom implementation, providing a structured foundation for the framework. Diagrammatic representation enhanced clarity and illustrated the interconnected concepts and key factors (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Psychometric Properties of the Questionnaire\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e3.1.1. Exploratory Factor Analysis\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eData Suitability\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe KMO measure was 0.93, indicating superb sampling adequacy.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eBartlett\u0026rsquo;s Test of Sphericity was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), confirming that the items were sufficiently correlated for EFA.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFactor Extraction and Rotation\u003c/b\u003e:\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eInitially, the 30-item questionnaire yielded five factors with eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1.00, collectively explaining 67.5% of the total variance. A scree plot confirmed the selection of factors, with a noticeable drop starting from the fifth factor. Based on the following criteria, three items were removed:\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eCross-Loadings\u003c/em\u003e: Item 30 was removed due to cross-loadings (\u0026ge;\u0026thinsp;0.30 on multiple factors).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eInsufficient Items\u003c/em\u003e: Items 5 and 7 were removed because they comprised a factor with only two items.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFinal Factor Structure\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003econsisted of 27 items distributed across four factors:\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eFactor 1\u003c/em\u003e: Student Engagement and Collaboration (12 items)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eFactor 2\u003c/em\u003e: Role of the Instructor (6 items)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eFactor 3\u003c/em\u003e: Technology Designs (5 items)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eFactor 4\u003c/em\u003e: Learning Environment (4 items)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eCommunalities for the 27 items ranged from 0.55 to 0.77, indicating that the extracted factors explained a substantial portion of the variance in the items, as presented in \u003cb\u003eSupplementary Table\u0026nbsp;1\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.1.2. Reliability Analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eCronbach\u0026rsquo;s alpha coefficients for the four factors ranged from 0.86 to 0.94, with an overall alpha of 0.96 for the entire questionnaire. No increase in alpha was observed upon deletion of any item, confirming high internal consistency, as presented in the following table (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReliability statistics using Cronbach's Alpha:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of items per factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCronbach's Alpha per Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCronbach's Alpha of all items\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 1: Student engagement and collaboration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 2: Role of instructor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 3: Technology designs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 4: Learning Environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \n\u003cp\u003e3.2. \u003cb\u003eDescriptive Statistics and Inter-Factor Correlations\u003c/b\u003e\u003c/p\u003e \n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eA total of 237 completed questionnaires were analysed, with 68% (n\u0026thinsp;=\u0026thinsp;161) female and 32% (n\u0026thinsp;=\u0026thinsp;76) male respondents.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDescriptive statistics for the four factors are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Notably, the Technology Designs factor (Factor 3) received the highest satisfaction score (mean\u0026thinsp;=\u0026thinsp;3.99).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePearson\u0026rsquo;s correlation coefficients among the factors ranged from 0.52 to 0.74, indicating moderate, significant positive correlations as presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeans and Standard deviation of the four factors of the Questionnaire (n\u0026thinsp;=\u0026thinsp;237):\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeans\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercentages\u003c/p\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 1: Student engagement and collaboration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 2: Role of instructor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 3: Technology designs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 4: Learning Environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eN.B. Scales were rated out of 5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson\u0026rsquo;s correlations between different factors of the used questionnaire (n\u0026thinsp;=\u0026thinsp;237):\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor 1: Student engagement and collaboration\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor 2:\u003c/p\u003e \u003cp\u003eRole of instructor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFactor 3: Technology designs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFactor 4: Learning Environment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFactor 1\u003c/b\u003e: Student engagement and collaboration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.74\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFactor 2\u003c/b\u003e: Role of instructor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.74\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFactor 3\u003c/b\u003e: Technology designs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.52\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFactor 4\u003c/b\u003e: Learning Environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e**. Correlation is significant at the 0.01 level (2-tailed).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eFlipped classrooms encourage students to participate and engage positively in their learning experiences (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This study implemented flipped classrooms alongside traditional teaching strategies in two courses (Instrumentation and Electronic Microscope). Learning materials were provided in advance, and scheduled training sessions facilitated interactive discussions and quizzes. A questionnaire was employed to assess students\u0026rsquo; perceptions of this instructional method.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Psychometric Properties of the Questionnaire\u003c/h2\u003e \u003cp\u003eTo evaluate the construct validity and reliability of the questionnaire, exploratory factor analysis (EFA) and reliability analysis were conducted. The EFA, performed using principal component analysis (PCA) with varimax rotation, identified four factors:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFactor 1\u003c/b\u003e: Student Engagement and Collaboration (12 items)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFactor 2\u003c/b\u003e: Role of the Instructor (6 items)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFactor 3\u003c/b\u003e: Technology Designs (5 items)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFactor 4\u003c/b\u003e: Learning Environment (4 items)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe KMO measure (0.93) indicated superb sampling adequacy, and Bartlett\u0026rsquo;s Test of Sphericity was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), confirming the suitability of the data for factor analysis. Initially, the 30-item questionnaire yielded five factors, but after removing three items due to cross-loadings or insufficient item representation, the final structure contained 27 items, explaining 67.5% of the total variance.\u003c/p\u003e \u003cp\u003eReliability analysis revealed strong internal consistency, with Cronbach\u0026rsquo;s alpha coefficients ranging from 0.86 to 0.94 for individual factors and an overall alpha of 0.96, confirming the instrument's robustness.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFactor 1: Student Engagement and Collaboration\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe findings showed that students highly valued the flipped classroom approach in enhancing engagement and collaboration. This aligns with previous research, which suggests that flipped classrooms foster critical thinking and improve comprehension of key concepts (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Additionally, flipped classrooms fulfil key psychological needs outlined in Self-Determination Theory by fostering autonomy, competence, and relatedness, leading to greater student motivation (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudents found flipped classrooms more motivating than traditional lectures, echoing results from Naing, Whittaker (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), who noted that flipped classrooms improve academic performance and enhance student satisfaction. Flipped classrooms can improve cognitive learning and support higher-order skills, such as problem-solving and application of knowledge (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eFactor 2: Role of the Instructor\u003c/b\u003e \u003c/p\u003e \u003cp\u003eInstructors in this study transitioned from information providers to facilitators, a shift that students found beneficial. This observation is consistent with findings from Tucker (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) where the students reported that instructors in flipped classrooms exhibited strong content expertise and were more approachable. Furthermore, research has shown that flipped classrooms strengthen instructor-student relationships and improve communication (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), ultimately contributing to a more interactive and supportive learning environment.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFactor 3: Technology Designs\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTechnology played a crucial role in the flipped classrooms, with students utilising videos, online materials, and digital tools for self-paced learning. This factor received the highest satisfaction score, indicating that students appreciated the flexibility offered by digital resources. Similar to findings by Hew and Lo (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), students valued pre-class materials, which enhanced their understanding of key concepts. Additionally, Johnson (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)and Phillips and Wiesbauer (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) reported that students appreciated the ability to pause, replay, and control video lectures at their convenience, reinforcing the effectiveness of instructional videos as an alternative to traditional lectures.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFactor 4: Learning Environment\u003c/b\u003e \u003c/p\u003e \u003cp\u003eStudents overwhelmingly agreed that flipped classrooms provided a more interactive and supportive learning environment. Consistent with previous research, flipped classrooms encouraged peer collaboration and engagement with instructors, optimising in-class time for meaningful discussions and activities(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Additionally, studies by Tang, Chen (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) and Naing, Whittaker (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) highlighted that flipped classrooms enhance motivation, improve students\u0026rsquo; communication skills, and support independent learning.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Developing the T.I.C.E.F. Framework for Optimising Flipped Classroom Implementations\u003c/h2\u003e \u003cp\u003eBased on the existing literature on flipped classrooms and the findings from this study, several recommendations were developed to enhance flipped classroom implementations, as presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. These recommendations were then synthesised into the \u003cb\u003eT.I.C.E.F. Framework\u003c/b\u003e (Technology, Instructor, Content, Environment, and Feedback), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. This synthesis process involved grouping related concepts into five interconnected categories, reflecting key aspects of effective flipped classroom design. The combined approach grounds the proposed strategies in established educational practices while tailoring them to the specific insights gathered from the questionnaire data. This structured framework provides educators with a comprehensive guide to optimising flipped classroom experiences, ensuring a balanced focus on technological tools, instructional roles, content delivery, learning environments, and feedback mechanisms.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRecommendations for Enhancing Flipped Classroom Implementation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecommendation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRationale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGrounding\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1. Develop High-Quality Pre-Class Materials\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEngaging, well-structured content increases student satisfaction and supports self-paced learning.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTechnology Designs (Factor 3), Literature (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2. Optimize In-Class Activities for Active Learning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFocus on interactive sessions and higher-order skills to foster engagement and critical thinking.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudent Engagement and Collaboration (Factor 1), Literature (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3. Redefine the Instructor\u0026rsquo;s Role\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShift from lecture-based to facilitative teaching to enhance student interaction and promote a supportive learning environment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRole of the Instructor (Factor 2), Literature (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4. Leverage Technology Effectively\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse digital tools that allow flexibility and self-paced learning to enhance understanding and accessibility.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTechnology Designs (Factor 3), Literature(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5. Cultivate a Supportive Learning Environment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFoster a collaborative, interactive environment to promote peer collaboration, motivation, and independent learning.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLearning Environment (Factor 4), Literature (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6. Implement Continuous Assessment and Feedback\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse regular low-stakes assessments and quizzes to monitor progress and gather feedback for instructional adjustments.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudent Engagement and Collaboration (Factor 1), Literature (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Limitations and Future Directions\u003c/h2\u003e \u003cp\u003eDespite this study's strengths, some limitations should be acknowledged. The cross-sectional design limits the ability to assess long-term impacts on learning outcomes. Additionally, reliance on self-reported data introduces potential biases related to individual perceptions. Future research should consider longitudinal studies to evaluate the sustained effects of flipped classrooms on academic performance and skill acquisition. Further questionnaire validation across diverse educational settings may also strengthen its applicability.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThrough a cross-sectional psychometric evaluation, this study explored undergraduate students' perceptions of flipped classrooms in medical instrumentation courses. The findings indicated that flipped classrooms significantly enhanced student engagement, collaboration, and motivation, with technology playing a pivotal role in facilitating self-paced learning. The four identified factors\u0026mdash;Student Engagement and Collaboration, Role of the Instructor, Technology Designs, and Learning Environment\u0026mdash;demonstrated strong internal consistency (Cronbach's alpha values ranging from 0.86 to 0.94), validating the effectiveness of the flipped classroom approach.\u003c/p\u003e \u003cp\u003eThe results emphasised the importance of structured pre-class materials, interactive in-class activities, and a supportive learning environment. Students appreciated the shift from traditional lectures to a more facilitative instructor role, which fostered communication and collaboration. Technology was also highlighted for providing flexible, self-paced learning opportunities catering to diverse learning styles.\u003c/p\u003e \u003cp\u003eBased on these findings and supported by existing literature, the study offers practical recommendations for instructors, including developing engaging pre-class materials, optimising in-class activities for higher-order skills, redefining the instructor\u0026rsquo;s role to facilitate collaboration, and leveraging technology to enhance student learning. Additionally, fostering a supportive learning environment and implementing continuous assessment and feedback mechanisms were identified as key components for maintaining engagement and improving outcomes.\u003c/p\u003e \u003cp\u003eThis study provides a structured framework, the T.I.C.E.F. Framework (Technology, Instructor, Content, Environment, and Feedback), for enhancing flipped classroom practices in medical education. The recommendations, grounded in rigorous psychometric evaluation, offer valuable insights for instructors seeking to optimise teaching strategies and improve student learning experiences. Future research should refine and validate these practices in diverse settings, ensuring their long-term effectiveness in promoting student success.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFCMS\u0026nbsp; Fakeeh College for Medical Sciences\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMLS\u0026nbsp; Medical Laboratory Science\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDSFH \u0026nbsp; Soliman Fakeeh Hospital\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e The study was conducted according to the guidelines of the Declaration of Helsinki. All participants voluntarily provided informed consent to participate in the study, with no obligations or benefits from the authors. Ethical clearance was obtained from the Institutional Review Board (IRB) at DSFH (Dr Soliman Fakeeh Hospital) (approval NO:49/IRB/2019).\u003c/p\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable to this study\u003c/p\u003e\u003ch2\u003eCompeting interest\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no external funding\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualisation: HMA; Study instrument and Collecting data: EG, SE, MH; Formal analysis of results: EG; Writing\u0026mdash;original draft: HMA; Developing conceptual framework: HMA; Review and editing: EG, SE, MH.All authors have read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e We acknowledge all the participants, students, and experts, as well as the support provided by Fakeeh College for Medical Sciences in fostering an environment conducive to research and academic writing.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData cannot be shared openly but are available on request from authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNaing C, Whittaker MA, Aung HH, Chellappan DK, Riegelman A. The effects of flipped classrooms to improve learning outcomes in undergraduate health professional education: A systematic review. Campbell Systematic Reviews. 2023;19(3):e1339.\u003c/li\u003e\n\u003cli\u003eLewis C. The flipped classroom: abandon the sage on the stage, and embrace the guide on the side. Resources in Medical Education American College of surgeons URL: https://www facs org/education/division-of-education/publications/rise/articles/flipped Fecha \u0026uacute;ltima consulta. 2020;16.\u003c/li\u003e\n\u003cli\u003eXu Z, Shi Y. Application of constructivist theory in flipped classroom-take college English teaching as a case study. Theory and Practice in Language Studies. 2018;8(7):880-7.\u003c/li\u003e\n\u003cli\u003eSletten SR. Investigating flipped learning: Student self-regulated learning, perceptions, and achievement in an introductory biology course. Journal of Science Education and Technology. 2017;26(3):347-58.\u003c/li\u003e\n\u003cli\u003eNichat A, Gajbe U, Bankar NJ, Singh BR, Badge AK. Flipped classrooms in medical education: improving learning outcomes and engaging students in critical thinking skills. Cureus. 2023;15(11).\u003c/li\u003e\n\u003cli\u003eHurtubise L, Hall E, Sheridan L, Han H. The flipped classroom in medical education: engaging students to build competency. Journal of Medical Education and Curricular Development. 2015;2:JMECD. S23895.\u003c/li\u003e\n\u003cli\u003ePhillips J, Wiesbauer F. The flipped classroom in medical education: A new standard in teaching. Trends in Anaesthesia and Critical Care. 2022;42:4-8.\u003c/li\u003e\n\u003cli\u003eZainuddin Z, Perera CJ. Exploring students\u0026rsquo; competence, autonomy and relatedness in the flipped classroom pedagogical model. Journal of Further and Higher Education. 2019;43(1):115-26.\u003c/li\u003e\n\u003cli\u003eHew KF, Lo CK. Flipped classroom improves student learning in health professions education: a meta-analysis. BMC medical education. 2018;18:1-12.\u003c/li\u003e\n\u003cli\u003eChen F, Lui AM, Martinelli SM. A systematic review of the effectiveness of flipped classrooms in medical education. Medical education. 2017;51(6):585-97.\u003c/li\u003e\n\u003cli\u003eReynolds G. Presentation Zen: Simple ideas on presentation design and delivery: New Riders; 2011.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Flaherty J, Phillips C. The use of flipped classrooms in higher education: A scoping review. The Internet and Higher Education. 2015;25:85-95.\u003c/li\u003e\n\u003cli\u003eAggarwal R, Ranganathan P. Study designs: Part 2 - Descriptive studies. Perspect Clin Res. 2019;10(1):34-6.\u003c/li\u003e\n\u003cli\u003ePierce R, Fox J. Vodcasts and active-learning exercises in a \u0026ldquo;flipped classroom\u0026rdquo; model of a renal pharmacotherapy module. American journal of pharmaceutical education. 2012;76(10):196.\u003c/li\u003e\n\u003cli\u003eMackey MJ. Examining the relationship between medical student satisfaction and academic performance in a pre-clinical, flipped-classroom curriculum. 2019.\u003c/li\u003e\n\u003cli\u003eChae SJ. Medical students\u0026apos; satisfaction on online flipped learning by learning styles. Korean J Med Educ. 2021;33(4):405-9.\u003c/li\u003e\n\u003cli\u003eAlavi M, Visentin DC, Thapa DK, Hunt GE, Watson R, Cleary M. Exploratory factor analysis and principal component analysis in clinical studies: Which one should you use. Journal of advanced nursing. 2020;76(8):1886-9.\u003c/li\u003e\n\u003cli\u003eLoewen S, Gonulal T. Exploratory factor analysis and principal components analysis. Advancing quantitative methods in second language research: Routledge; 2015. p. 182-212.\u003c/li\u003e\n\u003cli\u003eS\u0026uuml;r\u0026uuml;c\u0026uuml; L, Yıkılmaz İ, Maşlak\u0026ccedil;ı A. Exploratory factor analysis (EFA) in quantitative researches and practical considerations. G\u0026uuml;m\u0026uuml;şhane \u0026Uuml;niversitesi Sağlık Bilimleri Dergisi. 2022;13(2):947-65.\u003c/li\u003e\n\u003cli\u003eHadi NU, Abdullah N, Sentosa I. An easy approach to exploratory factor analysis: Marketing perspective. Journal of Educational and Social Research. 2016;6(1):215-23.\u003c/li\u003e\n\u003cli\u003eStreiner DL, Norman GR, Cairney J. Health measurement scales: a practical guide to their development and use: Oxford University Press, USA; 2015.\u003c/li\u003e\n\u003cli\u003eNgulube P, Mathipa ER, Gumbo MT. Theoretical and conceptual frameworks in the social and management sciences. Addressing research challenges: Making headway in developing researchers. 2015;43:66.\u003c/li\u003e\n\u003cli\u003eBotma Y, Van Rensburg GH, Coetzee IM, Heyns T. A conceptual framework for educational design at modular level to promote transfer of learning. Innovations in Education and Teaching International. 2015;52(5):499-509.\u003c/li\u003e\n\u003cli\u003eTucker B. The flipped classroom. Education next. 2012;12(1):82-3.\u003c/li\u003e\n\u003cli\u003ePapachristopoulos G, Lakin E, editors. Flipped Classroom and Independent Learning. Hellenic Conference on Innovating STEM Education: Interdisciplinary approach on Science, Technology, Engineering and Mathematics in Education\u0026ndash;STEM Education; 2016.\u003c/li\u003e\n\u003cli\u003eJohnson GB. Student perceptions of the flipped classroom: University of British Columbia; 2013.\u003c/li\u003e\n\u003cli\u003eTang F, Chen C, Zhu Y, Zuo C, Zhong Y, Wang N, et al. Comparison between flipped classroom and lecture-based classroom in ophthalmology clerkship. Medical education online. 2017;22(1):1395679.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Flipped Classes, Student Satisfaction, Medical Education, Active Learning, Psychometric Evaluation, Saudi Arabia","lastPublishedDoi":"10.21203/rs.3.rs-6048897/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6048897/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe flipped classroom approach has become an innovative teaching method that reverses traditional instructional sequences, allowing students to engage with lecture content outside the classroom and use in-class time for interactive, collaborative learning. Rooted in constructivist principles, this model promotes active learning, enhances student engagement, and fosters higher-order thinking skills. Despite its growing adoption, particularly accelerated by the COVID-19 pandemic, there remains limited evidence of its long-term impact on student performance and effectiveness in specialised contexts, such as medical education and instrumentation courses. This study evaluates undergraduate students' perceptions of the flipped classroom's effectiveness in enhancing student engagement, instructor support, technological design, and the overall learning environment within medical instrumentation courses.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted with 237 third-year undergraduate students enrolled in the Medical Laboratory Science program at Fakeeh College for Medical Sciences, Saudi Arabia. The flipped classroom model was implemented in two courses\u0026mdash;Instrumentation and Electronic Microscope\u0026mdash;over three 50-minute sessions per course. Pre-class materials were provided one week in advance through Blackboard, and in-class activities included quizzes, case discussions, and assignments, followed by constructive feedback. Student satisfaction was measured using a 30-item questionnaire. Exploratory factor analysis and reliability analysis were performed to assess the questionnaire's psychometric properties. Data analysis was conducted using SPSS, with statistical significance at p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe findings demonstrated strong internal consistency, with Cronbach\u0026rsquo;s alpha values ranging from 0.86 to 0.94. The flipped classrooms significantly foster student engagement and collaboration, improve the role of instructors, and enhance the learning environment through technology-driven, self-paced learning.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBased on these findings, practical recommendations were developed for instructors, including the creation of high-quality pre-class materials, optimisation of in-class activities for active learning, and the redefinition of the instructor\u0026rsquo;s role as a facilitator. The study also emphasises the importance of leveraging technology, cultivating a supportive learning environment, and implementing continuous assessment and feedback mechanisms. These insights led to developing the T.I.C.E.F. Framework (Technology, Instructor, Content, Environment, and Feedback), which offers a structured guide to optimising flipped classroom implementations and improving teaching strategies and student learning experiences.\u003c/p\u003e","manuscriptTitle":"Undergraduate Perceptions of Flipped Classrooms in Medical Instrumentation Courses: Insights and the T.I.C.E.F. Framework from a Cross-Sectional Psychometric Evaluation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-17 09:02:21","doi":"10.21203/rs.3.rs-6048897/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"99489709248715322880305577585143964018","date":"2025-04-24T14:20:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-14T06:11:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-08T17:22:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-19T18:06:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-18T16:49:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-03-18T16:48:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2c859daf-9d8e-46db-a109-6ba37fad0b93","owner":[],"postedDate":"April 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-04-17T09:02:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-17 09:02:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6048897","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6048897","identity":"rs-6048897","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}