Evaluation of Students’ Feedback Towards Flipped Classroom in Simulation based learning

Evaluation of Students’ Feedback Towards Flipped Classroom in Simulation based learning | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Students’ Feedback Towards Flipped Classroom in Simulation based learning Sidra Hassan, Syed Farjad Sultan, Shafaq Faraz, Kisa Fatima This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8992743/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background of the study: In recent years, the flipped classroom (FC) method has been integrated into undergraduate medical curricula. Studies have shown that FC enhances students’ critical thinking, clinical decision-making skills, and satisfaction, while also promoting collaborative learning. However, there is a lack of clear empirical evidence regarding the effectiveness of FC in developing clinical skills. Furthermore, not many research has yet investigated the impact of combining FC with simulated learning on clinical skills Objective To evaluate feedback of students towards implementation of flipped classroom in simulation training in undergraduate skills lab. Study Design: A descriptive cross-sectional study Study Setting : Dow Medical College, DUHS, Karachi Participants : This study was conducted on undergraduate MBBS students of Dow Medical College, DUHS, Karachi by using post simulation training survey form. Sample size : Sample size was calculated online by openEpi ( http://www.openepi.com/SampleSize/SSPropor.htm ). As the percent of attitude of undergraduate medical students towards FC with simulation was definitely unknown, we assumed that at 50% of them had positive response towards it and the worst acceptable level was 45%. The required sample size was about 197 at 95% confidence level. Thus, the final sample size was 200. Data Analysis: Statistical Package for the Social Science (SPSS) was used to analyze the data. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize students’ responses. Results Among 200 students, over 90% agreed that pre-class materials were clear and useful. In-class feedback was most favorable, with more than 95% reporting sessions were well organized, facilitators supportive, and hands-on practice helpful. Overall, over 95% considered the flipped classroom effective and preferred it to traditional lectures. Limitations : This study was based only on students’ opinions, which may be influenced by personal or social bias, and it did not measure actual knowledge or skills gained. Also, as it was done in a single institution and at one point in time, the results may not apply everywhere and do not show long-term effects on learning. Conclusion The flipped classroom in simulation-based learning was well received and viewed as effective in improving preparation, engagement, and skill development, making it a strong alternative to traditional teaching. Flipped Classroom Medical simulation Undergraduate Medical Students Feedback Traditional Classroom Figures Figure 1 Introduction Medical education has witnessed a significant shift in teaching methods recently, with an increasing emphasis on simulation in undergraduate curricula, particularly for basic and surgical skills. Simulation-based programs are enabling students to gain valuable hands-on experience necessary for their clinical rotations. Additionally, the ability to fail without consequences in simulations helps trainees learn and accelerate the learning curve, allowing them to confidently apply new skills in a clinical setting without compromising patient safety. Employers have noticed that recent medical graduates often lack the skills needed for basic clinical tasks. This is exacerbated by a decrease in opportunities for direct practical training, often due to patients' critical conditions. To address these challenges, simulation training using lab simulators has become more common to improve nurses' performance and compensate for limitations in hospital training. However, traditional simulation (TS) methods have been criticized for increasing stress due to the tension and anxiety from real-life scenarios, fear of mistakes, limited problem-solving, reduced self-confidence, and lower student satisfaction. Therefore, there is a growing recognition of the need for a new teaching approach to overcome these challenges and enhance the quality of nurse training. The flipped classroom (FC) model, where traditional lecture and homework elements are reversed. Fig. 1 illustrates the contrasting features of the traditional classroom and the flipped classroom within this context It has become increasingly popular in various preclinical and clinical educational programs, including radiology, surgery, emergency medicine, internal medicine, and obstetrics and gynecology. However, its use in simulation-based training programs is limited. Although the majority of studies have demonstrated the effects of FC model on the cognitive domain, there has been limited focus on its impact on the psychomotor domain. In recent years, the FC method has been integrated into undergraduate medical curricula. Studies have shown that FC enhances students’ critical thinking, clinical decision-making skills, and satisfaction, while also promoting collaborative learning. However, there is a lack of clear empirical evidence regarding the effectiveness of FC in developing clinical skills. Furthermore, not many research has yet investigated the impact of combining FC with simulated learning on clinical skills. To evaluate the effectiveness of the flipped classroom model in enhancing student knowledge, a survey was conducted to gather feedback from students. The survey covered areas such as students' preparation and engagement with pre-class materials, their experience with in-class activities, their understanding of concepts, time management, preference for the flipped classroom model compared to traditional lectures, overall satisfaction, and any additional comments or suggestions for improvement. The current study aimed to evaluate feedback of students towards implementation of flipped classroom in simulation training in undergraduate skills lab. Methodology This was an Observational, cross-sectional study. Data was collected from undergraduate MBBS students, batch 2029 of Dow Medical College, DUHS, Karachi. Sample size was calculated online by openEpi ( http://www.openepi.com/SampleSize/SSPropor.htm ). As the percent of attitude of undergraduate medical students towards FC with simulation was definitely unknown, we assumed that at 50% of them had positive response towards it and the worst acceptable level was 45%. The required sample size was about 197 at 95% confidence level. Thus, the final sample size was 200. A post simulation training survey form was used as a tool for the data collection. Statistical Package for the Social Science (SPSS) was used to analyze the data. The frequencies with percentages are calculated of categorical variables including responses on the Likert scale questionnaire items. Mean and standard deviations were computed for the average score of pre class, in class and overall feedback sections in which lower mean scores indicated stronger agreement and a more positive perception of the flipped classroom model. All the undergraduate MBBS students of batch 2029 who were willing to participate were included in the study whereas incomplete questionnaire and students who weren’t interested to participate were excluded from the study. Study participants were selected by convenient sampling technique. • Ethical consideration: Approval from research ethical committee of DUHS was taken prior to data collection. Oral informed consents were obtained from the participants after explanation of study objectives with strict confidentiality and the name and identity were optional. Results In table 01, more than 90% of students agreed or strongly agreed with each statement, showing that the pre-class component of the flipped classroom was effective in preparing them for in-class activities. More than half strongly agreed that the materials were clear and easy to access (58.5%), while another 36.5% agreed, leaving less than 1% who disagreed. Similarly, 56.5% strongly agreed and 40% agreed that the content was interesting and relevant. Most also felt they had enough preparation time, with only a small minority expressing concerns. The audiovisual quality of the videos was also rated highly. Table No. 01: Pre-Class Feedback (N = 200) Sr. No. Strongly Agree Agree Uncertain Disagree Strongly Disagree 1 The pre-class study material was clear and easy to access. 117 (58.5%) 73 (36.5%) 8 (4%) 1 (0.5%) 1 (0.5%) 2 You find the content interesting and relevant. 113 (56.5%) 80 (40%) 6 (3%) 0 0% 1 (0.5%) 3 You were given enough time for the preparation of class and study course material uploaded on LMS. 120 (60%) 65 (32.5%) 8 (4%) 6 (3%) 1 (0.5%) 4 The audiovisual quality of videos uploaded on LMS was adequate. 128 (64%) 66 (33%) 3 (1.5%) 2 (1%) 1 (0.5%) Table No. 02: In-Class Feedback (N = 200) Sr. No. Strongly Agree Agree Uncertain Disagree Strongly Disagree 1 The session was well organized and in accordance with Learning Objective. 140 (70%) 53 (26.5%) 6 (3%) 0 (0%) 1 (0.5%) 2 Practicing on manikin aids in knowledge retention of given skill. 144 (72%) 47 (23.5%) 6 (3%) 2 (1%) 1 (0.5%) 3 The manikins were kept in good condition. 123 (61.5%) 59 (29.5%) 9 (4.5%) 8 (4%) 1 (0.5%) 4 The facilitator provides sufficient time for hands on practice on manikins 148 (74%) 46 (23%) 3 (1.5%) 2 (1%) 1 (0.5%) 5 The facilitators were cooperative and helpful throughout the session. 151 (75.5%) 43 (21.5%) 4 (2%) 1 (0.5%) 1 (0.5%) 6 No. of Facilitators for hands on session was adequate 123 (61.5%) 67 (33.5%) 6 (3%) 3 (1.5%) 1 (0.5%) 7 Questions were adequately responded by the facilitators. 135 (67.5%) 63 (31.5%) 1 (0.5%) 0 (0%) 1 (0.5%) 8 The session progressed in logical order 125 (62.5%) 70 (35%) 3 (1.5%) 1 (0.5%) 1 (0.5%) The in-class feedback (Table 02) demonstrated positive responses from students. A large majority agreed or strongly agreed that the session was structured, aligned with the stated learning objectives and progressed in a logical order. More than 95% students felt that practicing on manikins enhanced their ability to retain knowledge and sufficient time was provided for hands-on practice. Facilitators were also rated highly for their cooperation and support as well as for adequately responding to students’ questions (99%). The sufficient number of facilitators was considered by 95% of students. Satisfaction with the condition of the manikins was also high (91%), though slightly lower than other areas, suggesting a minor scope for improvement. Table No. 03: Overall Feedback (N = 200) Sr. No. Strongly Agree Agree Uncertain Disagree Strongly Disagree 1 This teaching methodology (flip classroom) was appropriate for your learning style in simulation lab. 126 (63%) 64 (32%) 7 (3.5%) 2 (1%) 1 (0.5%) 2 After going through the pre-class material, you were motivated to complete the in-class activities. 109 (54.5%) 80 (40%) 10 (5%) 0 0% 1 (0.5%) 3 Flipped classroom technique is more effective for simulation training than traditional lecture-based classes. 128 (64%) 62 (31%) 6 (3%) 1 (0.5%) 3 (1.5%) 4 You prefer this approach for future session 133 (66.5%) 58 (29%) 6 (3%) 1 (0.5%) 2 (1%) Overall feedback reflected positive response to the flipped classroom model in table 03. Almost 95% of the students it suited their learning style in the simulation lab and found it was more effective approach as compared to traditional method. Most of them also preferred this approach for future sessions, while very few expressing uncertainty or disagreement. Table 04 Mean and standard deviation for feedback (N = 200) Sr. No. Mean Std. Deviation 1 Pre Class Feedback 1.47 0.54 2 In class Feedback 1.37 0.51 3 Overall Feedback 1.42 0.52 The results showed that students had a very positive opinion about the flipped classroom model (Table 04 ). Pre-class feedback was also positive (M = 1.47, SD = 0.54), demonstrating that students found the materials clear, easy to access, interesting, and that they had enough preparation time. The in-class feedback had the best score (M = 1.37, SD = 0.51), revealing most students strongly agreed that the sessions were well organized, the facilitators were helpful, there was enough time for practice, and the simulation activities helped them remember the skills. Overall feedback was also very good (M = 1.42, SD = 0.52), with students considering this approach was better than traditional teaching, and should be used in future classes. Table 05 Internal Consistency of questionnaire Reliability Statistics Cronbach's Alpha N of Items 0.939 16 In Table 05 , Cronbach’s alpha was calculated to analyze the internal consistency of questionnaire comprise of 16 statements. The analysis demonstrated excellent reliability (α = 0.939) which indicates that the questionnaire used in this study effectively measure students’ perceptions of the flipped classroom model in simulation-based learning. Discussions The flipped classroom approach, increasingly supported by research, is becoming a widely adopted strategy in higher education. In contrast to conventional teacher-centered instruction, this approach emphasizes active, student-centered learning and allows students to engage with online resources prior to class which enable them to study independently, regulate their learning pace and increase hands on time in class. Similarly, this study’s findings highlight the effectiveness of the flipped classroom approach particularly when it is combined with simulation and improving student learning and satisfaction. Feedback from the pre-class phase reflected strong student satisfaction, with over 90% affirming that the materials were clear, relevant, easily accessible, and of high audiovisual quality. This indicates that the preparatory component successfully supported students in getting ready for in-class learning activities. Findings from another study revealed that introducing instructional videos earlier in the course was associated with higher viewing and retention rates, suggesting that the timing of resource delivery plays a critical role in pre-class engagement. Although the overall student feedback towards pre-classroom was largely positive, a few highlighted concerns about the amount of preparation time required. This finding is consistent with previous flipped classroom research, which has similarly noted that some students encounter challenges in allocating sufficient time for pre-class learning activities while managing other academic responsibilities. In-class evaluation revealed highly positive student perceptions, with more than 95% of respondents expressing agreement or strong agreement on most items. Students emphasized that the sessions were well structured, followed a logical progression, and that facilitators were cooperative, supportive, and responsive to their questions. A recent study on flipped classroom simulation in nursing education reported that students who engaged in active, hands-on practice with adequate facilitator support demonstrated improved confidence and clinical skill performance compared to those in lecture-based settings. Students also appreciated the opportunity for hands-on practice with manikins, with the majority acknowledging that it enhanced their ability to retain knowledge. Overall feedback indicated strong student support for the flipped classroom model, with over 95% reporting that it suited their learning style, enhanced in-class participation, and proved more effective than traditional lectures. A similar proportion expressed preference for its continued use in future sessions. According to Sun and WC, Simulation based flipped classroom emphasizes application and practice, thereby fostering students' creative abilities. A 2025 systematic review reported that students found flipped classrooms more engaging and effective than traditional methods due to increased autonomy and active participation. Conclusion This study demonstrated that students responded positively to the flipped classroom model in simulation-based learning, perceiving it as more effective than traditional methods. Pre-class materials were considered helpful for preparation, while in-class activities, particularly hands-on practice supported by facilitator guidance were reported to significantly enhance learning. Overall, students favored the flipped approach over traditional lectures, suggesting its potential to enhance motivation, participation, and learning outcomes in health sciences education. Strength & Limitations of the study: The strengths of this study include its focus on student-centered feedback and the use of validated evaluation measures across multiple dimensions of learning. However, there are also some limitations. This study was based only on students’ opinions, which may be influenced by personal or social bias, and it did not measure actual knowledge or skills gained. Also, as it was done in a single institution and at one point in time, the results may not apply everywhere and do not show long-term effects on learning. Declarations Conflict of interest: None Data availability statement: Data are available from the corresponding author upon reasonable request and subject to institutional and ethical approval. Source of Funding: None Authors’ contribution: SH: Principal Investigator, Design, writing, and editing of manuscript. SFS: Conceiving of study idea and editing of manuscript. SF: Collection of data, Data Analysis and writing of results. KF: Collection of Data and Literature Review Acknowledgements: Authors would like to thank the undergraduate MBBS students of Dow Medical College for their participation in the survey who supported our work in this way and helped us to get results of better quality. References Aggarwal R, Moorthy K, Darzi A. Laparoscopic skills training and assessment. Journal of British Surgery. 2004 Dec;91(12):1549-58. https://doi.org/10.1002/bjs.4816. Dong C, Szarek JL, Reed T. The flipped classroom and simulation: a primer for simulation educators. Medical Science Educator. 2020 Dec;30(4):1627-32. https://doi.org/10.1007/s40670-020-01041-9. Gu M, Sok SR. Effects of simulation practicum using flipped learning for Korean nursing students. International Journal of Environmental Research and Public Health. 2020 Sep;17(18):6829. https://doi.org/10.3390/ijerph17186829. Boostel R, Felix JV, Bortolato-Major C, Pedrolo E, Vayego SA, Mantovani MD. 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Design and practice of blended learning for logistics system simulation course based on flipped classroom. Int J Learn Teach. 2019;5(2):170-4. https://doi.org/10.18178/ijlt.5.2.170-174. Spaic D, Bukumiric Z, Rajovic N, Markovic K, Savic M, Milin-Lazovic J, Grubor N, Milic N, Stanisavljevic D, Despotovic A, Bokonjic D. The flipped classroom in medical education: systematic review and meta-analysis. Journal of Medical Internet Research. 2025 Aug 13;27:e60757. https://doi.org/10.2196/60757 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. 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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-8992743","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":599121451,"identity":"f1abcb32-425f-46f7-8825-42e5f6e9e984","order_by":0,"name":"Sidra Hassan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYDACZgYDBsYGCPvAh4p/cmDGAyK1MB6cceaAMVhLAn574FqYD/O2HUgEs/FpkW9n3vbh5w47e/n2sweAWu6kzw87/BBoi52cbgMOKw6zFc/sPZOcuOFMXsLBOeee5W68nWYA1JJsbHYAhxZmHmMG3jbmBAOGHIMDb8qYczfOTgBpOZC4DYcW+WYeY8a/bfX28v1vDA7wsDGnG85O/4BXC8NhHmNm3rbDjA03cgwO8rQdTpCXzsFvC8gvzLJtxxM33HhjAAzkNMMN0jkFBxIMcPtFvv/wZsa3bdVAh+UYf/hQYSMvPzt9M5BhJ4dLCxZ7wSoNiFUOtreBFNWjYBSMglEwEgAAxmhpr4BFIAMAAAAASUVORK5CYII=","orcid":"","institution":"Dow University of Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Sidra","middleName":"","lastName":"Hassan","suffix":""},{"id":599121452,"identity":"f73dbd04-dede-4311-9d01-4898e5324e53","order_by":1,"name":"Syed Farjad Sultan","email":"","orcid":"","institution":"Dow University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Syed","middleName":"Farjad","lastName":"Sultan","suffix":""},{"id":599121453,"identity":"31b3babc-b63b-455b-9aa2-67619421177a","order_by":2,"name":"Shafaq Faraz","email":"","orcid":"","institution":"Dow University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Shafaq","middleName":"","lastName":"Faraz","suffix":""},{"id":599121454,"identity":"33f360f4-d3c0-460a-9c81-39e64cb2f66a","order_by":3,"name":"Kisa Fatima","email":"","orcid":"","institution":"Dow University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Kisa","middleName":"","lastName":"Fatima","suffix":""}],"badges":[],"createdAt":"2026-02-28 07:40:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8992743/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8992743/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104176812,"identity":"24455779-28d4-482d-83d6-0581d86f3265","added_by":"auto","created_at":"2026-03-08 16:39:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20618,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTraditional Classroom V/S Flipped Classroom\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8992743/v1/59d69dc18f13def9074cc989.jpg"},{"id":104414659,"identity":"952b6bec-2b4d-46de-97c1-7857463770fa","added_by":"auto","created_at":"2026-03-11 13:08:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":718967,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8992743/v1/e1add3a5-a6a8-4d88-a834-31291bbf9ee7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Students’ Feedback Towards Flipped Classroom in Simulation based learning","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMedical education has witnessed a significant shift in teaching methods recently, with an increasing emphasis on simulation in undergraduate curricula, particularly for basic and surgical skills.\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e Simulation-based programs are enabling students to gain valuable hands-on experience necessary for their clinical rotations. Additionally, the ability to fail without consequences in simulations helps trainees learn and accelerate the learning curve, allowing them to confidently apply new skills in a clinical setting without compromising patient safety.\u003ca class=\"FNLink\" href=\"#Fn2\" id=\"#FNLinkFn2\"\u003e\u003c/a\u003e\u003c/p\u003e \u003cp\u003eEmployers have noticed that recent medical graduates often lack the skills needed for basic clinical tasks. This is exacerbated by a decrease in opportunities for direct practical training, often due to patients' critical conditions.\u003ca class=\"FNLink\" href=\"#Fn3\" id=\"#FNLinkFn3\"\u003e\u003c/a\u003e To address these challenges, simulation training using lab simulators has become more common to improve nurses' performance and compensate for limitations in hospital training. However, traditional simulation (TS) methods have been criticized for increasing stress due to the tension and anxiety from real-life scenarios, fear of mistakes, limited problem-solving, reduced self-confidence, and lower student satisfaction. Therefore, there is a growing recognition of the need for a new teaching approach to overcome these challenges and enhance the quality of nurse training.\u003ca class=\"FNLink\" href=\"#Fn4\" id=\"#FNLinkFn4\"\u003e\u003c/a\u003e\u003c/p\u003e \u003cp\u003eThe flipped classroom (FC) model, where traditional lecture and homework elements are reversed.\u003ca class=\"FNLink\" href=\"#Fn5\" id=\"#FNLinkFn5\"\u003e\u003c/a\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the contrasting features of the traditional classroom and the flipped classroom within this context\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIt has become increasingly popular in various preclinical and clinical educational programs, including radiology, surgery, emergency medicine, internal medicine, and obstetrics and gynecology.\u003ca class=\"FNLink\" href=\"#Fn6\" id=\"#FNLinkFn6\"\u003e\u003c/a\u003e However, its use in simulation-based training programs is limited. Although the majority of studies have demonstrated the effects of FC model on the cognitive domain, there has been limited focus on its impact on the psychomotor domain.\u003ca class=\"FNLink\" href=\"#Fn7\" id=\"#FNLinkFn7\"\u003e\u003c/a\u003e\u003c/p\u003e \u003cp\u003eIn recent years, the FC method has been integrated into undergraduate medical curricula. Studies have shown that FC enhances students\u0026rsquo; critical thinking, clinical decision-making skills, and satisfaction, while also promoting collaborative learning.\u003ca class=\"FNLink\" href=\"#Fn8\" id=\"#FNLinkFn8\"\u003e\u003c/a\u003e However, there is a lack of clear empirical evidence regarding the effectiveness of FC in developing clinical skills. Furthermore, not many research has yet investigated the impact of combining FC with simulated learning on clinical skills.\u003ca class=\"FNLink\" href=\"#Fn9\" id=\"#FNLinkFn9\"\u003e\u003c/a\u003e\u003c/p\u003e \u003cp\u003eTo evaluate the effectiveness of the flipped classroom model in enhancing student knowledge, a survey was conducted to gather feedback from students. The survey covered areas such as students' preparation and engagement with pre-class materials, their experience with in-class activities, their understanding of concepts, time management, preference for the flipped classroom model compared to traditional lectures, overall satisfaction, and any additional comments or suggestions for improvement. The current study aimed to evaluate feedback of students towards implementation of flipped classroom in simulation training in undergraduate skills lab.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis was an Observational, cross-sectional study. Data was collected from undergraduate MBBS students, batch 2029 of Dow Medical College, DUHS, Karachi. Sample size was calculated online by openEpi (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.openepi.com/SampleSize/SSPropor.htm\u003c/span\u003e\u003cspan address=\"http://www.openepi.com/SampleSize/SSPropor.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). As the percent of attitude of undergraduate medical students towards FC with simulation was definitely unknown, we assumed that at 50% of them had positive response towards it and the worst acceptable level was 45%. The required sample size was about 197 at 95% confidence level. Thus, the final sample size was 200. A post simulation training survey form was used as a tool for the data collection.\u003c/p\u003e \u003cp\u003eStatistical Package for the Social Science (SPSS) was used to analyze the data. The frequencies with percentages are calculated of categorical variables including responses on the Likert scale questionnaire items. Mean and standard deviations were computed for the average score of pre class, in class and overall feedback sections in which lower mean scores indicated stronger agreement and a more positive perception of the flipped classroom model.\u003c/p\u003e \u003cp\u003eAll the undergraduate MBBS students of batch 2029 who were willing to participate were included in the study whereas incomplete questionnaire and students who weren\u0026rsquo;t interested to participate were excluded from the study. Study participants were selected by convenient sampling technique.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; Ethical consideration:\u003c/h2\u003e \u003cp\u003e Approval from research ethical committee of DUHS was taken prior to data collection. Oral informed consents were obtained from the participants after explanation of study objectives with strict confidentiality and the name and identity were optional.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn table 01, more than 90% of students agreed or strongly agreed with each statement, showing that the pre-class component of the flipped classroom was effective in preparing them for in-class activities. More than half strongly agreed that the materials were clear and easy to access (58.5%), while another 36.5% agreed, leaving less than 1% who disagreed. Similarly, 56.5% strongly agreed and 40% agreed that the content was interesting and relevant. Most also felt they had enough preparation time, with only a small minority expressing concerns. The audiovisual quality of the videos was also rated highly.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable No. 01: Pre-Class Feedback (N\u0026thinsp;=\u0026thinsp;200)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\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=\"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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSr. No.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStrongly\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUncertain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStrongly\u003c/p\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe pre-class study material was clear and easy to access.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e117\u003c/p\u003e \u003cp\u003e(58.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e73\u003c/p\u003e \u003cp\u003e(36.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e(4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYou find the content interesting and relevant.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003cp\u003e(56.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003cp\u003e(40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e(3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYou were given enough time for the preparation of class and study course material uploaded on LMS.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003cp\u003e(60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65\u003c/p\u003e \u003cp\u003e(32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e(4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e(3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe audiovisual quality of videos uploaded on LMS was adequate.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003cp\u003e(64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003cp\u003e(33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\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 \u003cb\u003eTable No. 02: In-Class Feedback (N\u0026thinsp;=\u0026thinsp;200)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\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=\"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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSr. No.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStrongly\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUncertain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStrongly\u003c/p\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe session was well organized and in accordance with Learning Objective.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140\u003c/p\u003e \u003cp\u003e(70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003cp\u003e(26.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e(3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePracticing on manikin aids in knowledge retention of given skill.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003cp\u003e(72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003cp\u003e(23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e(3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe manikins were kept in good condition.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003cp\u003e(61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59\u003c/p\u003e \u003cp\u003e(29.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e(4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e(4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe facilitator provides sufficient time for hands on practice on manikins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003cp\u003e(74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003cp\u003e(23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe facilitators were cooperative and helpful throughout the session.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003cp\u003e(75.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003cp\u003e(21.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e(2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. of Facilitators for hands on session was adequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003cp\u003e(61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003cp\u003e(33.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e(3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuestions were adequately responded by the facilitators.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003cp\u003e(67.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63\u003c/p\u003e \u003cp\u003e(31.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe session progressed in logical order\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003cp\u003e(62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003cp\u003e(35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\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\u003eThe in-class feedback (Table\u0026nbsp;02) demonstrated positive responses from students. A large majority agreed or strongly agreed that the session was structured, aligned with the stated learning objectives and progressed in a logical order. More than 95% students felt that practicing on manikins enhanced their ability to retain knowledge and sufficient time was provided for hands-on practice. Facilitators were also rated highly for their cooperation and support as well as for adequately responding to students\u0026rsquo; questions (99%). The sufficient number of facilitators was considered by 95% of students. Satisfaction with the condition of the manikins was also high (91%), though slightly lower than other areas, suggesting a minor scope for improvement.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable No. 03: Overall Feedback (N\u0026thinsp;=\u0026thinsp;200)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\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=\"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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSr. No.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStrongly\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUncertain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStrongly\u003c/p\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis teaching methodology (flip classroom) was appropriate for your learning style in simulation lab.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003cp\u003e(63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003cp\u003e(32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003cp\u003e(3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter going through the pre-class material, you were motivated to complete the in-class activities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003cp\u003e(54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003cp\u003e(40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e(5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFlipped classroom technique is more effective for simulation training than traditional lecture-based classes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003cp\u003e(64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003cp\u003e(31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e(3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(1.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYou prefer this approach for future session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133\u003c/p\u003e \u003cp\u003e(66.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003cp\u003e(29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e(3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(1%)\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\u003eOverall feedback reflected positive response to the flipped classroom model in table 03. Almost 95% of the students it suited their learning style in the simulation lab and found it was more effective approach as compared to traditional method. Most of them also preferred this approach for future sessions, while very few expressing uncertainty or disagreement.\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 04\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean and standard deviation for feedback (N\u0026thinsp;=\u0026thinsp;200)\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=\"left\" 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\u003eSr. No.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStd. Deviation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre Class Feedback\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn class Feedback\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall Feedback\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.52\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\u003eThe results showed that students had a very positive opinion about the flipped classroom model (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e04\u003c/span\u003e). Pre-class feedback was also positive (M\u0026thinsp;=\u0026thinsp;1.47, SD\u0026thinsp;=\u0026thinsp;0.54), demonstrating that students found the materials clear, easy to access, interesting, and that they had enough preparation time. The in-class feedback had the best score (M\u0026thinsp;=\u0026thinsp;1.37, SD\u0026thinsp;=\u0026thinsp;0.51), revealing most students strongly agreed that the sessions were well organized, the facilitators were helpful, there was enough time for practice, and the simulation activities helped them remember the skills. Overall feedback was also very good (M\u0026thinsp;=\u0026thinsp;1.42, SD\u0026thinsp;=\u0026thinsp;0.52), with students considering this approach was better than traditional teaching, and should be used in future classes.\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 05\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInternal Consistency of questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eReliability Statistics\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCronbach's Alpha\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN of Items\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.939\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\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\u003eIn Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e05\u003c/span\u003e, Cronbach\u0026rsquo;s alpha was calculated to analyze the internal consistency of questionnaire comprise of 16 statements. The analysis demonstrated excellent reliability (α\u0026thinsp;=\u0026thinsp;0.939) which indicates that the questionnaire used in this study effectively measure students\u0026rsquo; perceptions of the flipped classroom model in simulation-based learning.\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eThe flipped classroom approach, increasingly supported by research, is becoming a widely adopted strategy in higher education.\u003ca class=\"FNLink\" href=\"#Fn10\" id=\"#FNLinkFn10\"\u003e\u003c/a\u003e In contrast to conventional teacher-centered instruction, this approach emphasizes active, student-centered learning and allows students to engage with online resources prior to class which enable them to study independently, regulate their learning pace and increase hands on time in class.\u003ca class=\"FNLink\" href=\"#Fn11\" id=\"#FNLinkFn11\"\u003e\u003c/a\u003e Similarly, this study\u0026rsquo;s findings highlight the effectiveness of the flipped classroom approach particularly when it is combined with simulation and improving student learning and satisfaction.\u003c/p\u003e \u003cp\u003eFeedback from the pre-class phase reflected strong student satisfaction, with over 90% affirming that the materials were clear, relevant, easily accessible, and of high audiovisual quality. This indicates that the preparatory component successfully supported students in getting ready for in-class learning activities. Findings from another study revealed that introducing instructional videos earlier in the course was associated with higher viewing and retention rates, suggesting that the timing of resource delivery plays a critical role in pre-class engagement.\u003ca class=\"FNLink\" href=\"#Fn12\" id=\"#FNLinkFn12\"\u003e\u003c/a\u003e Although the overall student feedback towards pre-classroom was largely positive, a few highlighted concerns about the amount of preparation time required. This finding is consistent with previous flipped classroom research, which has similarly noted that some students encounter challenges in allocating sufficient time for pre-class learning activities while managing other academic responsibilities.\u003ca class=\"FNLink\" href=\"#Fn13\" id=\"#FNLinkFn13\"\u003e\u003c/a\u003e\u003c/p\u003e \u003cp\u003eIn-class evaluation revealed highly positive student perceptions, with more than 95% of respondents expressing agreement or strong agreement on most items. Students emphasized that the sessions were well structured, followed a logical progression, and that facilitators were cooperative, supportive, and responsive to their questions. A recent study on flipped classroom simulation in nursing education reported that students who engaged in active, hands-on practice with adequate facilitator support demonstrated improved confidence and clinical skill performance compared to those in lecture-based settings.\u003ca class=\"FNLink\" href=\"#Fn14\" id=\"#FNLinkFn14\"\u003e\u003c/a\u003e Students also appreciated the opportunity for hands-on practice with manikins, with the majority acknowledging that it enhanced their ability to retain knowledge.\u003c/p\u003e \u003cp\u003e Overall feedback indicated strong student support for the flipped classroom model, with over 95% reporting that it suited their learning style, enhanced in-class participation, and proved more effective than traditional lectures. A similar proportion expressed preference for its continued use in future sessions. According to Sun and WC, Simulation based flipped classroom emphasizes application and practice, thereby fostering students' creative abilities.\u003ca class=\"FNLink\" href=\"#Fn15\" id=\"#FNLinkFn15\"\u003e\u003c/a\u003e A 2025 systematic review reported that students found flipped classrooms more engaging and effective than traditional methods due to increased autonomy and active participation.\u003ca class=\"FNLink\" href=\"#Fn16\" id=\"#FNLinkFn16\"\u003e\u003c/a\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that students responded positively to the flipped classroom model in simulation-based learning, perceiving it as more effective than traditional methods. Pre-class materials were considered helpful for preparation, while in-class activities, particularly hands-on practice supported by facilitator guidance were reported to significantly enhance learning. Overall, students favored the flipped approach over traditional lectures, suggesting its potential to enhance motivation, participation, and learning outcomes in health sciences education.\u003c/p\u003e\n\u003ch3\u003eStrength \u0026 Limitations of the study:\u003c/h3\u003e\n\u003cp\u003eThe strengths of this study include its focus on student-centered feedback and the use of validated evaluation measures across multiple dimensions of learning. However, there are also some limitations. This study was based only on students\u0026rsquo; opinions, which may be influenced by personal or social bias, and it did not measure actual knowledge or skills gained. Also, as it was done in a single institution and at one point in time, the results may not apply everywhere and do not show long-term effects on learning.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eConflict of interest:\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eData availability statement:\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the corresponding author upon reasonable request and subject to institutional and ethical approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eSource of Funding:\u0026nbsp;\u003c/u\u003e\u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAuthors’ contribution:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eSH: Principal Investigator, Design, writing, and editing of manuscript.\u003c/li\u003e\n \u003cli\u003eSFS: Conceiving of study idea and editing of manuscript.\u003c/li\u003e\n \u003cli\u003eSF: Collection of data, Data Analysis and writing of results.\u003c/li\u003e\n \u003cli\u003eKF: Collection of Data and Literature Review\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAcknowledgements:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors would like to thank the undergraduate MBBS students of Dow Medical College for their participation in the survey who supported our work in this way and helped us to get results of better quality.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAggarwal R, Moorthy K, Darzi A. Laparoscopic skills training and assessment. Journal of British Surgery. 2004 Dec;91(12):1549-58. https://doi.org/10.1002/bjs.4816.\u003c/li\u003e\n\u003cli\u003eDong C, Szarek JL, Reed T. The flipped classroom and simulation: a primer for simulation educators. Medical Science Educator. 2020 Dec;30(4):1627-32. https://doi.org/10.1007/s40670-020-01041-9.\u003c/li\u003e\n\u003cli\u003eGu M, Sok SR. Effects of simulation practicum using flipped learning for Korean nursing students. International Journal of Environmental Research and Public Health. 2020 Sep;17(18):6829. https://doi.org/10.3390/ijerph17186829.\u003c/li\u003e\n\u003cli\u003eBoostel R, Felix JV, Bortolato-Major C, Pedrolo E, Vayego SA, Mantovani MD. Tensión del estudiante de enfermería en la simulación clínica: ensayo clínico aleatorizado. Revista Brasileira de Enfermagem. 2018;71:967-74. https://doi.org/10.1590/0034-7167-2017-0187 \u003c/li\u003e\n\u003cli\u003eHorton BW. Shifting from the sage on stage to the guide on the side: The impact on student learning and course evaluations. Journal of Hospitality \u0026amp; Tourism Education. 2001 Oct 1;13(5):26-34. https://doi.org/10.1080/10963758.2001.10696712.\u003c/li\u003e\n\u003cli\u003eHawks SJ. The flipped classroom: now or never?. AANA journal. 2014 Aug 1;82(4).\u003c/li\u003e\n\u003cli\u003eChiu HY, Kang YN, Wang WL, Huang HC, Wu CC, Hsu W, Tong YS, Wei PL. The effectiveness of a simulation-based flipped classroom in the acquisition of laparoscopic suturing skills in medical students—a pilot study. Journal of surgical education. 2018 Mar 1;75(2):326-32. https://doi.org/10.1016/j.jsurg.2017.07.007\u003c/li\u003e\n\u003cli\u003ePangandaman HK. Effects of flipped classroom videos in the return demonstration performance of nursing students. Sch J Appl Sci Res. 2018;1(4):55-8. \u003c/li\u003e\n\u003cli\u003eChoi J, Lee SE, Bae J, Kang S, Choi S, Tate JA, Yang YL. Undergraduate nursing students' experience of learning respiratory system assessment using flipped classroom: a mixed methods study. Nurse Education Today. 2021 Mar 1;98:104664. https://doi.org/10.1016/j.nedt.2020.104664\u003c/li\u003e\n\u003cli\u003eDehghanzadeh S, Jafaraghaee F. Comparing the effects of traditional lecture and flipped classroom on nursing students' critical thinking disposition: A quasi-experimental study. Nurse education today. 2018 Dec 1;71:151-6. https://doi.org/10.1016/j.nedt.2018.09.027\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 Mar 15;18(1):38. https://doi.org/10.1186/s12909-018-1144-z\u003c/li\u003e\n\u003cli\u003eRadhamani R, Kumar D, Nizar N, Achuthan K, Nair B, Diwakar S. What virtual laboratory usage tells us about laboratory skill education pre-and post-COVID-19: Focus on usage, behavior, intention and adoption. Education and information technologies. 2021 Nov;26(6):7477-95. https://doi.org/10.1007/s10639-021-10583-3\u003c/li\u003e\n\u003cli\u003eGutiérrez-González R, Royuela A, Zamarron A. Student engagement in a flipped undergraduate medical classroom to measure optimal video-based lecture length. Medical education online. 2025 Dec 31;30(1):2479752. https://doi.org/10.1080/10872981.2025.2479752\u003c/li\u003e\n\u003cli\u003eFahmi A, Mukminatien N, Ginting D, Kusumaningrum SR. The impact of flipping class intervention on reading comprehension: Different approaches and proficiency levels. Plos one. 2024 Jun 20;19(6). https://doi.org/10.1371/journal.pone.0305041.\u003c/li\u003e\n\u003cli\u003eKhadawardi, K., Mirdad, D., Nasief, H., Hassan, A., Waseem, H., Butt, A., Aldardeir, N. E., Salah, W., Zakariyah, A. F., \u0026amp; Alboog, A. (2025). Evaluating Medical Student Engagement in Flipped Classrooms: Insights on Motivation and Peer Learning. \u003cem\u003eJournal of Medical Education and Curricular Development\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e. https://doi.org/10.1177/23821205251320756\u003c/li\u003e\n\u003cli\u003eNasiri S, Hosseinabadi R, Mokhayeri Y, Beiranvand S. Impact of flipped classroom-based simulation of CPR on nursing students’ self-confidence, satisfaction, knowledge and skill: a quasi-experimental study. BMC Medical Education. 2025 Jul 1;25(1):980. https://doi.org/10.1186/s12909-025-07525-9.\u003c/li\u003e\n\u003cli\u003eRuslan MS, Sapiee NH, Kurnia KA, Amran NA, Abd Rahman N. Student adoption and effectiveness of flipped classroom implementation for process simulation class. Education Sciences. 2022 Oct 28;12(11):763. https://doi.org/10.3390/educsci12110763\u003c/li\u003e\n\u003cli\u003eAidoo B, Macdonald MA, Vesterinen VM, Pétursdóttir S, Gísladóttir B. Transforming teaching with ICT using the flipped classroom approach: Dealing with COVID-19 pandemic. Education sciences. 2022 Jun 20;12(6):421. https://doi.org/10.3390/educsci12060421\u003c/li\u003e\n\u003cli\u003eSun X, Wu C. Design and practice of blended learning for logistics system simulation course based on flipped classroom. Int J Learn Teach. 2019;5(2):170-4. https://doi.org/10.18178/ijlt.5.2.170-174.\u003c/li\u003e\n\u003cli\u003eSpaic D, Bukumiric Z, Rajovic N, Markovic K, Savic M, Milin-Lazovic J, Grubor N, Milic N, Stanisavljevic D, Despotovic A, Bokonjic D. The flipped classroom in medical education: systematic review and meta-analysis. Journal of Medical Internet Research. 2025 Aug 13;27:e60757. https://doi.org/10.2196/60757\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Flipped Classroom, Medical simulation, Undergraduate Medical Students, Feedback, Traditional Classroom","lastPublishedDoi":"10.21203/rs.3.rs-8992743/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8992743/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground of the study:\u003c/h2\u003e \u003cp\u003eIn recent years, the flipped classroom (FC) method has been integrated into undergraduate medical curricula. Studies have shown that FC enhances students\u0026rsquo; critical thinking, clinical decision-making skills, and satisfaction, while also promoting collaborative learning. However, there is a lack of clear empirical evidence regarding the effectiveness of FC in developing clinical skills. Furthermore, not many research has yet investigated the impact of combining FC with simulated learning on clinical skills\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate feedback of students towards implementation of flipped classroom in simulation training in undergraduate skills lab.\u003c/p\u003e\u003ch2\u003eStudy Design:\u003c/h2\u003e \u003cp\u003eA descriptive cross-sectional study\u003c/p\u003e\u003ch2\u003eStudy Setting\u003c/h2\u003e \u003cp\u003e: Dow Medical College, DUHS, Karachi\u003c/p\u003e\u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003e: This study was conducted on undergraduate MBBS students of Dow Medical College, DUHS, Karachi by using post simulation training survey form.\u003c/p\u003e\u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003e: Sample size was calculated online by openEpi (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.openepi.com/SampleSize/SSPropor.htm\u003c/span\u003e\u003cspan address=\"http://www.openepi.com/SampleSize/SSPropor.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). As the percent of attitude of undergraduate medical students towards FC with simulation was definitely unknown, we assumed that at 50% of them had positive response towards it and the worst acceptable level was 45%. The required sample size was about 197 at 95% confidence level. Thus, the final sample size was 200.\u003c/p\u003e\u003ch2\u003eData Analysis:\u003c/h2\u003e \u003cp\u003eStatistical Package for the Social Science (SPSS) was used to analyze the data. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize students\u0026rsquo; responses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 200 students, over 90% agreed that pre-class materials were clear and useful. In-class feedback was most favorable, with more than 95% reporting sessions were well organized, facilitators supportive, and hands-on practice helpful. Overall, over 95% considered the flipped classroom effective and preferred it to traditional lectures.\u003c/p\u003e\u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003e: This study was based only on students\u0026rsquo; opinions, which may be influenced by personal or social bias, and it did not measure actual knowledge or skills gained. Also, as it was done in a single institution and at one point in time, the results may not apply everywhere and do not show long-term effects on learning.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe flipped classroom in simulation-based learning was well received and viewed as effective in improving preparation, engagement, and skill development, making it a strong alternative to traditional teaching.\u003c/p\u003e","manuscriptTitle":"Evaluation of Students’ Feedback Towards Flipped Classroom in Simulation based learning","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 16:39:47","doi":"10.21203/rs.3.rs-8992743/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f19401a6-d5c2-4262-a38d-424ecf426701","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T12:19:39+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 16:39:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8992743","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8992743","identity":"rs-8992743","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}