Flipped Classroom Versus Team-Based Learning in Clinical Practice Skills: A Randomized Mixed-Methods Study

The COVID-19 pandemic posed challenges in implementing the team-based (TB) learning model for psychomotor skill-dependent manual therapy courses, necessitating alternative approaches such as the flipped classroom (FC) model. This study aims to measure senior physiotherapy students' theoretical knowledge, clinical practice skills (CPS), and motivation toward instructional materials while learning with TB and FC models. Participants were divided into the TB group (n=34) and the FC group (n=32). Theoretical knowledge was assessed through pre-, post-, retention tests; CPS through first and retention practical exams; student motivation through Instructional Materials Motivation Survey; and qualitative data through semi-structured interviews. There was no significant difference in post-test knowledge (PostK) and retention knowledge (RetK) between the groups following the experimental intervention. However, both groups showed a significant increase in PostK compared to pre-test knowledge (PreK). The FC group scored significantly higher than the TB group in some sub-dimensions of the first practical skills exam (FPex). No significant changes were observed in retention practical skills exams (RPex) in both groups compared to FPex. In conclusion, the FC model is as effective as the TB model in facilitating theoretical knowledge acquisition and provides greater benefits in CPS development. Students reported advantages of the FC model, such as the ability to rewatch instructional videos and increased flexibility in time and space. Motivation toward instructional materials was higher in the FC group. Considering both theoretical and practical skill acquisition, as well as qualitative advantages, physiotherapy educators may prefer the FC model for psychomotor skill-based courses.