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Research Article: Impact of a hybrid flipped classroom and case-based learning model on learning outcomes and competency development in Epidemiology

Date Published: 2026-07-15

Abstract:
To evaluate the efficacy of a hybrid teaching model integrating the Flipped Classroom (FC) and Case-Based Learning (CBL) in undergraduate Epidemiology education, and to compare its outcomes with standalone CBL and traditional Lecture-Based Learning (LBL), thereby providing theoretical evidence for curricular reform. A quasi-experimental design was employed involving students majoring in Preventive Medicine ( n =?100) and Clinical Medicine ( n =?98) at a university in Yunnan from January 2023 to December 2023. Participants were stratified into three groups: the Experimental Group (Preventive Medicine; 20% Flipped Classroom + 40% Case-Based Learning + 40% Lecture-Based Learning), the Internal Control Group (Preventive Medicine; 40% Case-Based Learning + 60% Lecture-Based Learning), and the External Control Group (Clinical Medicine; 100% Lecture-Based Learning). Outcome measures included competency enhancement, self-reported satisfaction, overall course evaluation, and knowledge acquisition assessed via pre- and post-course assessments. Significant differences were observed across the three groups regarding competency enhancement, specifically in the breadth of knowledge mastery ( Z =?8.871, p =?0.012), learning interest ( Z =?11.999, p =?0.002), self-directed learning agency ( Z =?6.736, p =?0.034), critical thinking ( Z =?7.511, p =?0.023), literature retrieval skills ( Z =?6.771, p =?0.034), and teamwork capabilities ( Z =?10.938, p =?0.004). In terms of satisfaction, significant variations were found in perceived overall learning effectiveness ( Z =?13.154, p =?0.001), instructional methods ( Z =?8.679, p =?0.013), instructional design ( Z =?10.920, p =?0.004), classroom atmosphere ( Z =?6.494, p =?0.039), and engagement ( Z =?6.555, p =?0.038). Regarding overall course evaluation, the hybrid model showed significant advantages in facilitating academic writing proficiency ( Z =?9.722, p =?0.008), professional technical skills ( Z =?19.378, p <?0.001), and preparation for advanced studies ( Z =?17.776, p <?0.001). Post-test scores differed significantly among the groups ( p <?0.001), with the Experimental Group achieving the highest mean score (68.2?±?12.0), followed by the Internal Control Group (66.5?±?10.6), and the External Control Group (59.6?±?10.3). The hybrid pedagogical model combining the Flipped Classroom and Case-Based Learning effectively enhances learning outcomes in undergraduate Epidemiology . It demonstrates distinct advantages in stimulating learning interest, fostering self-directed learning and critical thinking, and improving academic performance compared to traditional methods.

Introduction:
Epidemiology serves as a cornerstone course for majors in Public Health and Preventive Medicine. It plays a pivotal role in cultivating students’ abilities to analyze disease distribution and determinants, fostering scientific research thinking, and enhancing evidence-based decision-making capabilities ( 1–3 ). However, traditional Lecture-Based Learning (LBL), characterized by a teacher-centered approach and didactic instruction, often prioritizes knowledge transmission over active student engagement ( 4 , 5 ).…

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