Flipped Classroom Versus Conventional Didactic Teaching and Examination Performance Among Dental Students: A Prospective Comparative Cohort Analysis
Keywords:
flipped classroom; dental education; prosthodontics; didactic teaching; active learning; academic performance; examination scores; cohort study.Abstract
Background: Flipped classroom teaching moves initial exposure to instructional material before class and uses scheduled contact time for active learning, application and feedback. Evidence in health-professions and dental education suggests potential academic benefit, but effects vary by implementation and study design.
Objective: To compare preclinical prosthodontic examination performance across four annual dental student cohorts exposed to conventional/didactic or flipped classroom teaching.
Methods: This comparative cohort analysis included 400 undergraduate dental students from four annual cohorts of 100 students each. Conventional/didactic teaching was used in 2022 and 2024, and flipped classroom teaching in 2023 and 2025. Teaching occurred for approximately 6–8 hours per week from October to September. The primary outcome was a 0–100 preclinical complete-denture tooth-arrangement examination score. Because variances differed across cohorts, Welch’s one-way ANOVA was used, followed by pairwise Welch tests with Holm adjustment. Cohen’s d was used for standardized differences. A pooled comparison of conventional versus flipped cohorts was also performed.
Results: Mean scores were 64.35±6.56, 77.35±6.99, 68.44±11.34 and 86.41±5.75 for the 2022 conventional, 2023 flipped, 2024 conventional and 2025 flipped cohorts, respectively. Welch’s ANOVA showed a significant difference across cohorts (F (3,216.20) =228.83, p<0.001). The pooled conventional mean was 66.40±9.47 and the pooled flipped mean was 81.88±7.83. The mean difference was 15.49 marks (95% CI 13.78–17.19), Welch’s t=17.82, df=384.57, p<0.001; Cohen’s d=1.78.
Conclusion: Higher examination scores were observed in the flipped classroom cohorts. However, teaching approach was completely confounded with academic year, and examination, faculty, student and temporal differences may explain part of the observed association. The findings therefore support further controlled evaluation rather than a definitive causal claim.
