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Learning outcomes and cognitive levels were compared between the two groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted at a medical school in Meizhou, China, over an 18-week period. The curriculum covered the anatomy of nine major organ systems (excluding the nervous system).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 128 first-year clinical medicine students participated. The FCCL group (63.5% male) had a mean age of 19.13\u00b11.351 years, and the traditional group (67.1% male) had a mean age of 19.33\u00b11.481 years. No significant differences were found in gender (p=0.580) or age (p=0.414) between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>The FCCL group engaged in pre-class activities via the ChaoXing platform, which included instructional videos, key concept outlines and clinical cases. In-class sessions were dedicated to group discussions, specimen practice and case analysis. The control group received traditional PowerPoint-based lectures and completed post-class assignments. Both groups were taught by the same instructors, shared identical learning objectives and used the same laboratory materials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Outcomes included scores on a theoretical examination (TCE) and a laboratory examination (LCE), both designed based on Bloom\u2019s taxonomy; responses on a self-efficacy questionnaire (incorporating Likert-scale and open-ended items); and qualitative analysis of reflective journals from the FCCL group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No significant difference was observed in TCE scores between the FCCL and traditional groups (59.52%\u00b115.67% vs 55.5%\u00b114.31%, p=0.136). However, the FCCL group scored significantly higher on the LCE (65.94%\u00b113.71% vs 57.27%\u00b116.95%, p=0.004). Furthermore, the intervention group demonstrated superior performance on higher-order cognitive questions (application-type: +8%, p=0.036; analysis-type: +11%, p=0.009). Questionnaire results indicated that the FCCL approach enhanced students\u2019 learning motivation, critical thinking and collaborative skills (mean Likert scores &gt;4.5).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The integration of FC with CBL effectively enhanced medical students\u2019 higher-order cognitive abilities in anatomy, particularly in practical application and analytical skills, although its effect on the short-term retention of theoretical knowledge was limited. This approach offers a viable pathway for reforming anatomy education, though future studies with larger samples and longer follow-up are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102001","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T08:51:28Z","timestamp":1763628688000},"page":"e102001","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Synergising flipped classroom and case-based learning in resource-intensive anatomy education in China: a quasi-experimental study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5787-521X","authenticated-orcid":false,"given":"Qianyin","family":"Yao","sequence":"first","affiliation":[{"name":"Jiaying University, Meizhou, Guangdong, 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