Flipped Learning in Physiotherapy Education

This single-group quasi-experimental mixed-methods study will evaluate the effectiveness of flipped learning in undergraduate physiotherapy and rehabilitation education. The study will be conducted within the "Urogenital and Maternal Health in Physiotherapy and Rehabilitation" course among third-year students enrolled in the Physiotherapy and Rehabilitation Department at Lokman Hekim University.

The study aims to examine the effects of flipped learning on students' clinical decision-making skills, academic achievement, satisfaction with the learning method, and learning experiences. In addition, students' perceptions of flipped learning and conventional teaching will be explored through semi-structured individual interviews.

All students will receive the course content in two sequential educational phases. During the first phase, topics will be taught using the conventional teaching method, consisting of instructor-led presentations and question-and-answer sessions. During the second phase, flipped learning will be implemented. Before each flipped learning session, students will receive digital learning materials, including recorded videos, readings, quizzes, audio presentations, and short assessment questions. Students will be expected to review these materials before class. Class time will then be used for a brief topic review, case discussions, problem-solving activities, group work, and clinical reasoning exercises.

At the end of each flipped learning session, students will complete a reflective practice form based on the Reflective Practice Cycle. These forms will encourage students to identify the clinical problem in the case, describe challenging aspects of the learning process, explain the clinical knowledge used in decision-making, consider alternative assessment or treatment approaches, and reflect on how the activity may influence future clinical practice.

Quantitative assessments will be conducted after the conventional teaching period and after the flipped learning period. Clinical decision-making skills will be assessed using case analysis and Objective Structured Clinical Examination-like scenarios. Academic achievement will be evaluated using multiple-choice knowledge tests. Each test will include 25 five-option multiple-choice questions and a case-based clinical reasoning component scored using a rubric.

At the end of the flipped learning period, student satisfaction will be assessed using a five-item satisfaction questionnaire. The questionnaire will evaluate overall learning satisfaction, adequacy of digital content, quality of in-class activities, participation and motivation, and preference for flipped learning compared with conventional teaching. Course evaluation scores obtained from the university student information system may also be compared with the corresponding course evaluation results from the previous academic year.

For the qualitative component, approximately 8 to 12 volunteer students representing different levels of academic achievement will participate in semi-structured individual interviews after the flipped learning implementation. Interviews will explore students' experiences with conventional teaching and flipped learning, perceived effects on clinical reasoning, preparation process, motivation, participation, challenges, and recommendations for future course delivery. Interviews will be audio-recorded, transcribed, and analyzed using thematic or content analysis.

Participation in the research will be voluntary. Students who do not wish to participate will continue receiving the regular course content through conventional teaching methods and will not be disadvantaged academically. Participation or non-participation will not affect course grades or academic evaluations. All collected data will be stored securely and used only for scientific purposes. No medical intervention, biological sample collection, or physical examination will be performed.

• Student Satisfaction with Flipped Learning [Time frame: Through study completion, after 16 academic weeks]
• Qualitative Learning Experiences [Time frame: Through study completion, after 16 academic weeks]