What question did this study set out to answer?

This study aims to evaluate the effects of traditional, flipped, and AI-enhanced flipped classrooms on pharmacology education for international medical students.

June 3, 2026Open Access

From traditional classroom to AI-enhanced flipped classroom: a three-year pedagogical evolution for international students in pharmacology

Key Points

This study aims to evaluate the effects of traditional, flipped, and AI-enhanced flipped classrooms on pharmacology education for international medical students.
Three-year quasi-experimental design involving 68 international clinical medicine undergraduates.
Participants were grouped into traditional (n=21), flipped (n=16), and AI-enhanced flipped classrooms (n=31).
Evaluation included classroom interaction efficiency, academic performance assessments, and student questionnaires.
AI-enhanced flipped classroom showed significantly higher response rates than both flipped (p < 0.01) and traditional classrooms (p < 0.05).
Flipped and AI-enhanced classrooms had higher question accuracy compared to traditional classroom (p < 0.05 and p < 0.01, respectively).
The AI-enhanced flipped classroom group outperformed in assignment accuracy (p < 0.01) and pre-class preparation quality (p < 0.05).

Abstract

Pharmacology education faces challenges in developing higher-order thinking, especially for international students to overcome cross-cultural barriers. While flipped classrooms enhance interaction, their learning optimization remains uncertain. Artificial intelligence (AI) offers a promising pathway, yet empirical evidence on its impact on pharmacology education for international students is limited. This study aimed to compare the effects of three instructional models (traditional classroom, flipped classroom, and AI-enhanced flipped classroom) on pharmacology education for international medical students, specifically regarding their classroom interaction efficiency, academic performance, perceptions, and behavioral intentions. A three-year quasi-experimental study involved 68 international clinical medicine undergraduates, grouped by year into traditional classroom (2023, n = 21), flipped classroom (2024, n = 16), and AI-enhanced flipped classroom (2025, n = 31) groups. Evaluation included classroom interaction efficiency, academic performance, and a questionnaire for the AI-enhanced flipped classroom. The AI-enhanced flipped classroom demonstrated significantly higher response rates than both the flipped classroom (p < 0.01) and traditional classroom (p < 0.05) groups. Both flipped classroom (p < 0.05) and AI-enhanced flipped classroom (p < 0.01) groups achieved higher question accuracy than the traditional classroom group. The AI-enhanced flipped classroom group also showed superior assignment accuracy to the traditional classroom group (p < 0.01) and better pre-class preparation and PowerPoint quality score than the flipped classroom group (p < 0.05). Over 75% of students regularly used AI, valuing its efficiency and support while critically evaluating content reliability and desiring deeper collaborative roles for AI. This study confirms that the flipped classroom underpins enhanced pharmacology instruction. The AI-enhanced flipped classroom, serving as a cognitive tool, improves learning efficiency by optimizing information processing and empowering the learning process. This shift enables a renewed focus on cultivating higher-order clinical thinking and advances the establishment of a new paradigm in human-AI collaborative intelligent medical education.

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