Background Surgical education is crucial to patient care as it trains surgeons and equips medical students with knowledge and skills. Flipped classroom (FC) is an active teaching approach that has shown potential in medical education, but its impact on surgical education remains unclear. This study aimed to evaluate the effectiveness of FC compared with traditional lecture (TL) in surgical education. Methods Web of Science, PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched following a predefined protocol. Risk of bias was assessed by the Cochrane Risk of Bias Assessment Tool (version 2) and the “Risk of Bias” tool from the Cochrane Effective Practice and Organization of Care Group. The certainty of evidence (CoE) was measured applying the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Pooled effects of FC over TL were calculated using standard mean differences (SMDs) and 95% confidence intervals (CIs). Subgroup analyses were performed to explore potential sources of heterogeneity. Results A total of 11 studies were included in the systematic review and nine in the meta-analysis. FC showed significant benefits over TL in improving learning outcomes as measured by total scores (SMD = 0.37, 95% CI: 0.11–0.63, p = 0.005), theoretical scores (SMD = 0.32, 95% CI: 0.09–0.54, p = 0.005), and operational scores (SMD = 0.56, 95% CI: 0.33–0.78, p 0.00001). Study design, study direction, continent, curriculum type, and exam type may affect heterogeneity. The GRADE showed high CoE for total and operational scores and moderate CoE for theoretical scores in randomized studies, but very low CoE for three outcomes in non-randomized studies. Conclusion Current evidence suggests that FC may be more effective in surgical education for improving students’ academic performance compared with TL. It may serve as a promising approach for surgical education. More high-quality studies are expected to confirm these findings. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024602869 , identifier PROSPERO (CRD42024602869).
Cheng et al. (2026) studied this question.