Publication bias inflates flipped classroom effect estimates for knowledge outcomes but not for baseline knowledge.¶

Claim · All claims
Evidence · 1 study · quant-synthesis r2 · q3
Currency · newest study 2025 · not yet checked against its sources · not reviewed by a person

Subclaims¶

q3 i? Funnel plot asymmetry with significant small study effects (P<.001) was found for final knowledge scores, and trim-and-fill analysis attenuated the effect from SMD 0.90 to SMD 0.30; no publication bias was found for baseline knowledge (P=.98). → de Azevedo Cardoso T 2025

Evidence¶

de Azevedo Cardoso T 2025¶

de Azevedo Cardoso T, Aung H H, Yeh W-Y, Ozdamli F, Ignjatovic A, Spaic D, Bukumiric Z, Rajovic N, Markovic K, Savic M, Milin-Lazovic J, Grubor N, Milic N, Stanisavljevic D, Despotovic A, Bokonjic D, Vladicic Masic J, Janicijevic V, Masic S, Milic N. (2025). The Flipped Classroom in Medical Education: Systematic Review and Meta-Analysis. Journal of Medical Internet Research. https://doi.org/10.2196/60757

q3 · i? · quant-synthesis · r2

Funnel plot analysis of the 127-study knowledge meta-analysis showed high asymmetry with significant small study effects (P<.001). Trim-and-fill imputation reduced the pooled effect from SMD 0.90 to SMD 0.30 (95% CI 0.002-0.59, P=.049), though it remained statistically significant.

"the funnel plot showed high asymmetry (Figure S1 in Multimedia Appendix 1) with significant small study effects (P<.001). After applying the trim-and-fill method, the adjusted ES was attenuated (SMD 0.30, 95% CI 0.002-0.59; P=.049"

Discussion¶

Related Claims¶

• Flipped classroom instruction is associated with higher final knowledge scores than traditional instruction in medical education (SMD 0.90). — related
• Smaller, underpowered studies report larger flipped classroom effect sizes, indicating small-study and publication bias — related
• Publication bias is present in the Turkish flipped learning literature, and correcting it lowers the pooled effect from 0.895 to 0.713 — related
• Publication-bias checks indicate the pooled effect is unlikely to result from publication bias — reports the opposite
• Baseline knowledge differences between flipped classroom and control groups are small and may inflate final knowledge effect estimates. — related