The Effect of the Flipped Classroom on Students’ Soft Skill Development: Quasi-Experimental Study

Jaouad Elkhalladi; Amal Sefrioui; Lahoucine Amsdar

doi:10.1515/edu-2025-0063

Article Open Access

The Effect of the Flipped Classroom on Students’ Soft Skill Development: Quasi-Experimental Study

Jaouad Elkhalladi , Amal Sefrioui and Lahoucine Amsdar

Published/Copyright: April 22, 2025

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From the journal Open Education Studies Volume 7 Issue 1

Abstract

The flipped classroom is an innovative pedagogical strategy that can play a crucial role in the training of healthcare professionals, as soft skills are necessary competencies for the quality of patient care. This quasi-experimental study features a pre-test/post-test design, with a control group and an intervention group aiming to investigate the impact of flipped classrooms on the development of students’ soft skills. The study involved 82 students from the Higher Institute of Nursing and Health Technical Professions of Agadir who participated in the first semester of the 2022–2023 academic year. The results indicated a significant increase (p < 0.001, d = 2.11 [1.56, 2.64]) in the averages of the 10 soft skills studied in the intervention group compared with the control group, as well as a significant difference in satisfaction (p = 0.003), participation in learning activities (p < 0.001), and the usefulness of extending the use of the flipped classroom to other training institutes (p < 0.001), thus showing a positive effect of the flipped classroom. This result encourages the use of this pedagogical strategy in modules that focus on soft skills, such as social assistance and psychological support.

Keywords: soft skills; education; students; nursing; anatomy

1 Introduction

Innovation and reform of the teaching–learning system have become a necessity to keep pace with economic and technological development and to benefit from the widespread use of digital tools. The latter has influenced teaching methods and led to the emergence of new educational and pedagogical techniques and technologies such as the flipped classroom.

The flipped classroom is a pedagogical strategy (Tan, Yue, & Fu, 2017) in which students receive online documentation through digital tools such as platforms before the session (often in the form of video capsules and quizzes), while the classroom session is devoted to learning activities and exercises.

In the healthcare field, this pedagogical strategy has recently been used in both medical and nursing education (Dombrowski, Wrobel, Dazert, & Volkenstein, 2018); the latter is the basis for practices to promote the nursing profession and nursing science in general (Fontenot & McMurray, 2020). This strategy has had several benefits such as increasing student grades (Shang & Liu, 2018), motivation (Alonso, Vélez, Martínez-Monteagudo, & Rico-González, 2023), understanding (Bawaneh & Hamida Moumene, 2020), satisfaction (Murata et al., 2023), engagement (Lewis-Kipkulei, Singleton, Singleton, & Davis, 2021), and critical thinking (Etemadfar, Soozandehfar, & Namaziandost, 2020).

In this field, healthcare professionals suffer from anxiety, loss of control, and demoralisation caused mainly by the lack of knowledge and skills that allow them to flourish and take pride in the healthcare system (Berwick & Finkelstein, 2010). Ernawati and Bratajaya (2021) add that the nursing profession is highly stressful and complex and requires soft skills (SS) and high-level competencies to overcome constraints and ensure performance.

These soft skills are competencies that every individual needs to acquire and develop, especially nurses and healthcare professionals, to complement the technical skills acquired during the initial training of student nurses. Soft skills play an important role in improving the relationship between carer and patient, the quality of care, and patient satisfaction, as well as in developing human relations and improving working conditions.

Soft skills in nursing can be divided into three groups: personal skills such as initiative; social skills such as communication; and methodological skills such as analysis, reasoning, and stress management (Bratajaya & Ernawati, 2020). Similarly, according to a systematic review of the most useful skills in the field of healthcare, these include teamwork, communication, and decision-making (Gawronski et al., 2022). Other soft skills are also very important in nursing practice and nursing science, such as adaptation and creativity (Prestia, 2023), continuous learning (Vázquez-Calatayud, Errasti-Ibarrondo, & Choperena, 2021), and concern for good results (Kaushik, Srivastava, & Pemde, 2023).

In the same context, a number of studies have demonstrated the effectiveness of the flipped classroom in fostering the development of soft skills (Elkhalladi & Sefrioui, 2024a; Fung, Poon, & Ng, 2022). Similarly, Elkhalladi and Sefrioui (2024b) conducted a study with a single group of radiology students. To this end, this study aims to investigate the impact of the flipped classroom on the development of soft skills among nursing and health technology students in two independent groups from the Higher Institute of Nursing Professions and Health Technology in Agadir.

2 Literature Review

The flipped classroom is a pedagogical strategy or model (Andargeery, Bahri, Alhalwani, Alahmedi, & Ali, 2024) in which the traditional model of teaching is reversed, with lectures studied outside the classroom while the session in the classroom is devoted to learning activities and applications such as case studies, exercises, and syntheses. This strategy makes it possible to reinforce learning, improve results, and equip twenty-first-century students with the skills needed for success and integration into the world of work in the field of nursing and health technology (McLaughlin et al., 2014).

The use of this teaching strategy can be divided into four parts or stages: (1) preparing documentation in an interactive way, such as online documents and videos; (2) sharing this documentation with students; (3) checking students’ preparation; and (4) conducting learning activities in the classroom through discussion and case studies (Youhasan, Chen, Lyndon, & Henning, 2021).

Several terms are used in the literature as synonyms for soft skills such as social skills, interpersonal skills, transferable interpersonal skills (Zaťková & Poláček, 2015), and socio-relational skills necessary for teachers to foster efficiency and performance (Ngang, Yie, & Shahid, 2015). These soft skills are very useful for both healthcare professionals and students (Dalaya, Ishaquddin, Ghadage, & Hatte, 2015). Goldman and Wong (2020) add that training programmes must take into account the development of healthcare professionals’ skills either through basic or continuing training, especially soft skills for patient safety, improving patient care, and ensuring competent and reflective professionals (Goldman & Wong, 2020).

In addition, several studies have indicated the potential of flipped classrooms for developing students’ soft skills (Elkhalladi & Sefrioui, 2024a; Morin & Willox, 2022). Indeed, sharing the theoretical parts of the lessons before the session allows more time in the classroom for more learning activities such as case studies. This enables students to develop more reasoning, analysis, and critical thinking skills. Group work also enables students to develop communication, team spirit, decision-making, and leadership skills through discussions and learning activities such as projects.

Moreover, students are more satisfied with the flipped classroom (Shuai, Huiwen, Shihao, & Li, 2023), which can be explained by the active teaching methods used, such as projects and discussions, which motivate and engage students. In addition, consulting documentation at each student’s own pace gives students greater flexibility and autonomy in their learning.

However, there is little literature on the relationship between soft skills and the flipped classroom, particularly in nursing and health technology education (Ge, Chen, Yan, Chen, & Liu, 2020; Hu et al., 2018). This highlights the value of this study in exploring the empirical relationship between the flipped classroom and the development of soft skills.

Moreover, anatomy and physiology are a basic course for most nursing and medical professions that imparts a body of knowledge requiring memorisation as well as analysis and evaluation. In most institutions, this course is taught through the use of presentations in large rooms or lecture halls by traditional methods, with which many students are unable to keep up with the fast pace of the course and become less motivated and less attentive, especially in the theoretical part (Shang & Liu, 2018). Consequently, the use of innovative teaching strategies such as the flipped classroom based on active student-centred teaching is needed, as well as research on the effects of such strategies on the development of students’ soft skills, as well as their satisfaction and the usefulness of this teaching strategy.

3 Methodology

3.1 Study Design

This study adopted a quasi-experimental, pre-test/post-test design to investigate the effect of the flipped classroom on the development of soft skills among students in two options of the health techniques course at the Higher Institute of Nursing Professions and Technical Health (ISPITS) in Agadir, Morocco.

3.2 Study Environment

The Higher Institutes for Nursing Professions and Technical Health in Morocco are higher education institutions dedicated to the training of future health professionals via bachelor’s and master’s programmes. These institutions provide a comprehensive curriculum that integrates theoretical instruction with practical training to cultivate the necessary technical and non-technical abilities required for nursing and health technology professions, addressing the healthcare requirements of the public. Depending on the speciality, these institutes offer a variety of modules in their education system, including lectures, tutorials, practical work, and clinical internships. These modules include anatomy, physiology, radiological techniques, and nursing care.

3.3 Sampling and Setting

Subjects comprised students in the first semester of the radiology option (Group A) at ISPITS in Agadir (n = 43) and those in the first semester of the laboratory option (Group B) at the same institute (n = 39). An exhaustive list of this population was chosen with a response rate of 97.6% for Group A and 100% for Group B.

Subjects were recruited through non-random sampling based on a reasoned choice: the radiology option and the laboratory option are two options in the same health techniques stream, and the two options contained almost equal numbers of students. To minimise bias, the control group was chosen following a discussion with the students during the introductory session, and the course was taught by the same teacher to minimise the effect of the teacher’s competence, experience, and personality on the results. In addition, the same timetable and weekly lesson plans were used.

3.4 Study Variables

Independent variable: the teaching method.

One group was taught using the traditional method based on lectures, and the other group was taught using the flipped classroom method.

Dependent variable: soft skills.

Soft skills were measured using a questionnaire comprising 10 skills.

Course description: The aim of the anatomy and physiology module is to provide students with fundamental knowledge of human physiology and anatomy, with descriptions of each anatomical system and its physiology, as well as the functions and diagrams of the various anatomical apparatus. This 30 h module was taught an average of 4 h per week during October, November, and December 2022.

Group A (intervention group) was taught using the flipped classroom approach with out-of-class activities such as the video capsule and quizzes shared on the Google Classroom platform before the session, as well as in-class activities such as the correction of quizzes, problem solving, case studies, and exercises. During these activities, students will be guided by personalised and collective coaching aimed at successful teamwork, collaboration, and effective communication, as well as at developing students’ reflective and creative skills.

Group B (control group) will be taught using the traditional method based mainly on lectures and presentations.

3.5 Data Collection

The pre-test and post-test were administered via a questionnaire given to participants in the two groups. Participants were informed in the first session of the aim, method, and usefulness of the results, as well as the possibility of withdrawing from the study at any time. The pre-test was carried out in the first session, and the post-test in the last session for both groups (Figure 1).

Figure 1

Data collection process.

The participants received clear and simple instructions and guidelines, ample time to respond to any ambiguities or incomprehensible questions, and an explanation of the anonymity and confidentiality of the collected data to ensure the quality of the data. With regard to the author’s involvement, he was present during data collection and when answering all the questions, but without influencing the participants’ answers. A student distributed and collected the questionnaires to prevent any pressure on students who declined to participate. However, only one student freely expressed his preference not to participate in answering the questionnaire despite his interest in the flipped classroom teaching method.

This module was collected and taught by the author of this study.

The pre-test consists of two parts: The first part contains descriptive information about the participants, such as gender, age, digital tools used, and Internet connection.

The second part contains a soft skills measurement scale developed by Julien Berthaud in the context of higher education (Berthaud, 2017). It covers 10 soft skills: adaptability, learning, communication, creativity, stress management, initiative, decision-making, analytical reasoning, concern for results, and teamwork. Each soft skill is measured with four items scored on a Likert scale ranging from 1 to 4 according to the level of the skill: 0 = no, 1 = mostly no, and 2 = mostly yes to 3 = yes. It is possible to obtain the score of skill between 0 and 30 by multiplying Item 1 by 1, Item 2 by 2, Item 3 by 3, and Item 4 by 4. Cronbach’s α for this scale is between 0.63 (adaptability) and 0.80 (teamwork). The author’s permission to use this scale was obtained by email.

The post-test consists of three parts:

The first contains personal information such as age and gender.
The second part contains the soft skills measurement scale described in the previous paragraph.
The third part consists of three questions concerning satisfaction, participation in classroom activities, and the importance of generalising this teaching strategy.

This questionnaire was checked by four teachers in the field of nursing and health techniques and was written in French, the participants’ official language of the study. To validate reliability, Cronbach’s α was calculated as ranging from 0.83 (initiative competence) to 0.85 (analytical reasoning competence).

3.6 Data Analysis

The data were analysed using IBM SPSS version 25 software.

After verification of normality by the Kolmogorov–Smirnov test:

Student’s t-test of two paired samples was used to compare the means of variables with a normal distribution.

The Wilcoxon test of two paired samples was used to compare the means of variables with an abnormal distribution.

Student’s t-test of two independent samples was used to compare the means of variables with a normal distribution.

The Mann–Whitney test of two independent samples was used to compare the means of variables with a non-normal distribution.

The chi-square test was used to compare two independent qualitative variables and detect significant differences.

Cohen’s d test measures the size of the effect and evaluates the difference between two means by relating it to the standard deviation.

For the five tests, two hypotheses were tested: the null hypothesis (H0) that there is no significant difference between the matched conditions, and the alternative hypothesis (H1) that there is a significant difference.

4 Results

4.1 Demographic Characteristics and Digital Tools

As shown in Table 1, 65.1% of the participants in Group A were female with an average age of m = 19.30 ± 2.09; 48.8% of the participants used only smartphones and 39.5% used computers and smartphones to study; and 32 students (74.4%) had an Internet connection to study.

Table 1

Demographic characteristics of students and digital tools

		Group A		Group B
Variables		n (43)	%	n (39)	%
Gender	Female	28	65.1	25	64.1
Gender	Male	15	34.9	14	35.9
Mean age		19.30 ± 2.09		19.03 ± 1.09
Digital tools	PC	1	2.3	2	5.1
	Smartphone	21	48.8	16	41
	PC and smartphone	17	39.5	19	48.7
	Smartphone and tablet	0	0	1	2.6
	PC, smartphone, and tablet	4	9.3	1	2.6
Connection	Yes	32	74.4	26	66.7
Connection	No	11	25.6	13	33.3

In Group B, 64.1% of the participants are female, with a mean age of m = 19.03 ± 1.09; 41% of the participants used smartphones only and 48.7% used computers and smartphones to study; and 26 students (66.7%) had an Internet connection to study.

4.2 Level of Soft Skills

Table 2 shows a significant increase in the averages of 10 soft skills for Group A (intervention) compared with Group B (control).

Table 2

Comparison of soft skills between groups

Soft skills	Pro-test	Post-test	p-Value
Adaptability
Group A	16.74 ± 6.03	24.33 ± 4.56	p = 0.000*
Group A	16.74 ± 6.03	24.33 ± 4.56	d = 0.93 [0.56, 1.28]
Group B	15.92 ± 4.43	17.33 ± 4.90	p = 0.166
Group B	15.92 ± 4.43	17.33 ± 4.90	d = 0.24 [−0.078, 0.55]
p-Value	p = 0.488	p = 0.000*
p-Value	d = 0.15 [−0.28, 0.58]	d = 1.48 [0.98, 1.96]
Lifelong learning
Group A	15.95 ± 7.03	24.56 ± 4.93	p = 0.000*
Group A	15.95 ± 7.03	24.56 ± 4.93	d = 1.01 [0.63, 1.37]
Group B	16.92 ± 7.04	17.13 ± 4.37	p = 0.801
Group B	16.92 ± 7.04	17.13 ± 4.37	d = 0.02 [−0.29, 0.33]
p-Value	p = 0.542	p = 0.000*
p-Value	d = −0.13 [−0.57, 0.29]	d = 1.59 [1.08, 2.08]
Communication
Group A	14.33 ± 7.10	23.49 ± 5.55	p = 0.000*
Group A	14.33 ± 7.10	23.49 ± 5.55	d = 1.02 [0.65, 1.39]
Group B	15.54 ± 5.97	17.85 ± 6.38	p = 0.107
Group B	15.54 ± 5.97	17.85 ± 6.38	d = 0.26 [−0.05, 0.58]
p-Value	p = 0.408	p = 0.000*
p-Value	d = −0.18 [−0.61, 0.25]	d = 0.94 [0.48, 1.40]
Creativity
Group A	17.51 ± 7.20	25.60 ± 4.62	p = 0.001*
Group A	17.51 ± 7.20	25.60 ± 4.62	d = 0.92 [0.56, 1.27]
Group B	18.72 ± 6.75	18.31 ± 4.65	p = 0.566
Group B	18.72 ± 6.75	18.31 ± 4.65	d = −0.05 [−0.36, 0.26]
p-Value	p = 0.437	p = 0.000*
p-Value	d = −0.17 [−0.60, 0.26]	d = 1.57 [1.07, 2.06]
Stress management
Group A	15.05 ± 6.90	22.28 ± 5.94	p = 0.002*
Group A	15.05 ± 6.90	22.28 ± 5.94	d = 0.80 [0.45, 1.14]
Group B	15.64 ± 5.96	14.72 ± 5.14	p = 0.474
Group B	15.64 ± 5.96	14.72 ± 5.14	d = −0.11 [−0.43, 0.20]
p-Value	p = 0.679	p = 0.000*
p-Value	d = −0.09 [−0.52, 0.34]	d = 1.35 [0.87, 1.83]
Initiative
Group A	15.65 ± 6.62	23.81 ± 5.04	p = 0.000*
Group A	15.65 ± 6.62	23.81 ± 5.04	d = 0.95 [0.58, 1.30]
Group B	16.05 ± 6.12	16.74 ± 4.74	p = 0.567
Group B	16.05 ± 6.12	16.74 ± 4.74	d = 0.09 [−0.22, 0.40]
p-Value	p = 0.778	p = 0.000*
p-Value	d = −0.06 [−0.49, 0.37]	d = 1.44 [0.95, 1.92]
Decision-making
Group A	13.30 ± 6.40	21.79 ± 4.83	p = 0.000*
Group A	13.30 ± 6.40	21.79 ± 4.83	d = 1.07 [0.69, 1.45]
Group B	15.79 ± 6.54	15.51 ± 5.45	p = 0.755
Group B	15.79 ± 6.54	15.51 ± 5.45	d = −0.03 [−0.35, 0.27]
p-Value	p = 0.085	p = 0.000*
p-Value	d = −0.38 [−0.82, 0.05]	d = 1.22 [0.74, 1.69]
Analytical reasoning
Group A	15.37 ± 6.34	23.53 ± 5.63	p = 0.000*
Group A	15.37 ± 6.34	23.53 ± 5.63	d = 0.93 [0.56, 1.28]
Group B	15.05 ± 8.06	16.44 ± 6.07	p = 0.381
Group B	15.05 ± 8.06	16.44 ± 6.07	d = 0.13 [−0.17, 0.45]
p-Value	p = 0.843	p = 0.000*
p-Value	d = 0.04 [−0.38, 0.47]	d = 1.21 [0.73, 1.68]
Results-oriented
Group A	11.67 ± 8.46	24.28 ± 4.51	p = 0.000*
Group A	11.67 ± 8.46	24.28 ± 4.51	d = 1.28 [0.87, 1.68]
Group B	14.77 ± 7.46	17.44 ± 5.87	p = 0.088
Group B	14.77 ± 7.46	17.44 ± 5.87	d = 0.28 [−0.04, 0.59]
p-Value	p = 0.084	p = 0.000*
p-Value	d = −0.38 [−0.82, 0.05]	d = 1.31 [0.83, 1.79]
Teamwork
Group A	20.33 ± 4.63	27.00 ± 4.29	p = 0.000*
Group A	20.33 ± 4.63	27.00 ± 4.29	d = 0.95 [0.58, 1.31]
Group B	19.79 ± 6.94	19.85 ± 6.87	p = 0.974
Group B	19.79 ± 6.94	19.85 ± 6.87	d = 0.01 [−0.30, 0.31]
p-Value	p = 0.688	p = 0.000*
p-Value	d = 0.09 [−0.34, 0.52]	d = 1.26 [0.78,1.73]
Score SS
Group A	15.59 ± 4.59	24.07 ± 3.51	p = 0.000*
Group A	15.59 ± 4.59	24.07 ± 3.51	d = 1.43 [1.00, 1.86]
Group B	16.42 ± 4.33	17.13 ± 3.02	p = 0.406
Group B	16.42 ± 4.33	17.13 ± 3.02	d = 0.13 [−0.18, 0.44]
p-Value	p = 0.563	p = 0.000*
p-Value	d = −0.18 [−0.62, 0.24]	d = 2.11 [1.56, 2.64]

*p < 0.05; SS: soft skills; d: Cohen’s d.

For Group A, there was a significant increase in the averages of the following soft skills after using the flipped classroom: adaptability (p < 0.001), continuous learning (p < 0.001), communication (p < 0.001), creativity (p = 0.001), stress management (p = 0.002), initiative (p < 0.001), decision making (p < 0.001), reasoning (p < 0.001), concern for results (p < 0.001), teamwork (p < 0.001), and the total SS score (p < 0.001). For Group B, there was a slight increase in the averages for most of the soft skills in this study, but this was not significant.

For the pre-test, there was no significant difference between the two groups, whereas there was a very significant difference for the post-test: adaptability (p < 0.001), continuous learning (p < 0.001), communication (p < 0.001), creativity (p < 0.001), stress management (p < 0.001), initiative (p < 0.001), decision making (p < 0.001), analytical reasoning (p < 0.001), result focus (p < 0.001), teamwork (p < 0.001), and the total SS score (p < 0.001).

Furthermore, Cohen’s d score for soft skills is 2.11 [1.56, 2.64], with the lowest score for communication competence being 0.94 [0.48, 1.40] and the highest score for lifelong learning competence being 1.59 [1.08, 2.08].

4.3 Satisfaction, Participation, and Usefulness of the Flipped Classroom

Table 3 shows a significant difference in satisfaction (p = 0.003), with 53.5% of participants in the intervention group totally agreeing, while only 17.9% of participants in the control group totally agreed regarding satisfaction.

Table 3

Satisfaction, participation, and usefulness of the flipped classroom in ISPITS

		Group A		Group B		p-Value
Variables		N	(%)	N	(%)	p-Value
Satisfaction						0.003*
	Totally disagree	1	2.3	3	7.7
	Strongly disagree	1	2.3	6	15.4
	Neutral	5	11.6	12	30.8
	Strongly agree	13	30.2	11	28.2
	Totally agree	23	53.5	7	17.9
Participation						0.000*
	Totally disagree	2	4.7	2	5.1
	Strongly disagree	0	0.0	11	28.2
	Neutral	3	7.0	9	23.1
	Strongly agree	20	46.5	12	30.8
	Totally agree	18	41.9	5	12.8
Usefulness						0.000*
	Totally disagree	0	0.0	5	12.8
	Strongly disagree	0	0.0	8	20.5
	Neutral	7	16.3	11	28.2
	Strongly agree	15	34.9	11	28.2
	Totally agree	21	48.8	4	10.3

*p < 0.05.

There was also a significant difference in the impact of the teaching method on student participation (p < 0.001), with 41.9% of the participants in the intervention group but only 12.8% in the control group totally agreeing that the flipped classroom encourages participation in the class. The results of this study also showed that 48.8% of participants in the control group but only 4% of those in the control group totally agreed that the teaching method should be generalised to other classes at ISPITS (p < 0.001).

5 Discussion

In terms of demographic characteristics, the two groups had almost the same age (19 years) and almost the same percentage of female members (65.1% for Group A and 64.1% for Group B). More than 40% of participants in the two groups used only smartphones to study (48.8% for Group A and 41% for Group B), while the percentage of participants in Group A with a connection (74.4%) was higher than that in Group B (66.7%).

Concerning the level of soft skills in the pre-test, there was no significant difference between the two groups for either each soft skill studied or the total soft skills score. On the post-test, however, there was a significant difference between the groups for the skills of adaptability (p < 0.001), stress management (p < 0.001), initiative (p < 0.001), concern for results (p < 0.001), decision-making (p < 0.001), and continuous learning (p < 0.001). For this last skill, Narang et al. (2018) have already proposed the flipped classroom to develop this known skill through lifelong learning as well.

The results of this study also showed a significant increase in communication (p < 0.001), which is the most important soft skill according to teachers (Tang, 2020). There was also a significant increase in teamwork (p < 0.001), a very important skill and a basic activity in the flipped classroom in particular and active pedagogy in general to facilitate and promote individual and collective development (Musa, Mufti, Latiff, & Amin, 2012). There was a significant increase in the skill of creativity (p < 0.001), in line with the results of an Iranian study carried out in 2018 (p = 0.0001) using a pre-test and post-test among student nurses. There was also a significant increase in analytical reasoning skills (p < 0.001), given that a significant number of students suffer from deficits in this crucial skill (Smith, Black, & Hooper, 2020). Mastorovich (2023) adds that analysis and critical thinking in students are crucial in the clinical field.

In addition, there was a significant increase in the total score for the 10 soft skills (p < 0.001, d = 2.2). According to Cohen’s d, students who participated in the flipped classroom considerably outperformed those who took the standard course in terms of developing their soft skills. The effect size is considerable, and the difference between the two groups is not insignificant, according to the Cohen score. As a result, the flipped classroom has considerable value in today’s educational and professional contexts since it not only facilitates the transfer of knowledge but also greatly aids in the development of soft skills in aspiring professionals.

The results of our study are inconsistent with a Spanish study that showed the absence of a significant difference between the flipped classroom group and the control group after the use of the flipped classroom (Betti, Biderbost, & Domonte, 2022). However, this result aligns with other studies, such as the Elkhalladi and Sefrioui (2024b) study with radiology students and the Hamdan, Salleh, Shahrill, and Asamoah (2022) study in the agri-food sector, which also showed a significant difference between the flipped classroom group and the control group after using the flipped classroom (Mohamed, Hafez, Mohamed, Bauomy, & El-Sayed Aly, 2023).

Similarly, the social cognitive theory links the development of soft skills to self-efficacy and the impact of the study environment, particularly in areas such as stress management, concern for good results, teamwork, and communication. Furthermore, we can link the development of soft skills to the theory of experiential learning, particularly through reflection, which can foster the development of problem-solving and reasoning skills. Additionally, the integration of the flipped classroom, which incorporates learning activities like case studies and problem-based learning, with experiential learning can enhance students’ skills by creating a reflective, interactive learning environment that fosters the development of soft skills.

In the same sense, the flipped classroom is more compatible with and effective in the development of collaboration and communication, especially in programmed activities in the classroom, as well as reasoning skills and analysis, than traditional teaching methods (Özkan & Demirbağ, 2023).

As regards satisfaction with the teaching method used, there was a significant difference between the two groups (p = 0.003). This is in line with other studies showing the satisfaction of the students with the flipped classroom (Halterman, Broxton, & Joshua, 2024; Ng, 2024), as well as another German study which showed that students and teachers were very satisfied with the flipped classroom (Dombrowski et al., 2018). In addition, a significant difference was found between the two groups (p < 0.001) concerning participation in the class and the usefulness of the pedagogical method in other training institutes. This is in line with Murillo-Zamorano, López Sánchez, and Godoy-Caballero (2019), who showed that preparing students before the session through the flipped classroom increases their participation in teaching–learning activities. Also, the participants in this study recommended the generalisation of the flipped classroom to other training institutes (Murillo-Zamorano et al., 2019).

This study offers several intriguing practical implications, beginning with the enhancement of students’ soft skills, particularly in crucial areas for nurses and health technicians, like communication, teamwork, and stress management. This improvement is facilitated by the interactive activities and collaborative environment that the flipped classroom fosters. This study also encourages the education authorities to extend the use of the flipped classroom to other educational establishments, either as part of initial training or continuing education. This entails incorporating soft skills training into the curriculum to equip future healthcare professionals not only with technical and theoretical knowledge, but also with human and socio-relational skills. This approach not only meets the needs of the healthcare system, but also enhances the quality of nursing care through improved inter-professional collaboration and the carer–patient relationship, ultimately reducing medical errors and improving care for patients and the general population.

5.1 Strengths and Limitations

This study confirmed the positive impact of the flipped classroom in developing students’ soft skills, as well as their satisfaction and participation in learning activities, which could be very useful for extending this teaching strategy to other training institutes. Also, it advances knowledge of how an innovative teaching strategy can enhance conventional cognitive learning with soft skills that are critical for both professional and personal success in a world that is changing all the time.

Despite the significant findings from our study, we acknowledge its inherent limitations and their potential impact on the outcomes. These limitations include the slightly smaller sample size, the reduced hourly volume of 30 h, the absence of randomised sampling, the absence of a digital platform in this training institute, and the fact that 25% of the participants did not have a regular Internet connection. These factors could have limited the statistical validity and generalisability of the results.

To this end, it is necessary to increase the sample size by testing this methodology in the other specialties with a very large number of students and in the modules with a very high hourly volume, as well as to adopt random sampling to reinforce statistical validity. Additionally, we should motivate the education system administrators to allocate resources towards the establishment of a digital platform and guarantee unrestricted student access to the internet, thereby enhancing accessibility for all students.

Additionally, there are several suggestions to help the health sciences adopt the flipped classroom. First, we should train teachers on the usefulness and proper use of the flipped classroom, along with the digital tools that enable the creation of videos, quizzes, and infographics. Second, we should motivate political decision-makers to incorporate flipped classroom training into both initial and ongoing teacher training programmes, supply the essential equipment, digital platforms, and internet connections, and assist teachers by exchanging experiences, refining, and adapting to enhance the implementation of the flipped classroom in this domain. This will, in turn, enhance the readiness of future professionals for clinical scenarios and foster the development of their hard and soft skills.

6 Conclusion

The flipped classroom is an innovative teaching strategy in nursing and health sciences education, and soft skills are essential skills in the world of work in general and the health sector in particular.

The results of this study showed a significant increase (p < 0.001) in the average scores for the 10 soft skills for Group A (use of the flipped classroom) compared with Group B (use of the traditional method). There was a significant difference in participants’ satisfaction (p = 0.003), participation in learning activities (p < 0.001), and views of the usefulness of extending the use of the flipped classroom to other training institutes (p < 0.001).

7 Recommendations and Further Research

This pedagogical strategy will enable students, in addition to developing technical skills and academic success, to develop their soft skills, which are essential for personal development, interpersonal skills such as communication and teamwork, and the development of high-level reflexivity skills such as analysis, reasoning, and creativity as well as the development of lifelong learning skills and, consequently, patient care and the well-being of the population.

In addition, the development of soft skills alongside technical skills will enable future graduates to integrate more easily into the job market. In addition to the need to master active pedagogy and the flipped classroom, teachers must also master a range of mentoring skills to guide and encourage the development of students’ soft skills.

A number of recommendations may be useful, such as adding soft skills to the initial training programme for students and in-service training for healthcare professionals, as well as training teachers on the flipped classroom and creating digital platforms for putting the necessary documentation online and sharing teachers’ experiences. Other studies might usefully examine the impact of the flipped classroom on students’ soft skills in their final training or work placement periods, as well as in other non-health sectors and primary and secondary education.

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Acknowledgements

We would like to thank all the participants, both students and teachers.

Funding information: The authors state no funding involved.
Author contributions: J.E., A.S., conceptualization, methodology, investigation, resources, data curation, writing-original draft, writing-review & editing. L.A., software, validation, formal analysis, visualization, and supervision.
Conflict of interest: The authors state no conflict of interest.
Data availability statement: The data utilized in this article are available upon request from the authors.
Ethical consideration: Authorisation n°39/22 from the Ethics Committee of Mohamed V University in Rabat. Written consent was obtained from the participants, and the anonymity and confidentiality of the data were respected.

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Received: 2024-04-15

Revised: 2025-02-13

Accepted: 2025-02-23

Published Online: 2025-04-22

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.1515/edu-2025-0063

Keywords for this article

soft skills; education; students; nursing; anatomy

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