Personalized evaluation of the flipped classroom teaching model for clinical internship lectures using eye-tracking: a randomized controlled trial

Background: The flipped classroom (FC), as an emerging instructional model, is increasingly being applied in medical education. However, there remains a need for objective evidence regarding its specific effectiveness in the clinical teaching of scoliosis, particularly concerning its impact on interns' cognitive processing. This study aimed to objectively evaluate the effectiveness of FC compared to the traditional didactic classroom (TDC) in the clinical teaching of scoliosis by integrating eye-tracking technology. Methods: This randomized controlled trial was conducted in September 2025. A total of 30 rehabilitation medicine interns were enrolled and randomly assigned to either the FC group (n=15) or the TDC group (n=15). The FC group experienced a flipped classroom model comprising pre-class preparation, in-class presentation and discussion, and hands-on practice. The TDC group received instruction primarily through a lecture-based approach. Following the instructional period, we recorded eye-tracking metrics for all participants as they observed standardized scoliosis cases, which included both physical examinations and X-ray images. A comparison of theoretical and oral assessment scores was conducted between the two groups. We also collected and analyzed questionnaire feedback from the FC group. Results: Analysis of eye-tracking data showed that during imaging examination tasks, the FC group demonstrated significantly lower total fixation duration, fewer fixations, and a reduced ratio of fixation time within the areas of interest (ROI) than the TDC group ( p < 0.05), which suggests more efficient information extraction and visual processing. Regarding academic performance, the FC group significantly outperformed the TDC group on both theoretical examinations and oral assessments ( p < 0.05). Questionnaire results further indicated that interns in the FC group held a highly favorable view of the teaching model, with an overall satisfaction rate of 90.0%. Conclusion: The flipped classroom model enhanced learning and cognitive processing efficiency for interns in scoliosis clinical teaching. This approach supported knowledge integration and cultivated clinical application skills. Interns responded favorably to the method, which warranted broader implementation. Trial registration: ChiCTR2500107768, Registration Date 2025-08-18.