Flipped Classroom Showdown: Game-Based Vs. Case-Based Learning in Pharmacy Education Publisher Pubmed



Amini M ; Amini S ; Alizadeh M
Source: BMC Medical Education Published:2026

Abstract

Background: Active learning methods like flipped classrooms, case-based learning (CBL), and game-based learning (GBL) are increasingly important in medical and pharmacy education. While studies suggest integrating these methods may improve outcomes, direct comparisons of CBL and GBL within flipped classrooms are limited, often focusing on small sample sizes and different student populations. This study compares the effectiveness of GBL and CBL in a flipped classroom for pharmacy education which are held completely virtual, aiming to assess learning outcomes and student satisfaction. Methods: Participants were randomly assigned to the GBL or CBL group. In-class activities for both groups followed virtual flipped instruction classrooms on pharmacotherapy topics. Knowledge-based tests were used to assess learning outcomes, and a reliable and validated questionnaire was employed to measure student satisfaction. The basis for data analysis would include demographic data and the results of tests and questionnaires on satisfaction assessment. Data were analyzed via descriptive statistics methods (means, frequencies, percentages, standard deviations, and variances) and inferential analyses (Student’s t-test, analysis of variance, and correlation). Results: The 56 fourth-year PharmD students completed the study. Whereas both groups showed significant learning outcome gains (CBL T1-T3: ρ = 0.006, GBL: T1-T3 ρ = 0.001, T2-T3 ρ = 0.002), the scores for all tests were invariably higher in GBL; however, none of them are significant. Satisfaction with the learning method as also greater in the GBL group (3.82) than in the CBL group (3.61), particularly for students with lower GPAs in the GBL group (t = -0.412, ρ = 0.033). No statistically significant differences were observed for either the test scores or the satisfaction levels of either group; however, for the final test scores and progress rates, GBL had a slight-to-moderate effect size advantage (Cohen’s d = -0.36, -0.34 respectively). Conclusions: This study demonstrated that both case-based learning (CBL) and game-based learning (GBL) within a virtual flipped classroom framework significantly enhanced student learning outcomes, without any statistically significant differences in test performance or student satisfaction between the two methods. Overall, both CBL and GBL prove to be equally effective in pharmacy education in a virtual environment. © The Author(s) 2026.