Flipped Classroom With SNAPPS Lifts Emergency Interns’ Knowledge and Skills in Trial

A randomized controlled trial of 104 fifth-year undergraduate medical interns has found that combining a flipped classroom approach with the SNAPPS teaching framework produced higher theoretical knowledge scores, higher clinical competence ratings, and greater teaching satisfaction than conventional lecture-based teaching during emergency department rotations. The study, authored by Ying Lan and Wang Li, was published open access in BMC Medical Education on 28 August 2026.

Between 2023 and 2025, interns undertaking their clinical rotation in the Emergency Department were randomly assigned to one of two groups. Fifty-one interns received the combined flipped classroom and SNAPPS teaching model, while 53 received lecture-based teaching. All participants had completed identical preclinical coursework before entering the department, which established a comparable baseline across the two arms of the trial.

The researchers compared three sets of outcomes: theoretical knowledge scores measured on admission to and discharge from the rotation, clinical competence assessed with the Mini-CEX evaluation tool, and teaching satisfaction. At admission, there was no significant difference in theoretical scores between the two groups, with a P value greater than 0.05, indicating that the cohorts started on an equal footing before the teaching interventions began.

By discharge, the picture had changed. The theoretical score of the reform group was significantly higher than that of the control group, and both groups showed significant improvement compared with their own admission scores, with P values below 0.05. The Mini-CEX results also favored the combined model: interns taught with flipped classroom plus SNAPPS scored significantly higher in medical history taking, physical examination, condition assessment, and clinical judgment, all with P values below 0.05.

Teaching satisfaction told a similar but not uniform story. The reform group rated four dimensions significantly higher than the control group: teaching content, learning resources, classroom atmosphere, and teaching methods. However, the advantage did not extend to every measure. No significant differences emerged between the two groups in doctor-patient communication or professional literacy, and the groups were also statistically indistinguishable in their satisfaction with instructor competence and in perceived learning burden, with all of these comparisons yielding P values greater than 0.05.

The authors conclude that the flipped classroom combined with the SNAPPS teaching model can significantly improve theoretical knowledge and core clinical thinking among emergency medicine interns while also enhancing teaching satisfaction, and they describe the approach as worthy of clinical promotion. The trial’s randomized design, its use of identical preclinical preparation across both groups, and its measurement of outcomes at two time points support the internal comparison reported in the study, while the findings are specific to fifth-year undergraduate interns rotating through emergency medicine during the 2023 to 2025 study period.

Subject of Research: Application effect of flipped classroom combined with SNAPPS teaching model in emergency medicine interns

Article Title: Application effect of flipped classroom combined with SNAPPS teaching model in emergency medicine interns

Article References: Lan, Y., & Li, W. (2026). Application effect of flipped classroom combined with SNAPPS teaching model in emergency medicine interns. BMC Medical Education. https://doi.org/10.1186/s12909-026-10282-y

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10282-y

Keywords: flipped classroom, SNAPPS, emergency medicine, medical interns, randomized controlled trial, Mini-CEX, clinical competence, teaching satisfaction, medical education, lecture-based teaching, BMC Medical Education, Application