**1. Introduction**

The European Union Joint Research Center argues that traditional lecture-based education is severely limited and incapable of adequately embodying the key visions of future education [1]. The traditional classroom, focusing on knowledge delivery via rote learning, has seen a shift toward a more learner-centered classroom with the introduction of various teaching and learning methods. Flipped learning is one such methodology that is focused on interaction with students as opposed to a unidirectional monologue; it is also known as reverse learning. Flipped learning, or a student-oriented learning method, consists of pre-class, in-class, and post-class activities. Pre-class activities guide students to actively learn the lesson beforehand using multimedia materials; in-class activities involve instructor-learner interaction based on knowledge acquired via pre-class activities. Post-class activities help reinforce and expand on the acquired learning [2].

Flipped learning promotes instructor-student interaction in contrast to unidirectional teaching. With the introduction and popularization of various educational media that help increase learners' understanding, the demand for high-quality lectures is also on the rise [3]. Many colleges use learner-centered classes to strengthen students' competence, in which the class contents are explored in depth [4]. There is also active ongoing research on flipped learning [5,6]. Since students learn the lesson in advance using media that can be accessed anywhere and at any time, their understanding of the lesson is improved during the actual class, which leads to greater satisfaction in class [7]. However, to maximize the

**Citation:** Park, J.H.; Han, W.S.; Kim, J.; Lee, H. Strategies for Flipped Learning in the Health Professions Education in South Korea and Their Effects: A Systematic Review. *Educ. Sci.* **2021**, *11*, 9. https://doi.org/10.3390/ educsci11010009

Received: 1 December 2020 Accepted: 29 December 2020 Published: 31 December 2020

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional clai-ms in published maps and institutio-nal affiliations.

**Copyright:** © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

effectiveness of flipped learning, few conditions need to be met, such as active student participation, appropriate instructor intervention, and regulation of pre-learning. Courses must be designed specifically for each subject based on an analysis of numerous cases prior to applying flipped learning.

Learner-centered instruction is also being implemented currently in undergraduate health professions education to foster the competencies of health professionals [8]. Studies on learner-centered instruction, including flipped learning, have reported that such learning methods are effective in improving students' self-directed learning abilities, problem-solving, interpersonal skills, clinical performance, critical thinking, and academic achievements, thereby increasing academic performance [9–12]. A recent systematic literature review on flipped learning in South Korean nursing education found improvements in students' learning capability [5]. Hew and Lo conducted a meta-analysis on the flipped classroom approach in education for the health professions using journals in the Journal Citation Report [7]. However, no systematic literature review has been published that targeted health professions education in South Korea. It is necessary to conduct an indepth analysis of learner-centered instruction cases in health and allied health majors to foster prospective health professionals who will be in charge of public health. Further, as flipped learning was introduced in colleges in Korea only in 2013, efforts to stabilize and enhance its efficiency of operation and develop instruments for quality control have been inadequate [13]. Therefore, this study proposes directions for research on flipped learning in health professions education and for an effective application of flipped learning in health professions education by systematically reviewing the latest pertinent studies. The specific objectives of this study are to analyze the general characteristics, the measured variables and outcomes, and the strategies used in studies on flipped learning in the health professions education.

#### **2. Materials and Methods**

#### *2.1. Study Design*

This paper is a systematic review of studies analyzing the effects of flipped learning in undergraduate health majors in Korea to identify the latest research trend and assess the teaching strategies and their effectiveness. The literature search strategy was based on the participant-intervention-comparators-outcome (PICO) framework [14].

#### *2.2. Literature Search*

The keywords for the participants (P) of the study were undergraduate allied health majors (excluding medicine, dentistry, Korean medicine, pharmacy). The keyword for the intervention (I) was flipped learning. The comparator (C) referred to conventional lecture-based classes. The keyword of the outcomes (O) referred to the major outcomes of flipped learning. To examine the latest trend in flipped learning research, the search was limited to Korean studies published between January 2017 and March 2020. The search was performed on Korea Med, National Digital Science Library (NDSL), Korean Studies Information Service System (KISS), and the Korean Citation Index (KCI). The database used for the search was based on the report of Kim et al. [15] and included the search engine of the Core of the Core, standard ideal (COSI) model, which is the protocol for literature review databases in Korea. Four researchers performed the search independently, and studies were selected after reviewing them against the inclusion and exclusion criteria. The search strategy generated a total of 2155 studies with 20 studies from Korea Med, 549 studies from KISS, 784 studies from NDSL, and 802 studies from KCI. After excluding 1539 studies on medicine and non-health majors, 533 duplicate searches, and 62 studies that meet the exclusion criteria (but were qualitative studies, literature reviews, or published before 2017), the manuscripts of 21 studies were selected and subsequently acquired.

The quality of the selected studies was appraised independently by four researchers using the methodology checklist for cohort studies published by the Scottish Intercollegiate Guidelines Network (SIGN) [16]. Studies that compared the outcomes of flipped learning

and conventional lecture-based classes were included, and after re-discussing studies on which the researchers had divided opinions regarding the comparison groups, a total of 10 studies were finally selected for the analysis (see Figure 1).

**Figure 1.** Precedent studies' selection flowchart.
