Effects of problem-based learning and flipped classroom educational methods on patient safety knowledge, attitudes and skills among nursing students: A systematic review and network meta-analysis.
Abstract
Aim
To compare the effects of problem-based learning (PBL) and flipped classroom (FC) on patient safety knowledge, attitudes and skills among undergraduate nursing students.
Background
Patient safety is central to healthcare quality and nursing education is essential for developing safety competencies. PBL and FC are widely used active pedagogies, but their head-to-head comparative effectiveness remains uncertain.
Design
Systematic review and network meta-analysis conducted according to PRISMA-NMA guidelines (PROSPERO: CRD420261280066). DATA SOURCES PubMed, Scopus, Web of Science, Embase, CINAHL and Cochrane Library were searched from inception to 6 January 2026, supplemented by Google Scholar, trial registries and reference screening.
Methods
Interventional studies comparing PBL or FC with conventional education were eligible. Risk of bias was assessed using RoB 2 and ROBINS-I and certainty using CINeMA. Random-effects frequentist network meta-analyses were performed using netmeta in R.
Results
Thirteen studies involving 979 participants were included, with eight contributing to the network meta-analysis. FC improved knowledge (SMD = 1.06, 95% CI 0.40-1.72) and skill (SMD = 0.92, 95% CI 0.35-1.49), but not attitude (SMD = 0.33, 95% CI -0.30 to 0.95). PBL ranked highest across all three domains (P-scores of 0.73-0.96), although each PBL estimate was based on a single study. Heterogeneity was substantial and certainty ranged from low to very low.
Conclusion
At low to very low certainty, FC and PBL may enhance patient safety knowledge and skill, whereas effects on attitudes remain uncertain. Because no head-to-head trial exists, no firm ranking of the two pedagogies is currently possible; adequately powered direct comparisons are needed. REGISTRATION The systematic review protocol has been successfully registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261280066).