Flipped classroom combined with problem-based learning in peri-operative anaphylaxis training for nurse anesthetists: a randomized controlled trial

Abstract Background Peri-operative anaphylaxis is a rare but life-threatening emergency that demands strong team coordination and rapid response from nurse anesthetists. Although flipped classroom (FC) and problem-based learning (PBL) have shown promise in medical education, their combined effectiveness in the training of nurse anesthetists remains unclear. This study aims to access the influence of FC-PBL teaching method in the perioperative allergy treatment training on the performance and satisfaction of anesthesia nurses. Methods This double blind, randomized controlled trial was conducted at the First Affiliated Hospital of Zhengzhou University between December 15, 2025 and March 31, 2026. A total of 96 nurse anesthetists were randomly assigned to a control group (traditional lectures, n = 48) or an experimental group (integrated FC-PBL, n = 48). Outcomes included the Team Emergency Assessment Measure (TEAM) score, theoretical knowledge, practical skills, student satisfaction and self-confidence in learning. Independent samples t tests or Mann–Whitney U tests were used for between group comparisons, and paired t tests or Wilcoxon signed rank tests for within group comparisons. Results A total of 92 participants completed the study (control group, n = 45; experimental group, n = 47). After the training, the TEAM total score was significantly higher in the experimental group than in the control group (median 39, 34.5–40 vs. median 37, 35–38; Z = − 2.999, P = 0.003). Significant improvements in favor of the experimental group were observed in the leadership ( P = 0.013) and teamwork ( P = 0.017) subscales, whereas task management did not differ significantly between groups ( P = 0.565). Theoretical knowledge scores were higher in the experimental group (85.40 ± 2.98 vs. 81.80 ± 4.29; mean difference 3.60, 95% CI -2.07 to -5.14; P < 0.001), as were practical skill scores (41.28 ± 5.34 vs. 39.31 ± 3.78; mean difference 1.97, 95% CI 0.06–3.88; P = 0.044). The experimental group also reported a significantly higher total score on the satisfaction and self-confidence scale (54.64 ± 4.47 vs. 52.67 ± 4.76; P = 0.044) and higher self-confidence in learning (33.43 ± 2.51 vs. 32.11 ± 2.53; P = 0.014), whereas the student satisfaction subscale did not differ significantly between groups (21.21 ± 2.23 vs. 20.56 ± 2.33; P = 0.170). Conclusion The integrated FC-PBL teaching model significantly improved team emergency performance, theoretical knowledge, practical skills, and self-confidence in learning among nurse anesthetists in peri-operative anaphylaxis training, representing an effective and acceptable strategy for continuing education in anesthesia nursing. Trial Registration ChiCTR2500114190 (http://www.chictr.org.cn). Registered on December 9, 2025.