During the flipped classroom session, students were divided into six groups, and each group consisted of eight to nine students. The classroom was modified to accommodate small group seating around tables. Each session started with a fifteen-minute pre-quiz. Afterwards, students summarized the main points about concepts they learned in the videos (e.g. roles of the respiratory system, functions of the organs of the respiratory system, muscles of breathing, pressure gradients affecting the flow of air, process of gas exchange and transport of oxygen and carbon dioxide, etc.). Each group was given a set of exercises, case studies, and problems relevant to the video material they had watched (see Additional file 1). Each group was responsible for one objective and tasked to discuss about it for 15 min and solve the corresponding exercises. Then, the groups were mixed so students were able to solve all the exercises, discuss them with their peers, and learn together to achieve all the objectives. The instructor passed between the groups to listen to discussion, answer questions, solve discrepancies, and clarify concepts. Each session ended with a fifteen-minute post-quiz.

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