From traditional classroom to AI-enhanced flipped classroom: a three-year pedagogical evolution for international students in pharmacology.

BACKGROUND: Pharmacology education faces challenges in developing higher-order thinking, especially for international students to overcome cross-cultural barriers. While flipped classrooms enhance interaction, their learning optimization remains uncertain. Artificial intelligence (AI) offers a promising pathway, yet empirical evidence on its impact on pharmacology education for international students is limited. OBJECTIVE: This study aimed to compare the effects of three instructional models (traditional classroom, flipped classroom, and AI-enhanced flipped classroom) on pharmacology education for international medical students, specifically regarding their classroom interaction efficiency, academic performance, perceptions, and behavioral intentions. METHODS: A three-year quasi-experimental study involved 68 international clinical medicine undergraduates, grouped by year into traditional classroom (2023, n = 21), flipped classroom (2024, n = 16), and AI-enhanced flipped classroom (2025, n = 31) groups. Evaluation included classroom interaction efficiency, academic performance, and a questionnaire for the AI-enhanced flipped classroom. RESULTS: The AI-enhanced flipped classroom demonstrated significantly higher response rates than both the flipped classroom (p < 0.01) and traditional classroom (p < 0.05) groups. Both flipped classroom (p < 0.05) and AI-enhanced flipped classroom (p < 0.01) groups achieved higher question accuracy than the traditional classroom group. The AI-enhanced flipped classroom group also showed superior assignment accuracy to the traditional classroom group (p < 0.01) and better pre-class preparation and PowerPoint quality score than the flipped classroom group (p < 0.05). Over 75% of students regularly used AI, valuing its efficiency and support while critically evaluating content reliability and desiring deeper collaborative roles for AI. CONCLUSION: This study confirms that the flipped classroom underpins enhanced pharmacology instruction. The AI-enhanced flipped classroom, serving as a cognitive tool, improves learning efficiency by optimizing information processing and empowering the learning process. This shift enables a renewed focus on cultivating higher-order clinical thinking and advances the establishment of a new paradigm in human-AI collaborative intelligent medical education.