Comparison of a touch surgery–based flipped classroom with a conventional flipped classroom on knowledge, cognitive performance, and motivation in surgical technology students: a randomized controlled trial

Abstract Background Surgical technologists must increasingly anticipate surgeons’ needs and develop cognitive understanding of surgical procedures to support intraoperative performance. However, limited evidence exists on integrating cognitive task analysis–based simulation as a pre-class activity within flipped classroom models for surgical technology students. This study evaluated whether a Touch Surgery–based flipped classroom improves knowledge, cognitive performance, and motivation compared with a conventional flipped classroom. Methods This randomized controlled trial (pretest–posttest design) was conducted from February to May 2026 with 67 surgical technology students at Ardabil University of Medical Sciences. Participants were randomly allocated to an intervention group (Touch Surgery simulation-based flipped classroom) or a control group (flipped classroom with narrated PowerPoint materials). Data were collected using a demographic questionnaire, a researcher-developed knowledge and cognitive performance test, and the Course Interest Survey (CIS). Results Both groups showed significant improvements in knowledge and cognitive performance from pre-test to post-test ( p < 0.05). While no significant between-group difference was observed in post-test knowledge scores ( p > 0.05), the intervention group demonstrated significantly higher post-test cognitive performance compared with the control group ( p < 0.05). Overall motivation did not differ significantly between the two groups ( p > 0.05); however, the intervention group showed significantly higher scores on the attention subscale ( p < 0.05). Conclusion Integrating the Touch Surgery simulation into a flipped classroom model significantly enhanced cognitive performance and self-reported attentional engagement among surgical technology students, although it did not significantly affect overall knowledge acquisition or general motivation. These findings suggest that cognitive simulation platforms offer a feasible and effective strategy for promoting procedural cognition and step-by-step learning in surgical technology curricula, with potential implications for learner-centered education in resource-limited settings. Trial registration This study was prospectively registered in the Iranian Registry of Clinical Trials (IRCT20220518054911N1) on 5 February 2026. The full trial details are available at: https://irct.ir/trial/88845 .