Background In a flipped classroom, students acquire knowledge before class and deepen and apply this knowledge during class. This way, lower-order learning goals are achieved before class and higher-order skills are reached during class. This study aims to provide an overview of the factors that contribute to the effectiveness of the flipped classroom and how these factors can be stimulated. The effectiveness of the flipped classroom is conceptualized in this study as test scores, the achievement of higher learning goals, and student perceptions. Methods A state-of-the-art review was conducted. The databases MEDLINE, PsycINFO, PubMed, Web of Science, and Scopus were consulted. The timeframe is 2016 till 2020. The studies were qualitatively analyzed according to the grounded theory method. Results After screening the studies based on the inclusion-and exclusion criteria, 88 studies were included in this review. The qualitative analysis of these studies revealed six main factors that affect the effectiveness of the flipped classroom: student characteristics, teacher characteristics, implementation, task characteristics, out-of-class activities, and in-class activities. Mediating factors are, amongst other factors, the learner’s level of self-regulated learning, teacher’s role and motivation, assessment approach, and guidance during self-study by means of prompts or feedback. These factors can be positively stimulated by structuring the learning process and focusing the teacher training on competencies and learning-and teaching approaches that are essential for the flipped classroom. Conclusion This paper provides insight into the factors that contribute to the effectiveness of the flipped classroom and how these factors could be stimulated. In order to stimulate the effectiveness of the flipped classroom, the positively and negatively affecting factors and mediating factors should be taken into account in the design of the flipped classroom. The interventions mentioned in this paper could also be used to enhance the effectiveness.

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In the present study, language development of Dutch children with a cochlear implant (CI) in a bilingual educational setting and Flemish children with a CI in a dominantly monolingual educational setting is compared. In addition, we compared the development of spoken language with the development of sign language in Dutch children. Eighteen children with a CI participated in the study: six Dutch children older than 18 months at implantation and 12 Flemish children, of whom seven were younger than 18 months at implantation and fi ve were older than 18 months. Tests were administered on auditory perception, speech intelligibility, spoken language and sign language (Dutch children). Five assessments were made to monitor language development of the children: a pre-test before implantation and four post-tests at six, 12, 24 and 36 months after implantation. In general, Flemish children showed more progress in spoken language development than Dutch children. Moreover, earlier implanted Flemish children showed more progress than later implanted Flemish children. This applies to auditory perception, speech intelligibility and spoken language. Whereas spoken language of Dutch children improved in the course of time, the development of sign language in Dutch children did not show any progress. Despite possible alternative explanations, such as better residual aided hearing before implantation or more professional support, it is plausible that the differences are partly caused by the linguistic environment. The lack of progress in development of sign language might be explained by the decreasing use of sign language by parents after implantation.