Background <p>Diverse teaching strategies, including flipped classroom (FC) approaches, are increasingly used in anatomy education to enhance learning outcomes. However, their implications are difficult to interpret when instructional methods vary alongside cohort characteristics such as instructional language. This study examined academic performance, learning satisfaction, and state anxiety in two pre-existing cohorts of first-year dental medicine students differing in instructional sequence and language.</p> Methods <p>This quasi-experimental study included 186 volunteer first-year dental medicine students (Turkish-language cohort [TC]: <i>n</i> = 93; English-language cohort [EC]: <i>n</i> = 93) who took anatomy for the first time in spring 2025. The TC received the traditional education model in both the third and fourth curricular blocks (Committee 3 and Committee 4), whereas the EC received FC instruction in Committee 3 and the traditional education model in Committee 4. Accordingly, the study represents a cohort comparison within a natural dual-language educational setting rather than a design intended to isolate an independent instructional effect. Academic achievement was assessed using identical 40-item multiple-choice theory examinations at the end of each committee. Satisfaction was assessed using separate 10-item, method-specific Likert questionnaires administered after Committee 4 and was interpreted exploratorily because the instruments were not identical across cohorts. State anxiety was measured with the State–Trait Anxiety Inventory, State scale (STAI-S).</p> Results <p>Mean theory scores were higher in the EC than in the TC in both Committee 3 (53.48 ± 18.85 vs. 46.25 ± 20.00) and Committee 4 (52.38 ± 22.67 vs. 39.66 ± 18.42). Adjusted analyses indicated that the magnitude of the between-cohort difference varied across committees and that the adjusted contrasts remained in the same direction across both committees, although effect sizes were small. Because instructional sequence, instructional language, and cohort membership were not independent, these findings are interpreted as adjusted cohort-level contrasts rather than evidence of an isolated FC effect. Post-course STAI-S scores were similar across cohorts. Satisfaction findings are presented as exploratory summaries because different method-specific questionnaires were used across cohorts.</p> Conclusion <p>This study characterizes cohort-level differences in theory examination performance, state anxiety, and satisfaction within a quasi-experimental dual-language anatomy education setting among first-year dental medicine students. Beyond these descriptive findings, the results demonstrate how performance differences can emerge in dual-language contexts where instructional methods and language tracks are structurally confounded. For dental medicine anatomy educators, this carries a clear practical implication that comparisons across dual-language cohorts may conflate instructional and language effects and therefore require anatomy-specific baseline assessment and equivalent learner-report measures for meaningful interpretation.</p>