Measuring effectiveness of Integrating Basic Sciences with Clinical Practice through analysis of learning outcome achievement across curriculum phases; a comparative study

Measuring effectiveness of Integrating Basic Sciences with Clinical Practice through analysis of learning outcome achievement across curriculum phases; a comparative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Measuring effectiveness of Integrating Basic Sciences with Clinical Practice through analysis of learning outcome achievement across curriculum phases; a comparative study Hamdi Almaramhy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6025698/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 4 You are reading this latest preprint version Abstract Background: Effective integration of basic and clinical sciences is pivotal in medical education, influencing students’ ability to apply knowledge in clinical settings. This study evaluates the integration efficiency of basic sciences in differing phases of a spirally integrated curriculum through the lens of program learning outcomes (PLOs). Methods: A quantitative comparative analysis was conducted across phases 1 (years 1 and 2) and 3 (year 5) of a medical curriculum. Data were collected from summative assessments, with Multiple-Choice Questions (MCQs) assessing knowledge and Objective Structured Clinical Examinations (OSCEs) assessing psychomotor skills. Achievements of course learning outcomes (CLOs) were quantified as percentages and correlated to PLOs. Statistical evaluation was performed using paired t-tests, setting significance at p < 0.05. Results: Phase 1 demonstrated successful attainment of all 12 PLOs, with achievement percentages ranging from 70-80% or higher. In contrast, phase 3 revealed lower achievement levels in specific PLOs, notably PLO 1.4. Significant disparities in mean achievements for factual knowledge PLOs (except PLO 1.2) and cognitive PLOs 2.2 and 2.3 were observed between the two phases. No significant differences were noted in psychomotor PLOs. Conclusion: The study highlights challenges in effectively integrating basic sciences within the clinical components of the curriculum, despite its structural advantages. These findings advocate for refined integration strategies to bolster clinical reasoning and educational efficacy, contributing substantively to discussions on enhancing medical education practices and suggesting directions for future research. integrated curriculum curriculum evaluation program learning outcomes medical education Figures Figure 1 Figure 2 Figure 3 Introduction Integrating basic and clinical sciences in medical education presents several challenges that significantly impact students' learning experiences and their capacity to apply knowledge in clinical settings. These challenges arise from the medical curriculum's design and the teaching methods employed, both of which may create gaps in effectively integrating theoretical knowledge and practical skills. The need for effective curriculum integration has become increasingly apparent as it offers potential benefits in enhancing student engagement, participation, and motivation. Integrated curricula, unlike traditional segmented teaching approaches, strive for a holistic understanding of the interconnectedness of various disciplines [1]. Despite its widespread adoption [2] and the theoretical benefits it offers, there remains a scarcity of direct empirical evidence evaluating the effectiveness of these integration strategies, particularly in preparing students to apply foundational knowledge in clinical scenarios. Kulasegaram et al. emphasized in their comprehensive literature review that assessing how learners apply basic science knowledge in clinical reasoning and skill performance is crucial for evaluating the efficacy of integration approaches [3]. A review of existing literature reveals a variety of assessment methodologies that indirectly indicate the effects of integration, such as specific pre- or post-class reflection questions [4], combined multiple-choice and essay questions that provide details of underlying processes for clinical scenario results [5], concept maps for assessing knowledge integration [6], long essays for evaluating knowledge integration in problem-based learning [7], and progress tests [8]. Biggs suggested that assessment methods in the curriculum should align with teaching methods to effectively measure learning outcomes [9]. Indeed, the assessment of program learning outcomes (PLOs) is a critical component of medical education, ensuring that graduates possess the necessary knowledge, skills, and competencies for effective medical practice. While various methods have been employed to indirectly evaluate basic sciences integration in clinical settings, there is a scarcity of research utilizing summative assessment results to directly measure the achievement of PLOs. By using this assessment to reflect on the integration of basic science knowledge across preclinical and clinical phases, educational programs can bridge gaps in quality and effectiveness. Addressing this gap is crucial for ensuring the quality and effectiveness of medical education programs. Doing so provides educators with valuable insights into the extent to which foundational knowledge is effectively integrated and applied in clinical contexts. This information is vital for informing curricular revisions, enhancing teaching methods, and refining assessment practices, thereby better preparing future physicians for the demands of modern healthcare. Aligning with this perspective, our objective is to assess the achievement of PLOs through summative assessments as a direct approach to evaluate the integration of basic sciences within our curriculum. By comparing the achievement of PLOs between preclinical and clinical phases, we aim to gauge the extent to which basic sciences are effectively integrated and applied in clinical contexts. To rigorously assess these elements, this study will apply the conceptual framework developed by Goff et al., which outlines a four-stage process for evaluating course learning outcomes: establishing expectations, mapping assessment tasks, collecting and analyzing assessment results, and planning program improvements [10]. This framework will be enriched by alignment insights from Badawy et al. to evaluate the achievement of program learning outcomes if PLOs are well aligned with course learning outcomes (CLOs) [11]. Utilizing this conceptual framework allows for a detailed examination of the alignment between educational content administered throughout various phases of the medical curriculum and the consequent student performance as reflected in the achievement of PLOs. This analytical approach is vital for ensuring the effective transmission of foundational knowledge from the initial phase to the clinical phase. This study aims to investigate the extent to which summative assessment results measure the achievement of PLOs in medical education, focusing particularly on basic sciences-related PLOs. It seeks to quantify how achievement levels of basic science-related learning outcomes, as assessed by summative assessments, reflect the integration of basic science knowledge across preclinical and clinical phases of the medical curriculum. Methods Study Design The study utilized a quantitative comparative design to evaluate the effectiveness of a spiral curriculum and basic sciences integration across phases, focusing on PLOs achieved in phases one and three. By aligning exam components with CLOs, the research assessed knowledge and skills domains. This methodology is lauded for its precision and objectivity and employed rigorous statistical analysis to examine curriculum dynamics over time and groups. Study Setting : The study was conducted at Taibah University's College of Medicine in Madinah, Saudi Arabia. The curriculum is built on a five-year problem-based learning (PBL) framework divided into three phases. The early phase (years 1 and 2) focuses on fundamental sciences, with a 70:30 ratio favoring basic sciences. Phases two (years 3 and 4) and three (year 5) reverse the emphasis, focusing 70% on clinical sciences. Learners take five courses in phase one and six in phase three, with five clinical courses and one focused on research. Figure 1. Curriculum Assessment : The end-of-course assessment consists of multiple-choice questions (MCQs) and objective structured clinical examination (OSCE) stations. The program assessment committee (PAC) monitors assessment validity and reliability. Validation techniques for MCQs include determining content and face validity, as well as construct validity verification using check, item discrimination, and difficulty indices. Reliability coefficients ensure consistency. OSCE criterion validity is checked by comparing scores to averages, while consistency and inter-rater reliability ensure checklist validity by two evaluators. Data Collection and Measurement of PLOs: The method included an in-depth review of course specifications, exam blueprints across phase 1 (year 1 and 2) and phase 3 (year 5), and overall program specifications to ensure compliance with Biggs' constructive alignment principles. Such an in-depth review ensured a robust foundation for data collection. Central to the methodology was identifying PLOs relevant to knowledge and skills domains, focusing on basic and clinical sciences integration, Table 1. The precise achievement values for CLOs were calculated through direct assessment. This involved tagging MCQs to CLOs within the knowledge domain. Each CLO achievement value was derived from the average percentage of difficulty indices across pertinent MCQs, yielding a single percentage indicative of each knowledge-based course learning outcome's achievement. Skills-based CLOs employed results from OSCE stations, with station achievement values derived from class-wide average grades. If a skill CLO involved multiple stations, the average percentage across stations represented the outcome. The percentage values for CLO achievement were systematically gathered for courses in phases 1 and 3. This was reinforced by aligning all CLOs with appropriate PLOs of corresponding domains, facilitating curriculum effectiveness assessment. To objectively measure PLO achievement within the phases, the study averaged the percentage values of all CLOs aligned with each PLO. This procedure enabled distinct PLO percentage derivation for both phases. Aligning with standards set by the National Center for Academic Accreditation and Evaluation, PAC established a benchmark percentage for each PLO at 60% or above. Figure 3. Effectiveness of basic sciences integration was assessed by comparing average percentage values (mean) for each PLO across knowledge and skills domains in phases 1 and 3. This comparison reflected the curriculum's success in fostering effective integration across phases. Table 1: Program Intended Learning Outcomes that examine the integration of basic sciences with clinical one. Data Analysis Data were analyzed using IBM SPSS Statistics (version 23), exploring the curriculum's spiral design. This involved a comparative analysis of learning outcomes achievement across phases 1 and 3, focusing on identifying significant differences in the means of PLOs between these phases. Statistical Testing The statistical analysis centered on paired t-tests to evaluate mean differences between dependent groups—achievement levels in phases 1 and 3. A p-value under 0.05 was the threshold for statistical significance, with a 95% confidence interval guiding interpretation of mean differences observed between key phases. Results Alignment of Program Learning Outcomes (PLOs) and Course Learning Outcomes (CLOs) The analysis of alignment between PLOs and CLOs within the medical curriculum across phases one and three addressed factual knowledge, cognitive knowledge, and psychomotor skills. Comprehensive assessments were conducted, showcasing PLOs achievement post-alignment with CLOs. Data Normality An initial assessment verified data normality to confirm parametric tests' appropriateness. Skewness and kurtosis values within the range of −2 to +2 affirmed normal data distribution. Achievement of Program Learning Outcomes In phase one, all 12 PLOs concerning basic sciences integration with clinical knowledge achieved 70% or higher. Conversely, phase three revealed PLOs 1.1, 1.3, 1.4, and 1.5 did not meet comparable achievement levels, indicating potential integration issues. Notably, PLO 1.4—focused on understanding diseases and their environmental and social determinants—consistently underachieved across phase three. Mean Achievement Values and Domain Analysis Phase one exhibited high achievement levels in factual knowledge (83.75%), cognitive knowledge (82.34%), and psychomotor skills (83.88%). In contrast, phase three witnessed a focus shift towards practical skills, with decreased factual (59.87%) and cognitive knowledge (74.08%), while maintaining high psychomotor skills (79.34% ,peaking 83.56%). Table 2. Mean Achievement Percentages of PLOs Aligned with CLOs in Phases 1 and 3 by Domain. Table 3. Paired Samples Descriptive Statistics of the LOCs Achievement (Mean) in Phases 1 & 3. Statistical Analysis of Learning Outcomes by Domain : - Factual Knowledge: Significant differences were observed in mean achievement for PLOs 1.1, 1.3, 1.4, and 1.5 between phases 1 and 3 (p < 0.05), except for PLO 1.2. - Cognitive Knowledge: Significant differences between phases for PLOs 2.2 and 2.3 (p = 0.002 and 0.014) suggest inadequate integration in advanced courses, notably in medicine, surgery, and child health. - Psychomotor Skills: No significant differences in mean scores for psychomotor PLOs between phases were observed. Table 4. Paired sample t-test of means difference for factual knowledge PLOs in phases 1 & 3 Table 5. Paired sample t-test results and mean differences for cognitive knowledge domain PLOs between phases 1 and 3. Table 6. Paired sample t-test for means difference for Psychomotor PLOs in phases 1 & 3 Overall, Domain Comparison: The aggregated mean differences for each domain's PLOs highlighted significant differences in factual knowledge between phases 1 and 3 (p < 0.023), while cognitive and psychomotor domains did not exhibit significant variances. tables 7&8. Table 7. Paired Samples Statistics for means of means of all LOCs serving factual, cognitive, and psychomotor domains in phase one and phase 3 Table 8. Paired Samples Test for means difference of means of all LOCs serving factual, cognitive, and psychomotor domains in phase one and phase 3. Discussion This study aimed to evaluate basic sciences integration into the clinical phase of the spirally integrated medical curriculum at Taibah University's College of Medicine. The study evaluated the attainment of PLOs by measuring factual, cognitive, and psychomotor domains throughout two critical curricular phases using summative assessment data. Results show a notable difference in the accomplishment of some PLOs between clinically oriented Phase 3 and foundational Phase 1, especially in factual knowledge acquisition (PLOs 1.1, 1.3, 1.4, 1.5). Phase 1 showed complete accomplishment of all twelve basic sciences-related PLOs, indicating strong foundational knowledge. However, Phase 3 exhibited a decline in factual knowledge achievement. This pattern was less pronounced in the cognitive domain, with lower accomplishment in Phase 3, particularly for PLO 2.2 and 2.3. This observation highlights challenges in applying prior knowledge to clinical reasoning processes, emphasizing the critical role of pre-existing knowledge in improving diagnostic reasoning capabilities. Consistent with the perspective recognizing knowledge as foundational in medical expertise development [12], our analysis of psychomotor domains revealed no significant performance differences between academic stages, suggesting uniform clinical skills development facilitated by the curriculum. This consistency aligns with findings by Gordon et al., who observed that stable, continuous exposure to clinically oriented tasks enhances practical skills essential for practice [13]. Similarly, Kerdijk et al. found that longitudinal structures support incremental acquisition of complex clinical competencies [12]. Structured, clinical environments foster self-regulated learning, enabling students to refine skills, imperative for adept medical professionals. Our findings, however, indicate a gap leading to missed opportunities. The program-level analysis showed significant differences in LOs addressing factual knowledge, cognitive knowledge, and psychomotor domains between phases, notably factual knowledge (p<0.05), less so in cognitive domains (p = 0.06). This pattern emphasizes knowledge's influence on cognition and reasoning abilities, alongside diagnostic reasoning facilitating information retrieval from sources like patient scenarios [14, 15]. Cognitive psychology research shows regular rehearsal during learning improves memory retention, affecting decision-making processes [16, 17]. Identified shortcomings necessitate rigorous revision of basic sciences integration in the clinical phase, necessitating in-depth discussion with students and tutors to identify and close integration gaps. CLO-PLO mapping facilitates a PLO assessment rubric developed through aligning CLO assessments to appropriate PLOs, providing a clear, solid PLO assessment plan [10, 18]. Our work attempted to objectively assess PLO accomplishment using summative assessment data, reflecting basic sciences' integration into the clinical phase—a novel approach given no similar metrics in the literature review. Debate on grading efficacy to assess student achievements and learning outcomes reflects varying opinions. Yorke criticizes grading susceptibility to socio-cultural biases [19], while Caspersen et al. argue exams and grades as primary tools for evaluating student learning outcomes, emphasizing aggregate results can reflect program effectiveness if aligned with desired outcomes [20]. Limitations We recognize limitations, which, if addressed, might broaden future research depth and scope. Focus on a single institution reduces external validity and applicability. Future research should cover broader settings to improve findings' generalizability. Generalizability is also limited by a small exam result sample from a specific cohort. Expanding the sample to include many batches over the curriculum will reduce confounding effects and improve validity [21,22]. Evaluating program learning outcomes using year-end summative exams may jeopardize internal validity due to external variables' influence and MCQ question limitations. Diverse evaluation techniques offer a more complete picture. Relying on quantitative analysis limits insights into factor relationships and generalizability. Adding qualitative methodologies like questionnaires and focus groups helps comprehend and validate quantitative results [23]. Future research should deepen insights into medical education and curricular effectiveness by addressing current study limitations through methodological changes. Extending the research period to include multiple student cohorts over three to four years can improve summative assessment score reliability and validity for evaluating learning outcomes. Adding a qualitative component is recommended to provide deeper insights into curriculum integration effectiveness, offering a comprehensive context understanding and corroborating quantitative findings. Including student and tutor perspectives enriches studies holistically. The study underscores how balanced curriculum designs integrating basic sciences and clinical skills enhance graduates' proficiency in theoretical applications and practice. This involves developing structures reiterating basic sciences throughout all phases, contextually linking them to clinical practice. Assessment practices should evolve to include tools accurately assessing integration. Faculty development is crucial, necessitating interdisciplinary training and collaboration. Continuous evaluation ensures curriculum relevance and effectiveness alongside scientific and healthcare advancements. Engaging stakeholders in curriculum development aligns it with demands and diverse perspectives. Collectively, these steps advocate revising medical education holistically, creating a curriculum that imparts knowledge and prepares students for practice, thereby improving training and healthcare outcomes. Conclusion While the spirally integrated curriculum has the potential to facilitate learning across domains, challenges persist in adequately integrating basic science knowledge into clinical settings. Addressing these gaps is crucial for enhancing reasoning and delivering a comprehensive learning experience. Our findings contribute to the larger discussion concerning curriculum effectiveness in medical education, offering a framework for future research aimed at improving teaching techniques and outcomes. Declarations Acknowledgements NA Funding The authors have not received any financial support. Contributions Hamdi Almaramhy participated in study design collecting the data , performed formal analysis and calculation ,and wrote the manuscript. Cees Vleuten participated in the study design and in reviewing and editing the manuscript . All authors approved the final version of this manuscript. Corresponding author Correspondence to: Cees van der Vleuten. Email : [email protected] . Ethics approval and consent to participate This study adhered to the Declaration of Helsinki. The data were not specifically gathered for the purpose of this study but were used from our existing regular database of test achievements . The need for consent to participate was waived by the Ethics Committee of Taibah university college of medicine (IORG0008716 – IRB00010413). Consent for publication Not applicable. Competing interests The authors declare no competing interests. Declaration of data availability . The datasets used in the current study are available from the corresponding author upon reasonable request. References Drake SM, Reid J. Integrated curriculum: Increasing relevance while maintaining accountability. Research Monograph 28. The Literacy and Numeracy Secretariat; 2010. Harden RM, Stamper N. What is a spiral curriculum? Med Teach. 1999;21(2):141–143. Kulasegaram KM, Martimianakis MA, Mylopoulos M, Whitehead CR, Woods NN. Cognition before curriculum. Acad Med. 2013;88(10):1578–1585. Goldman E, Schroth WS. Perspective: Deconstructing integration: A framework for the rational application of integration as a guiding curricular strategy. Acad Med. 2012;87(6):729–734. Bierer SB, Dannefer EF, Taylor C, Hall P, Hull AL. Methods to assess students' acquisition, application, and integration of basic science knowledge in an innovative competency-based curriculum. Med Teach. 2008;30(7):171–177. McGaghie WC, McCrimmon DR, Mitchell G, Thompson JA, Ravitch MM. Quantitative concept mapping in pulmonary physiology: Comparison of student and faculty knowledge structures. Adv Physiol Educ. 2000;23(1):S72. Ferguson KJ. Beyond multiple-choice questions: Using case-based learning patient questions to assess clinical reasoning. Med Educ. 2006;40(11):1143–1144. Wrigley W, Van Der Vleuten CPM, Freeman A, Muijtjens A. A systemic framework for the progress test: Strengths, constraints, and issues: AMEE Guide No. 71. Med Teach. 2012;34(9):683–697. Biggs J. Enhancing teaching through constructive alignment. High Educ. 1996;32(3):347–364. Goff L, Potter MK, Pierre E, Carey T, Gullage A, Kustra E, et al. Learning outcomes assessment: A practitioner's handbook. 2015. Badawy M, Abd El-Aziz A, Hefny H. Exploring and measuring the key performance indicators in higher education institutions. Int J Intell Comput Inf Sci. 2018;18(1):37–47. Kerdijk W, Snoek JW, van Hell EA, Cohen-Schotanus J. The effect of implementing undergraduate competency-based medical education on students’ knowledge acquisition, clinical performance and perceived preparedness for practice: a comparative study. BMC Med Educ. 2013;13:1–9. Gordon J, Hazlett C, Ten Cate O, Mann K, Kilminster S, Prince K, et al. Strategic planning in medical education: enhancing cultural and organizational climates. Med Educ. 2000;34(2):135–144. Brauer DG, Ferguson KJ. The integrated curriculum in medical education: AMEE guide no. 96. Med Teach. 2015;37(4):312–322. Woods NN, Brooks LR, Norman GR. It all makes sense: Biomedical knowledge, causal connections and memory in the novice diagnostician. Adv Health Sci Educ. 2007;12:405–415. Craik FI, Lockhart RS. Levels of processing: A framework for memory research. J Verbal Learn Verbal Behav. 1972;11(6):671–684. Ebbinghaus H. Memory: A Contribution to Experimental Psychology. Dover Publications; 1885. Mahzari M, AlNahedh T, Ahmed AA, Al Rumyyan A, Shaban S, Magzoub ME. Practical Guide to Undergraduate Medical Curriculum Alignment and Mapping. Adv Med Educ Pract. 2023;14:1001–1012. Yorke M. Summative assessment: Dealing with the ‘measurement fallacy.’ Stud High Educ. 2011;36(3):251–273. Caspersen J, Smeby JC, Aamodt PO. Measuring learning outcomes. Eur J Educ. 2017;52(1):20–30. Hanley JA, Moodie EE. Sample size, precision and power calculations: a unified approach. J Biomet Biostat. 2011;2(124):1–7. Springate SD. The effect of sample size and bias on the reliability of estimates of error: a comparative study of Dahlberg's formula. Eur J Orthod. 2012;34(2):158–163. Austin Z, Sutton J. Qualitative research: Getting started. Can J Hosp Pharm. 2014;67(6):436–440. Tables Table 1: Program Intended Learning Outcomes that examine the integration of basic sciences with clinical one: 1. Knowledge (Lower Cognitive Function): 1.1. Demonstrate knowledge and understanding of the sciences basic to medicine in terms of the major body systems' typical structure and function and how they interrelate. 1.2 Identify the principles of scientific methodology in both investigation and research. 1.3. Discuss behavior and relationships between individuals and their families and society. 1.4. Describe diseases, including environmental and social determinants, and how they may spread. 1.5. Discuss therapy, including the actions of drugs and underlying pharmacological principles 2. Cognitive Skills (Higher Cognitive function) 2.1 Apply to medical practice biomedical scientific principles, method and knowledge relating to: anatomy, biochemistry, cell biology, genetics, immunology, microbiology, molecular biology, nutrition, pathology, pharmacology and physiology. 2.2 Demonstrate the ability to solve clinical problems by evaluation and critical review of evidence, and the integration of knowledge across a range of subjects and make clinical decisions based on evidence and findings. 2.3. Formulate a differential diagnosis based on sound ability to define a patient's problem and interpret findings from the history, physical examination, and mental state examination. 2.4. Formulate and justify a plan for treatment, management (including selecting and interpreting appropriate investigations), and prevention for common clinical problems. 5. Psychomotor (skills): 5.1. Take and record a structured, patient centered clinical history in an appropriate manner. 5.2. Undertake a relevant, systematic, physical, and mental state examination. 5.4. Perform safely and effectively a range of diagnostic and therapeutic practical procedures (as listed in the program competency list), including drug prescribing, and administering. Table 2. Mean percentage values representing the degree of achievement of program learning outcomes (PLOs) after they had Aligned with course learning outcomes (CLOs) in phases 1 and 3, with PLOs categorized into the domains of factual knowledge, cognitive knowledge, and psychomotor skills. Program learning outcomes Factual knowledge Cognitive knowledge psychomotor 1.1 1.2 1.3 1.4 1.5 2.1 2.2 2.3 2.4 5.1 5.2 5.4 Courses LOs in phase 1 C1EMFS 80.36 * 77.66 83.25 76.50 85.02 85.8 80.73 88.73 83.40 83.88 79.34 80.01 C2LC 86.33 66.33 81.75 89.66 78.80 81.66 87.47 81.47 89.50 86.75 91.45 82.20 C3CRF 85.86 59.78 80.71 86.81 84.46 75.3 85.39 88.62 86.75 76.30 76.90 83.10 C4MM 79.46 49.5 85 77.70 82.30 82.3 85.65 89.41 73.80 87.5 73.30 86.50 C5NM 84.76 81 82.60 83.60 84.75 86.66 83.91 86.01 81.10 85 75.90 73.70 Average degree of achievement 83.75 66.85 82.66 83.07 82.85 82.34 84.63 86.85 82.91 83.88 79.38 81.1 Courses LOs in phase 3 C1 Med 59.33 61.20 46.62 51.41 68.33 64.71 37.66 56.62 59.35 81.38 82.60 81.45 C2 Surg. 53.10 69.86 46.80 54.90 62.60 77.63 58.90 46.50 62.33 76.65 88.82 88.12 C3 EM 74.73 63.75 72.62 56.60 71.01 80.25 50.57 82.80 71.26 79.21 79.21 78.94 C4 WH 57.36 75.11 51.25 49.70 59.82 75.71 59.00 57.44 80.57 76.42 80.44 80.71 C5 CH 54.85 77.62 72.54 54.76 55.30 72.12 65.20 70.71 80.57 83.03 84.21 80.31 Average degree of achievement 59.87 67.51 57.97 53.47 63.41 74.08 54.27 62.81 70.82 79.34 83.56 81.91 *The numbers in the table represent the percentage of achievement based on the calculated mean of the student scores in the summative assessment. Table 3 Paired Samples Descriptive Statistics of the LOCs achievement (mean) in phases 1&3. N Minimum Maximum Mean Std. Deviation Skewness Kurtosis Statistic Statistic Statistic Statistic Std. Error Statistic Statistic Std. Error Statistic Std. Error P1 1.1 5 79.46 86.33 83.35 1.44 3.21 -0.516 .913 -2.919 2.000 P1 1.2 5 49.50 81.00 66.85 5.78 12.93 -0.287 .913 -1.424 2.000 P1 1.3 5 80.71 85.00 82.66 0.72 1.62 0.472 .913 .267 2.000 P1 1.4 5 78.80 85.02 83.07 1.17 2.62 -1.469 .913 1.547 2.000 P1 1.5 5 76.50 89.66 82.85 2.54 5.69 -0.036 .913 -2.360 2.000 P1 2.1 5 75.30 86.66 82.34 2.01 4.49 -1.050 .913 1.074 2.000 P1 2.2 5 80.73 87.47 84.63 1.13 2.52 -0.918 .913 11111111111.232 2.000 P1 2.3 5 81.47 89.41 86.85 1.46 3.27 -1.509 .913 1.821 2.000 P1 2.4 5 73.80 89.50 82.91 2.69 6.01 -.803 .913 .601 2.000 P1 5.1 5 76.30 87.50 83.89 2.00 4.47 -1.696 .913 3.083 2.000 P1 5.2 5 73.30 91.45 79.38 3.17 7.09 1.729 .913 3.290 2.000 P1 5.4 5 73.70 86.50 81.07 2.12 4.74 -0.903 .913 1.480 2.000 P3 1.1 5 53.10 74.73 59.87 3.86 8.64 1.826 .913 3.562 2.000 P3 1.2 5 61.20 77.62 69.51 3.16 7.06 -0.065 .913 -2.382 2.000 P3 1.3 5 46.62 72.62 57.97 6.02 13.47 0.526 .913 -3.238 2.000 P31.4 5 49.70 56.60 53.47 1.26 2.83 -0.498 .913 -1.669 2.000 P3 1.5 5 55.30 71.01 63.41 2.84 6.35 -0.038 .913 -1.530 2.000 P3 2.1 5 64.71 80.25 74.08 2.69 6.02 -1.046 .913 .895 2.000 P3 2.2 5 37.66 65.20 54.27 4.76 10.64 -1.078 .913 .922 2.000 P3 2.3 5 46.50 82.80 62.81 6.31 14.10 0.556 .913 -.517 2.000 P3 2.4 5 59.35 80.57 70.82 4.44 9.92 -0.112 .913 -2.772 2.000 P3 5.1 5 76.42 83.03 79.34 1.29 2.89 0.250 .913 -2.176 2.000 P3 5.2 5 79.21 88.82 83.06 1.68 3.75 0.930 .913 .622 2.000 P3 5.4 5 78.94 88.12 81.91 1.61 3.59 1.871 .913 3.847 2.000 Valid N (listwise) 5 P1= phase 1 learning outcomes P3= phase 2 learning outcomes Table 4. Paired sample t-test of means difference for factual knowledge PLOs in phases 1 &3. Paired Differences t df Sig. (2-tailed) Mean difference Std. Deviation Std. Error Mean 95% Confidence Interval of the Difference Lower Upper Pair 1 P1 1.1 P3 1.1 23.48 8.61 3.85 12.78 34.18 6.095 4 0.004 Pair 2 P1 1.2 P3 1.2 -2.65 15.26 6.82 -21.60 16.29 -0.389 4 0.717 Pair 3 P1 1.3 P3 1.3 24.70 14.31 6.40 6.92 42.47 3.858 4 0.018 Pair 4 P1 1.4 P3 1.4 29.59 3.90 1.74 24.75 34.43 16.979 4 0.000 Pair 5 P1 1.5 P3 1.5 19.44 8.36 3.74 9.07 29.82 5.203 4 0.007 - P1: Phase one program learning outcomes. -. P3: Phase two program learning outcomes. Table 5. Paired sample t-test results and mean differences for the cognitive knowledge domain PLOs between phases 1 and 3. Paired Differences t df Sig. (2-tailed) Mean difference Std. Deviation Std. Error Mean 95% Confidence Interval of the Difference Lower Upper Pair 6 P1 2.1 P3 2.1 8.26 9.99 4.47 -4.14 20.66 1.849 4 0.138 Pair 7 P1 2.2 P3 2.2 30.36 9.14 4.09 19.02 41.71 7.429 4 0.002 Pair 8 P1 2.3 P3 2.3 24.03 12.80 5.73 8.14 39.93 4.197 4 0.014 Pair 9 P1 2.4 P3 2.4 12.09 14.76 6.60 -6.23 30.42 1.832 4 0.141 -. P1: Phase one program learning outcomes. -. P3: Phase two program learning outcomes. Table 6. Paired sample t-test for Means difference for Psychomotor PLOs in phases 1 &3. Paired Differences t df Sig. (2-tailed) Mean difference Std. Deviation Std. Error Mean 95% Confidence Interval of the Difference Lower Upper Pair 1 P1 5.1 P3 5.1 -12.23 39.09 17.48 -60.77 36.31 -.699 4 0.523 Pair 2 P1 5.2 P3 5.2 -19.55 35.51 15.88 -63.64 24.55 -1.231 4 0.286 Pair 3 P1 5.4 P3 5.4 -33.25 47.35 21.17 -92.04 25.54 -1.570 4 0.191 -. P1: Phase one program learning outcomes. -. P3: Phase two program learning outcomes. Table 7 Paired Samples Statistics for means of means of all LOCs that serve factual knowledge, cognitive, and psychomotor domains in phase one and phase 3. Mean N Std. Deviation Std. Error Mean Pair 1 K1 85.40 5 3.11 1.39 K2 70.52 5 8.16 3.6 Pair 2 C1 88.26 4 1.42 0.71 C2 77.21 4 8.08 4.04 Pair 3 P1 88.48 3 2.62 1.51 P3 86.66 3 3.16 1.82 K1: the mean of aggregated means of all factual knowledge domain LOCs in phase 1. K2: the mean of aggregated means of all factual knowledge domain LOCs in phase 3. C1: the mean of aggregated means of all cognitive knowledge domain LOCs in phase 1. C2: the mean of aggregated means of all cognitive knowledge domain LOCs in phase 3. P1: the mean of aggregated means of all psychomotor domain LOCs in phase 1. P3: the mean of aggregated means of all psychomotor domain LOCs in phase 3 Table 8. Paired Samples Test for means difference of means of all LOCs that serve factual knowledge, cognitive, and psychomotor domains in phase one and phase 3. Paired Differences t df Sig. (2-tailed) Mean difference Std. Deviation Std. Error Mean 95% Confidence Interval of the Difference Lower Upper Pair 1 K1- K2 14.89 9.31 4.16 3.32 26.45 3.58 4 0.023 Pair 2 C1 - C2 11.06 7.56 3.78 -0.98 23.09 2.92 3 0.061 Pair 3 P1 - P3 1.83 3.12 1.80 -5.93 9.59 1.01 2 0.418 K1: the mean of aggregated means of all factual knowledge domain LOCs in phase 1. K2: the mean of aggregated means of all factual knowledge domain LOCs in phase 3. C1: the mean of aggregated means of all cognitive knowledge domain LOCs in phase 1. C2: the mean of aggregated means of all cognitive knowledge domain LOCs in phase 3. P1: the mean of aggregated means of all psychomotor domain LOCs in phase 1. P3: the mean of aggregated means of all psychomotor domain LOCs in phase 3. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 14 Feb, 2025 Editor assigned by journal 14 Feb, 2025 Submission checks completed at journal 14 Feb, 2025 First submitted to journal 13 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6025698","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":415866205,"identity":"1edac1b1-9e49-4817-bcc0-60b1f3f05c24","order_by":0,"name":"Hamdi Almaramhy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYBACAwh1gIEfSB4GMRCChLRItpGsxeAYAwMzUVrMxQ4/+/Az507i5vvNDw8X1NxJbGBv3ibB8McOpxbL2WnGM3u3PUvcdozN4PCMY88SG3iOlUkwtiXjdtjtBGMG3m2HgVoYDA7zsB1ObJDIMZNgbGDGoyX9M+NfoJbNbewfDvP8A2qRf2MGdFg9Hi05xswgWzaw8Rgc5m0D2cID1MJ2GJ+WYmbZbYeNZxzLKTg8s++wcRtPWrFFYttxfA7bzPh222HZ/ubjmz8XfAMy2A9vvPHhTzVOLTDg2ABjsYGIBIIaGBjsiVAzCkbBKBgFIxUAAFMzYGmiAepvAAAAAElFTkSuQmCC","orcid":"","institution":"Taibah University","correspondingAuthor":true,"prefix":"","firstName":"Hamdi","middleName":"","lastName":"Almaramhy","suffix":""}],"badges":[],"createdAt":"2025-02-13 20:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6025698/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6025698/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76728653,"identity":"01287fc8-288c-471a-b38b-749be06001e4","added_by":"auto","created_at":"2025-02-20 06:03:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":293861,"visible":true,"origin":"","legend":"\u003cp\u003eA four-stage cycle conceptual framework to evaluate the course learning outcomes (CLOs)\u003c/p\u003e\n\u003cp\u003e*Adopted with modification from Goff et al., 2015. Learning Outcomes Assessment, A Practitioner's Handbook.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6025698/v1/3e80a89874e699e52167ed87.png"},{"id":76729752,"identity":"64f1443e-cd5e-4c2e-9514-23f2e09745e7","added_by":"auto","created_at":"2025-02-20 06:11:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1096332,"visible":true,"origin":"","legend":"\u003cp\u003ePhases and courses in our curriculum.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6025698/v1/186f55c09e7912f7876d85f8.png"},{"id":76728642,"identity":"622574e8-7f57-4dec-8a68-559d4551b028","added_by":"auto","created_at":"2025-02-20 06:03:39","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":200970,"visible":true,"origin":"","legend":"\u003cp\u003elevels of program learning outcomes achievement according to our program assessment committee.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6025698/v1/a36b8f7ebce5e0c2935384a4.png"},{"id":76729954,"identity":"101ec2a6-edd2-42c3-87f8-4ada6f925338","added_by":"auto","created_at":"2025-02-20 06:19:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3087009,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6025698/v1/0392a586-20ab-4a75-a8ef-6c6933497440.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMeasuring effectiveness of Integrating Basic Sciences with Clinical Practice through analysis of learning outcome achievement across curriculum phases; a comparative study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntegrating basic and clinical sciences in medical education presents several challenges that significantly impact students\u0026apos; learning experiences and their capacity to apply knowledge in clinical settings. These challenges arise from the medical curriculum\u0026apos;s design and the teaching methods employed, both of which may create gaps in effectively integrating theoretical knowledge and practical skills. The need for effective curriculum integration has become increasingly apparent as it offers potential benefits in enhancing student engagement, participation, and motivation. Integrated curricula, unlike traditional segmented teaching approaches, strive for a holistic understanding of the interconnectedness of various disciplines [1]. Despite its widespread adoption [2] and the theoretical benefits it offers, there remains a scarcity of direct empirical evidence evaluating the effectiveness of these integration strategies, particularly in preparing students to apply foundational knowledge in clinical scenarios.\u003c/p\u003e\n\u003cp\u003eKulasegaram et al. emphasized in their comprehensive literature review that assessing how learners apply basic science knowledge in clinical reasoning and skill performance is crucial for evaluating the efficacy of integration approaches [3]. A review of existing literature reveals a variety of assessment methodologies that indirectly indicate the effects of integration, such as specific pre- or post-class reflection questions [4], combined multiple-choice and essay questions that provide details of underlying processes for clinical scenario results [5], concept maps for assessing knowledge integration [6], long essays for evaluating knowledge integration in problem-based learning [7], and progress tests [8].\u003c/p\u003e\n\u003cp\u003eBiggs suggested that assessment methods in the curriculum should align with teaching methods to effectively measure learning outcomes [9]. Indeed, the assessment of program learning outcomes (PLOs) is a critical component of medical education, ensuring that graduates possess the necessary knowledge, skills, and competencies for effective medical practice.\u003c/p\u003e\n\u003cp\u003eWhile various methods have been employed to indirectly evaluate basic sciences integration in clinical settings, there is a scarcity of research utilizing summative assessment results to directly measure the achievement of PLOs. By using this assessment to reflect on the integration of basic science knowledge across preclinical and clinical phases, educational programs can bridge gaps in quality and effectiveness. Addressing this gap is crucial for ensuring the quality and effectiveness of medical education programs. Doing so provides educators with valuable insights into the extent to which foundational knowledge is effectively integrated and applied in clinical contexts. This information is vital for informing curricular revisions, enhancing teaching methods, and refining assessment practices, thereby better preparing future physicians for the demands of modern healthcare.\u003c/p\u003e\n\u003cp\u003eAligning with this perspective, our objective is to assess the achievement of PLOs through summative assessments as a direct approach to evaluate the integration of basic sciences within our curriculum. By comparing the achievement of PLOs between preclinical and clinical phases, we aim to gauge the extent to which basic sciences are effectively integrated and applied in clinical contexts.\u003c/p\u003e\n\u003cp\u003eTo rigorously assess these elements, this study will apply the conceptual framework developed by Goff et al., which outlines a four-stage process for evaluating course learning outcomes: establishing expectations, mapping assessment tasks, collecting and analyzing assessment results, and planning program improvements [10]. This framework will be enriched by alignment insights from Badawy et al. to evaluate the achievement of program learning outcomes if PLOs are well aligned with course learning outcomes (CLOs) [11]. Utilizing this conceptual framework allows for a detailed examination of the alignment between educational content administered throughout various phases of the medical curriculum and the consequent student performance as reflected in the achievement of PLOs. This analytical approach is vital for ensuring the effective transmission of foundational knowledge from the initial phase to the clinical phase.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study aims to investigate the extent to which summative assessment results measure the achievement of PLOs in medical education, focusing particularly on basic sciences-related PLOs. It seeks to quantify how achievement levels of basic science-related learning outcomes, as assessed by summative assessments, reflect the integration of basic science knowledge across preclinical and clinical phases of the medical curriculum.\u003c/p\u003e\n"},{"header":"Methods","content":"\u003cp\u003e\u003cu\u003eStudy Design\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe study utilized a quantitative comparative design to evaluate the effectiveness of a spiral curriculum and basic sciences integration across phases, focusing on PLOs achieved in phases one and three. By aligning exam components with CLOs, the research assessed knowledge and skills domains. This methodology is lauded for its precision and objectivity and employed rigorous statistical analysis to examine curriculum dynamics over time and groups.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eStudy Setting\u003c/u\u003e:\u003c/p\u003e\n\u003cp\u003eThe study was conducted at Taibah University\u0026apos;s College of Medicine in Madinah, Saudi Arabia. The curriculum is built on a five-year problem-based learning (PBL) framework divided into three phases. The early phase (years 1 and 2) focuses on fundamental sciences, with a 70:30 ratio favoring basic sciences. Phases two (years 3 and 4) and three (year 5) reverse the emphasis, focusing 70% on clinical sciences. Learners take five courses in phase one and six in phase three, with five clinical courses and one focused on research. Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCurriculum Assessment\u003c/u\u003e:\u003c/p\u003e\n\u003cp\u003eThe end-of-course assessment consists of multiple-choice questions (MCQs) and objective structured clinical examination (OSCE) stations. The program assessment committee (PAC) monitors assessment validity and reliability. Validation techniques for MCQs include determining content and face validity, as well as construct validity verification using check, item discrimination, and difficulty indices. Reliability coefficients ensure consistency. OSCE criterion validity is checked by comparing scores to averages, while consistency and inter-rater reliability ensure checklist validity by two evaluators.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cu\u003eData Collection and Measurement of PLOs:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe method included an in-depth review of course specifications, exam blueprints across phase 1 (year 1 and 2) and phase 3 (year 5), and overall program specifications to ensure compliance with Biggs\u0026apos; constructive alignment principles. Such an in-depth review ensured a robust foundation for data collection.\u003c/p\u003e\n\u003cp\u003eCentral to the methodology was identifying PLOs relevant to knowledge and skills domains, focusing on basic and clinical sciences integration, Table 1.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The precise achievement values for CLOs were calculated through direct assessment. This involved tagging MCQs to CLOs within the knowledge domain. Each CLO achievement value was derived from the average percentage of difficulty indices across pertinent MCQs, yielding a single percentage indicative of each knowledge-based course learning outcome\u0026apos;s achievement.\u003c/p\u003e\n\u003cp\u003eSkills-based CLOs employed results from OSCE stations, with station achievement values derived from class-wide average grades. If a skill CLO involved multiple stations, the average percentage across stations represented the outcome. The percentage values for CLO achievement were systematically gathered for courses in phases 1 and 3. This was reinforced by aligning all CLOs with appropriate PLOs of corresponding domains, facilitating curriculum effectiveness assessment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo objectively measure PLO achievement within the phases, the study averaged the percentage values of all CLOs aligned with each PLO. This procedure enabled distinct PLO percentage derivation for both phases. Aligning with standards set by the National Center for Academic Accreditation and Evaluation, PAC established a benchmark percentage for each PLO at 60% or above. Figure 3.\u003c/p\u003e\n\u003cp\u003eEffectiveness of basic sciences integration was assessed by comparing average percentage values (mean) for each PLO across knowledge and skills domains in phases 1 and 3. This comparison reflected the curriculum\u0026apos;s success in fostering effective integration across phases.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eProgram Intended Learning Outcomes that examine the integration of basic sciences with clinical one.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cu\u003eData Analysis\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using IBM SPSS Statistics (version 23), exploring the curriculum\u0026apos;s spiral design. This involved a comparative analysis of learning outcomes achievement across phases 1 and 3, focusing on identifying significant differences in the means of PLOs between these phases.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Statistical Testing\u003c/p\u003e\n\u003cp\u003eThe statistical analysis centered on paired t-tests to evaluate mean differences between dependent groups\u0026mdash;achievement levels in phases 1 and 3. A p-value under 0.05 was the threshold for statistical significance, with a 95% confidence interval guiding interpretation of mean differences observed between key phases.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAlignment of Program Learning Outcomes (PLOs) and Course Learning Outcomes (CLOs)\u003c/p\u003e\n\u003cp\u003eThe analysis of alignment between PLOs and CLOs within the medical curriculum across phases one and three addressed factual knowledge, cognitive knowledge, and psychomotor skills. Comprehensive assessments were conducted, showcasing PLOs achievement post-alignment with CLOs.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eData Normality\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAn initial assessment verified data normality to confirm parametric tests\u0026apos; appropriateness. Skewness and kurtosis values within the range of \u0026minus;2 to +2 affirmed normal data distribution.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cu\u003eAchievement of Program Learning Outcomes\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eIn phase one, all 12 PLOs concerning basic sciences integration with clinical knowledge achieved 70% or higher. Conversely, phase three revealed PLOs 1.1, 1.3, 1.4, and 1.5 did not meet comparable achievement levels, indicating potential integration issues. Notably, PLO 1.4\u0026mdash;focused on understanding diseases and their environmental and social determinants\u0026mdash;consistently underachieved across phase three.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cu\u003eMean Achievement Values and Domain Analysis\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003ePhase one exhibited high achievement levels in factual knowledge (83.75%), cognitive knowledge (82.34%), and psychomotor skills (83.88%). In contrast, phase three witnessed a focus shift towards practical skills, with decreased factual (59.87%) and cognitive knowledge (74.08%), while maintaining high psychomotor skills (79.34% ,peaking 83.56%).\u003c/p\u003e\n\n\u003cp\u003eTable 2.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Mean Achievement Percentages of PLOs Aligned with CLOs in Phases 1 and 3 by Domain.\u003c/p\u003e\n\n\u003cp\u003eTable 3.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Paired Samples Descriptive Statistics of the LOCs Achievement (Mean) in Phases 1 \u0026amp; 3.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eStatistical Analysis of Learning Outcomes by Domain\u003c/u\u003e:\u003c/p\u003e\n\u003cp\u003e- Factual Knowledge: Significant differences were observed in mean achievement for PLOs 1.1, 1.3, 1.4, and 1.5 between phases 1 and 3 (p \u0026lt; 0.05), except for PLO 1.2.\u003c/p\u003e\n\u003cp\u003e- Cognitive Knowledge: Significant differences between phases for PLOs 2.2 and 2.3 (p = 0.002 and 0.014) suggest inadequate integration in advanced courses, notably in medicine, surgery, and child health.\u003c/p\u003e\n\u003cp\u003e- Psychomotor Skills: No significant differences in mean scores for psychomotor PLOs between phases were observed.\u003c/p\u003e\n\n\u003cp\u003eTable 4.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Paired sample t-test of means difference for factual knowledge PLOs in phases 1 \u0026amp; 3\u003c/p\u003e\n\n\u003cp\u003eTable 5.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Paired sample t-test results and mean differences for cognitive knowledge domain PLOs between phases 1 and 3.\u003c/p\u003e\n\n\u003cp\u003eTable 6.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePaired sample t-test for means difference for Psychomotor PLOs in phases 1 \u0026amp; 3\u003c/p\u003e\n\n\n\n\u003cp\u003eOverall, Domain Comparison:\u003c/p\u003e\n\u003cp\u003eThe aggregated mean differences for each domain\u0026apos;s PLOs highlighted significant differences in factual knowledge between phases 1 and 3 (p \u0026lt; 0.023), while cognitive and psychomotor domains did not exhibit significant variances. tables 7\u0026amp;8.\u003c/p\u003e\n\u003cp\u003eTable 7.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePaired Samples Statistics for means of means of all LOCs serving factual, cognitive, and psychomotor domains in phase one and phase 3\u003c/p\u003e\n\n\u003cp\u003eTable 8.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePaired Samples Test for means difference of means of all LOCs serving factual, cognitive, and psychomotor domains in phase one and phase 3.\u003c/p\u003e\n"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to evaluate basic sciences integration into the clinical phase of the spirally integrated medical curriculum at Taibah University\u0026apos;s College of Medicine. The study evaluated the attainment of PLOs by measuring factual, cognitive, and psychomotor domains throughout two critical curricular phases using summative assessment data. Results show a notable difference in the accomplishment of some PLOs between clinically oriented Phase 3 and foundational Phase 1, especially in factual knowledge acquisition (PLOs 1.1, 1.3, 1.4, 1.5).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Phase 1 showed complete accomplishment of all twelve basic sciences-related PLOs, indicating strong foundational knowledge. However, Phase 3 exhibited a decline in factual knowledge achievement. This pattern was less pronounced in the cognitive domain, with lower accomplishment in Phase 3, particularly for PLO 2.2 and 2.3. This observation highlights challenges in applying prior knowledge to clinical reasoning processes, emphasizing the critical role of pre-existing knowledge in improving diagnostic reasoning capabilities.\u003c/p\u003e\n\u003cp\u003eConsistent with the perspective recognizing knowledge as foundational in medical expertise development [12], our analysis of psychomotor domains revealed no significant performance differences between academic stages, suggesting uniform clinical skills development facilitated by the curriculum. This consistency aligns with findings by Gordon et al., who observed that stable, continuous exposure to clinically oriented tasks enhances practical skills essential for practice [13]. Similarly, Kerdijk et al. found that longitudinal structures support incremental acquisition of complex clinical competencies [12]. Structured, clinical environments foster self-regulated learning, enabling students to refine skills, imperative for adept medical professionals. Our findings, however, indicate a gap leading to missed opportunities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe program-level analysis showed significant differences in LOs addressing factual knowledge, cognitive knowledge, and psychomotor domains between phases, notably factual knowledge (p\u0026lt;0.05), less so in cognitive domains (p = 0.06). This pattern emphasizes knowledge\u0026apos;s influence on cognition and reasoning abilities, alongside diagnostic reasoning facilitating information retrieval from sources like patient scenarios [14, 15]. Cognitive psychology research shows regular rehearsal during learning improves memory retention, affecting decision-making processes [16, 17].\u003c/p\u003e\n\u003cp\u003eIdentified shortcomings necessitate rigorous revision of basic sciences integration in the clinical phase, necessitating in-depth discussion with students and tutors to identify and close integration gaps. CLO-PLO mapping facilitates a PLO assessment rubric developed through aligning CLO assessments to appropriate PLOs, providing a clear, solid PLO assessment plan [10, 18].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur work attempted to objectively assess PLO accomplishment using summative assessment data, reflecting basic sciences\u0026apos; integration into the clinical phase\u0026mdash;a novel approach given no similar metrics in the literature review. Debate on grading efficacy to assess student achievements and learning outcomes reflects varying opinions. Yorke criticizes grading susceptibility to socio-cultural biases [19], while Caspersen et al. argue exams and grades as primary tools for evaluating student learning outcomes, emphasizing aggregate results can reflect program effectiveness if aligned with desired outcomes [20].\u003c/p\u003e\n\u003cp\u003eLimitations\u003c/p\u003e\n\u003cp\u003eWe recognize limitations, which, if addressed, might broaden future research depth and scope. Focus on a single institution reduces external validity and applicability. Future research should cover broader settings to improve findings\u0026apos; generalizability. Generalizability is also limited by a small exam result sample from a specific cohort. Expanding the sample to include many batches over the curriculum will reduce confounding effects and improve validity [21,22]. Evaluating program learning outcomes using year-end summative exams may jeopardize internal validity due to external variables\u0026apos; influence and MCQ question limitations. Diverse evaluation techniques offer a more complete picture. Relying on quantitative analysis limits insights into factor relationships and generalizability. Adding qualitative methodologies like questionnaires and focus groups helps comprehend and validate quantitative results [23].\u003c/p\u003e\n\u003cp\u003eFuture research should deepen insights into medical education and curricular effectiveness by addressing current study limitations through methodological changes. Extending the research period to include multiple student cohorts over three to four years can improve summative assessment score reliability and validity for evaluating learning outcomes. Adding a qualitative component is recommended to provide deeper insights into curriculum integration effectiveness, offering a comprehensive context understanding and corroborating quantitative findings. Including student and tutor perspectives enriches studies holistically.\u003c/p\u003e\n\u003cp\u003eThe study underscores how balanced curriculum designs integrating basic sciences and clinical skills enhance graduates\u0026apos; proficiency in theoretical applications and practice. This involves developing structures reiterating basic sciences throughout all phases, contextually linking them to clinical practice. Assessment practices should evolve to include tools accurately assessing integration. Faculty development is crucial, necessitating interdisciplinary training and collaboration. Continuous evaluation ensures curriculum relevance and effectiveness alongside scientific and healthcare advancements. Engaging stakeholders in curriculum development aligns it with demands and diverse perspectives. Collectively, these steps advocate revising medical education holistically, creating a curriculum that imparts knowledge and prepares students for practice, thereby improving training and healthcare outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWhile the spirally integrated curriculum has the potential to facilitate learning across domains, challenges persist in adequately integrating basic science knowledge into clinical settings. Addressing these gaps is crucial for enhancing reasoning and delivering a comprehensive learning experience. Our findings contribute to the larger discussion concerning curriculum effectiveness in medical education, offering a framework for future research aimed at improving teaching techniques and outcomes.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have not received any financial support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHamdi Almaramhy participated in study design collecting the data , performed formal analysis and calculation ,and wrote the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Cees Vleuten participated in the study design and in reviewing \u0026nbsp;and editing the manuscript .\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All authors approved the final version of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to:\u003c/p\u003e\n\u003cp\u003eCees van der Vleuten.\u003c/p\u003e\n\u003cp\u003eEmail : [email protected].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adhered to the Declaration of Helsinki. The data were not specifically gathered for the purpose of this study but were used from our existing regular database of test achievements\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eThe need for consent to participate was waived by the Ethics Committee of Taibah university college of medicine (IORG0008716 \u0026ndash; IRB00010413).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of data availability\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eThe datasets used in the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDrake SM, Reid J. Integrated curriculum: Increasing relevance while maintaining accountability. Research Monograph 28. The Literacy and Numeracy Secretariat; 2010.\u003c/li\u003e\n\u003cli\u003eHarden RM, Stamper N. What is a spiral curriculum? Med Teach. 1999;21(2):141\u0026ndash;143.\u003c/li\u003e\n\u003cli\u003eKulasegaram KM, Martimianakis MA, Mylopoulos M, Whitehead CR, Woods NN. Cognition before curriculum. Acad Med. 2013;88(10):1578\u0026ndash;1585.\u003c/li\u003e\n\u003cli\u003eGoldman E, Schroth WS. Perspective: Deconstructing integration: A framework for the rational application of integration as a guiding curricular strategy. Acad Med. 2012;87(6):729\u0026ndash;734.\u003c/li\u003e\n\u003cli\u003eBierer SB, Dannefer EF, Taylor C, Hall P, Hull AL. Methods to assess students\u0026apos; acquisition, application, and integration of basic science knowledge in an innovative competency-based curriculum. Med Teach. 2008;30(7):171\u0026ndash;177.\u003c/li\u003e\n\u003cli\u003eMcGaghie WC, McCrimmon DR, Mitchell G, Thompson JA, Ravitch MM. Quantitative concept mapping in pulmonary physiology: Comparison of student and faculty knowledge structures. Adv Physiol Educ. 2000;23(1):S72.\u003c/li\u003e\n\u003cli\u003eFerguson KJ. Beyond multiple-choice questions: Using case-based learning patient questions to assess clinical reasoning. Med Educ. 2006;40(11):1143\u0026ndash;1144.\u003c/li\u003e\n\u003cli\u003eWrigley W, Van Der Vleuten CPM, Freeman A, Muijtjens A. A systemic framework for the progress test: Strengths, constraints, and issues: AMEE Guide No. 71. Med Teach. 2012;34(9):683\u0026ndash;697.\u003c/li\u003e\n\u003cli\u003eBiggs J. Enhancing teaching through constructive alignment. High Educ. 1996;32(3):347\u0026ndash;364.\u003c/li\u003e\n\u003cli\u003eGoff L, Potter MK, Pierre E, Carey T, Gullage A, Kustra E, et al. Learning outcomes assessment: A practitioner\u0026apos;s handbook. 2015.\u003c/li\u003e\n\u003cli\u003eBadawy M, Abd El-Aziz A, Hefny H. Exploring and measuring the key performance indicators in higher education institutions. Int J Intell Comput Inf Sci. 2018;18(1):37\u0026ndash;47.\u003c/li\u003e\n\u003cli\u003eKerdijk W, Snoek JW, van Hell EA, Cohen-Schotanus J. The effect of implementing undergraduate competency-based medical education on students\u0026rsquo; knowledge acquisition, clinical performance and perceived preparedness for practice: a comparative study. BMC Med Educ. 2013;13:1\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eGordon J, Hazlett C, Ten Cate O, Mann K, Kilminster S, Prince K, et al. Strategic planning in medical education: enhancing cultural and organizational climates. Med Educ. 2000;34(2):135\u0026ndash;144.\u003c/li\u003e\n\u003cli\u003eBrauer DG, Ferguson KJ. The integrated curriculum in medical education: AMEE guide no. 96. Med Teach. 2015;37(4):312\u0026ndash;322.\u003c/li\u003e\n\u003cli\u003eWoods NN, Brooks LR, Norman GR. It all makes sense: Biomedical knowledge, causal connections and memory in the novice diagnostician. Adv Health Sci Educ. 2007;12:405\u0026ndash;415.\u003c/li\u003e\n\u003cli\u003eCraik FI, Lockhart RS. Levels of processing: A framework for memory research. J Verbal Learn Verbal Behav. 1972;11(6):671\u0026ndash;684.\u003c/li\u003e\n\u003cli\u003eEbbinghaus H. Memory: A Contribution to Experimental Psychology. Dover Publications; 1885.\u003c/li\u003e\n\u003cli\u003eMahzari M, AlNahedh T, Ahmed AA, Al Rumyyan A, Shaban S, Magzoub ME. Practical Guide to Undergraduate Medical Curriculum Alignment and Mapping. Adv Med Educ Pract. 2023;14:1001\u0026ndash;1012.\u003c/li\u003e\n\u003cli\u003eYorke M. Summative assessment: Dealing with the \u0026lsquo;measurement fallacy.\u0026rsquo; Stud High Educ. 2011;36(3):251\u0026ndash;273.\u003c/li\u003e\n\u003cli\u003eCaspersen J, Smeby JC, Aamodt PO. Measuring learning outcomes. Eur J Educ. 2017;52(1):20\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eHanley JA, Moodie EE. Sample size, precision and power calculations: a unified approach. J Biomet Biostat. 2011;2(124):1\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eSpringate SD. The effect of sample size and bias on the reliability of estimates of error: a comparative study of Dahlberg\u0026apos;s formula. Eur J Orthod. 2012;34(2):158\u0026ndash;163.\u003c/li\u003e\n\u003cli\u003eAustin Z, Sutton J. Qualitative research: Getting started. Can J Hosp Pharm. 2014;67(6):436\u0026ndash;440. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eProgram Intended Learning Outcomes that examine the integration of basic sciences with clinical one:\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4659%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1. Knowledge (Lower Cognitive Function):\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79.5341%;\"\u003e\n \u003cp\u003e1.1. Demonstrate knowledge and understanding of the sciences basic to medicine in terms of the major body systems\u0026apos; typical structure and function and how they interrelate.\u003c/p\u003e\n \u003cp\u003e1.2 Identify the principles of scientific methodology in both investigation and research.\u003c/p\u003e\n \u003cp\u003e1.3. Discuss behavior and relationships between individuals and their families and society.\u003c/p\u003e\n \u003cp\u003e1.4. Describe diseases, including environmental and social determinants, and how they may spread.\u003c/p\u003e\n \u003cp\u003e1.5. Discuss therapy, including the actions of drugs and underlying pharmacological principles\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4659%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2. Cognitive Skills (Higher Cognitive function)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79.5341%;\"\u003e\n \u003cp\u003e2.1 Apply to medical practice biomedical scientific principles, method and knowledge relating to: anatomy, biochemistry, cell biology, genetics, immunology, microbiology, molecular biology, nutrition, pathology, pharmacology and physiology.\u003c/p\u003e\n \u003cp\u003e2.2 Demonstrate the ability to solve clinical problems by evaluation and critical review of evidence, and the integration of knowledge across a range of subjects and make clinical decisions based on evidence and findings.\u003c/p\u003e\n \u003cp\u003e2.3. Formulate a differential diagnosis based on sound ability to define a patient\u0026apos;s problem and interpret findings from the history, physical examination, and mental state examination.\u003c/p\u003e\n \u003cp\u003e2.4. Formulate and justify a plan for treatment, management (including selecting and interpreting appropriate investigations), and prevention for common clinical problems.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4659%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5. Psychomotor (skills):\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79.5341%;\"\u003e\n \u003cp\u003e5.1. Take and record a structured, patient centered clinical history in an appropriate manner.\u003c/p\u003e\n \u003cp\u003e5.2. Undertake a relevant, systematic, physical, and mental state examination.\u003c/p\u003e\n \u003cp\u003e5.4. Perform safely and effectively a range of diagnostic and therapeutic practical procedures (as listed in the program competency list), including drug prescribing, and administering.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMean percentage values representing the degree of achievement of program learning outcomes (PLOs) after they had Aligned with course learning outcomes (CLOs) in phases 1 and 3, with PLOs categorized into the domains of factual knowledge, cognitive knowledge, and psychomotor skills.\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"711\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eProgram learning outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Factual knowledge\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Cognitive knowledge \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; psychomotor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eCourses\u003c/p\u003e\n \u003cp\u003eLOs in phase 1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eC1EMFS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e80.36\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e77.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e83.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e76.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e85.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e85.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e80.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e88.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e83.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e83.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e79.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e80.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eC2LC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e86.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e66.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e81.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e89.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e78.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e81.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e87.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e81.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e89.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e86.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e91.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e82.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eC3CRF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e85.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e59.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e80.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e86.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e84.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e75.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e85.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e88.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e86.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e76.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e76.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e83.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eC4MM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e79.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e77.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e82.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e82.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e85.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e89.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e73.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e73.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e86.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eC5NM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e84.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e82.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e83.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e84.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e86.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e83.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e86.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e81.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45px;\"\u003e\n \u003cp\u003e75.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e73.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;Average degree of achievement\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e83.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e66.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e82.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e83.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e82.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e82.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e84.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e86.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e82.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e83.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e79.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e81.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eCourses LOs in phase 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eC1 Med\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e59.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e61.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e46.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e51.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e68.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e64.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e37.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e56.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e59.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e81.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e82.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e81.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eC2 Surg.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e53.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e69.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e46.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e54.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e62.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e77.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e58.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e46.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e62.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e76.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e88.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e88.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eC3 EM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e74.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e63.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e72.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e56.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e71.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e80.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e50.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e82.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e71.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e79.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e79.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e78.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eC4 WH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e57.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e75.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e51.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e49.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e59.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e75.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e59.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e57.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e80.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e76.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e80.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e80.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eC5 CH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e54.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e77.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e72.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e54.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e55.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e72.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e65.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e70.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e80.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e83.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e84.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e80.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eAverage degree of\u003c/p\u003e\n \u003cp\u003eachievement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e59.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e67.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e57.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e53.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e63.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e74.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e54.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e62.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e70.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e79.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e83.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e81.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;*The numbers in the table represent the percentage of achievement based on the calculated mean of the student scores in the summative assessment.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePaired Samples Descriptive Statistics of the LOCs achievement (mean) in phases 1\u0026amp;3.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"657\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003eSkewness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eKurtosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 54px;\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003eStd. Error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003eStd. Error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003eStd. Error\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP1 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e79.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e86.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e83.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-2.919\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP1 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e49.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e81.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e66.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e5.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e12.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-1.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP1 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e80.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e85.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e82.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP1 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e78.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e85.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e83.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-1.469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP1 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e76.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e89.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e82.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e5.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-2.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP1 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e75.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e86.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e82.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e4.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-1.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP1 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e80.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e87.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e84.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e11111111111.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e2.000 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP1 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e81.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e89.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e86.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-1.509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP1 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e73.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e89.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e82.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-.803\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP1 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e76.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e87.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e83.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e4.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-1.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e3.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP1 5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e73.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e91.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e79.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e3.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e7.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e3.290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP1 5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e73.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e86.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e81.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e4.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP3 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e53.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e74.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e59.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e8.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.826\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e3.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP3 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e61.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e77.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e69.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e7.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-2.382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP3 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e46.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e72.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e57.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e6.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e13.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-3.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e49.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e56.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e53.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.498\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-1.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP3 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e55.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e71.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e63.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-1.530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP3 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e64.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e80.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e74.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-1.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP3 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e37.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e65.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e54.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-1.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e.922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP3 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e46.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e82.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e62.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e6.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e14.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-.517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP3 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e59.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e80.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e70.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e4.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-2.772\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP3 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e76.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e83.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e79.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e-2.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP3 5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e79.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e88.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e83.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e.622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eP3 5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e78.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e88.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e81.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.871\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e3.847\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eValid N (listwise)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;P1= phase 1 learning outcomes\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eP3= phase 2 learning outcomes\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 4.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePaired sample t-test of means difference for factual knowledge PLOs in phases 1 \u0026amp;3.\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"654\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003ePaired Differences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eStd. Error Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e95% Confidence Interval of the Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003ePair 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eP1 1.1 P3 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e23.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e8.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e12.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e34.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003ePair 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eP1 1.2 P3 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e15.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e-21.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e16.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.717\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003ePair 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eP1 1.3 P3 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e24.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e14.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e42.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3.858\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003ePair 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eP1 1.4 P3 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e29.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e24.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e34.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e16.979\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003ePair 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eP1 1.5 P3 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e19.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e8.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e29.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e- P1: Phase one program learning outcomes.\u003c/p\u003e\n\u003cp\u003e-. P3: Phase two program learning outcomes.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 5.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePaired sample t-test results and mean differences for the cognitive knowledge domain PLOs between phases 1 and 3.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 382px;\"\u003e\n \u003cp\u003ePaired Differences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eStd. Error Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e95% Confidence Interval of the Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003ePair 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eP1 \u0026nbsp; \u0026nbsp; 2.1 \u0026nbsp;P3 \u0026nbsp; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e-4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e20.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1.849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003ePair 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eP1 \u0026nbsp; \u0026nbsp; 2.2 \u0026nbsp;P3 \u0026nbsp; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e19.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e41.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e7.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003ePair 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eP1 \u0026nbsp; \u0026nbsp; 2.3 P3 \u0026nbsp; 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e24.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e12.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e5.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e8.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e39.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003ePair 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eP1 \u0026nbsp; \u0026nbsp; 2.4 P3 \u0026nbsp; \u0026nbsp;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e12.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e14.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e6.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e-6.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e30.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;-. P1: Phase one program learning outcomes.\u003c/p\u003e\n\u003cp\u003e-. P3: Phase two program learning outcomes.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 6.\u003c/p\u003e\n\u003cp\u003ePaired sample t-test for Means difference for Psychomotor PLOs in phases 1 \u0026amp;3.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"628\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003ePaired Differences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eStd. Error Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e95% Confidence Interval of the Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003ePair 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eP1 \u0026nbsp;5.1 \u0026nbsp;P3 \u0026nbsp; \u0026nbsp; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-12.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e39.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e17.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-60.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e36.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-.699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.523\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003ePair 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eP1 \u0026nbsp;5.2 \u0026nbsp;P3 \u0026nbsp; \u0026nbsp; 5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-19.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e35.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e15.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-63.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e24.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-1.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;0.286\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003ePair 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eP1 \u0026nbsp;5.4 P3 \u0026nbsp;5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-33.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e47.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e21.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-92.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e25.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-1.570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e-.\u0026nbsp; P1: Phase one program learning outcomes.\u003c/p\u003e\n\u003cp\u003e-. P3: Phase two program learning outcomes.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 7\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePaired Samples Statistics for means of means of all LOCs that serve factual knowledge, cognitive, and psychomotor domains in phase one and phase 3.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"566\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eStd. Error Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003ePair 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eK1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e85.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eK2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e70.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e8.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003ePair 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eC1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e88.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eC2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e77.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e8.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e4.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003ePair 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e88.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e86.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;K1: the mean of aggregated means of all factual knowledge domain LOCs in phase 1.\u003c/p\u003e\n\u003cp\u003eK2: the mean of aggregated means of all factual knowledge domain LOCs in phase 3.\u003c/p\u003e\n\u003cp\u003eC1: the mean of aggregated means of all cognitive knowledge domain LOCs in phase 1.\u003c/p\u003e\n\u003cp\u003eC2: the mean of aggregated means of all cognitive knowledge domain LOCs in phase 3.\u003c/p\u003e\n\u003cp\u003eP1: the mean of aggregated means of all psychomotor domain LOCs in phase 1.\u003c/p\u003e\n\u003cp\u003eP3: the mean of aggregated means of all psychomotor domain LOCs in phase 3\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 8.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePaired Samples Test for means difference of means of all LOCs that serve factual knowledge, cognitive, and psychomotor domains in phase one and phase 3.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"632\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"3\" valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"bottom\" style=\"width: 390px;\"\u003e\n \u003cp\u003ePaired Differences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003eStd. Error Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 158px;\"\u003e\n \u003cp\u003e95% Confidence Interval of the Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePair 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; K1- K2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e14.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e9.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e4.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e3.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e26.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e3.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePair 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eC1 - C2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e11.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e7.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e-0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e23.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e2.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003ePair 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003eP1 - P3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e3.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e-5.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e9.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;K1: the mean of aggregated means of all factual knowledge domain LOCs in phase 1.\u003c/p\u003e\n\u003cp\u003eK2: the mean of aggregated means of all factual knowledge domain LOCs in phase 3.\u003c/p\u003e\n\u003cp\u003eC1: the mean of aggregated means of all cognitive knowledge domain LOCs in phase 1.\u003c/p\u003e\n\u003cp\u003eC2: the mean of aggregated means of all cognitive knowledge domain LOCs in phase 3.\u003c/p\u003e\n\u003cp\u003eP1: the mean of aggregated means of all psychomotor domain LOCs in phase 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eP3: the mean of aggregated means of all psychomotor domain LOCs in phase 3.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"integrated curriculum, curriculum evaluation, program learning outcomes, medical education","lastPublishedDoi":"10.21203/rs.3.rs-6025698/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6025698/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Effective integration of basic and clinical sciences is pivotal in medical education, influencing students’ ability to apply knowledge in clinical settings. This study evaluates the integration efficiency of basic sciences in differing phases of a spirally integrated curriculum through the lens of program learning outcomes (PLOs).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: \u0026nbsp;A quantitative comparative analysis was conducted across phases 1 (years 1 and 2) and 3 (year 5) of a medical curriculum. Data were collected from summative assessments, with Multiple-Choice Questions (MCQs) assessing knowledge and Objective Structured Clinical Examinations (OSCEs) assessing psychomotor skills. Achievements of course learning outcomes (CLOs) were quantified as percentages and correlated to PLOs. Statistical evaluation was performed using paired t-tests, setting significance at p \u0026lt; 0.05.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Phase 1 demonstrated successful attainment of all 12 PLOs, with achievement percentages ranging from 70-80% or higher. In contrast, phase 3 revealed lower achievement levels in specific PLOs, notably PLO 1.4. Significant disparities in mean achievements for factual knowledge PLOs (except PLO 1.2) and cognitive PLOs 2.2 and 2.3 were observed between the two phases. No significant differences were noted in psychomotor PLOs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: The study highlights challenges in effectively integrating basic sciences within the clinical components of the curriculum, despite its structural advantages. These findings advocate for refined integration strategies to bolster clinical reasoning and educational efficacy, contributing substantively to discussions on enhancing medical education practices and suggesting directions for future research. \u0026nbsp;\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Measuring effectiveness of Integrating Basic Sciences with Clinical Practice through analysis of learning outcome achievement across curriculum phases; a comparative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-20 05:47:35","doi":"10.21203/rs.3.rs-6025698/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-14T13:30:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-02-14T13:17:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-02-14T11:56:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-02-13T19:59:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f071f6f7-706e-4fc3-b34f-d113d3b860ca","owner":[],"postedDate":"February 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T15:09:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-20 05:47:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6025698","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6025698","identity":"rs-6025698","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}