Fig. 4

Item analysis and summative scores. Cardiovascular physiology knowledge was assessed by the summative exam of 61 multiple-choice questions with single best answers, consisting of 45 lecture-pertinent questions and 16 items of the 2D-integrative-class–relevant questions. a Difficulty index and b discrimination index of the summative exam are presented as a proportion of the questions to the total number in that category. c Students’ summative scores are categorised by student performance tertiles of the overall physiological exam score, test-centred acceptability index (AI), and question category (lecture-pertinent or 2D-integrative-class–relevant learning method). Box-and-whisker plot presents the Tukey method of which boxes indicate interquartile range (IQR), whiskers indicate 1.5 times IQR, lines in the box indicate the median, and plus signs in the box indicate the mean. Blank dots indicate individual scores higher than the upper whisker or lower than the lower whisker. Letters and symbols indicate statistical significance: A (acceptability index), Q (question category), P (students’ performance tertile), A×P (interaction of A and P), A×Q (interaction of A and Q), A×Q×P (interaction of A, Q, and P), and * (difference from the other subgroups by post-hoc Tukey test)