highly significantp < 0.001
Substantial improvements in theoretical knowledge were observed across all domains From T1 to T2, participants showed highly significant gains in overall test performance (mean score increase: +36.3%, p < 0.001, d = − 4.1), with particularly large effects in the categories “normal findings” (d = − 5.2, p < 0.001), “ultrasound basics” (d = − 2.1, p < 0.001), “assignment task” (d= -1.8, p < 0.001), and “pathologies” (d = − 1.3, p < 0.001).