highly significantP < .0001
There was a highly significant progression towards more complexity, with lower Bloom's scores in Cycle 1 relative to Cycle 2 (mean difference = 0.42, Wilcoxon rank sum test W = 2044567, P < .0001), and lower in Cycle 2 compared to Cycle 3 (mean difference = 0.84, W = 120920, P < .0001).