The mean scores of each student on knowledge test and skill performance were computed and used as a dependent variable, whereas “modes of instruction” (web-based education, web-enhanced learning and in class-instruction) were considered as independent variables. Since the data were not normally distributed, differences between the scores of the experimental and control groups were analyzed using the Mann–Whitney U test. Data of the experimental group regarding the web-based education and web-enhanced education were analyzed using the Wilcoxon signed rank test. Inter-rater reliability between observers
was assessed using Cohen's kappa coefficient. A p value of 0.05 was set for statistical significance.