Triangulating curriculum gaps in radiological sciences education: a longitudinal multi-source analysis of blueprint alignment, student performance, and national licensure outcomes

Curriculum alignment with national licensure examinations is a foundational quality indicator in health professions education. For radiological sciences programs, gaps between taught content and examination blueprints can directly suppress graduate pass rates. Most published gap analyses rely on a single evidence source, typically curriculum mapping alone, which cannot confirm whether a curriculum gap has translated into a genuine performance deficit. This study introduces a three-source triangulation framework combining curriculum mapping, longitudinal student marks, and verified licensure examination outcomes to produce a more robust and actionable gap evidence base. A retrospective longitudinal analysis was conducted in the Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University. The curriculum (135 credit hours, 33 courses) was mapped against the Saudi Radiologic Technologist Licensure Examination (SRTLE) eleven-section blueprint. Course-level performance data (14,203 student-course records across 14 semesters, 1441–1447 Hijri) were aggregated to the domain level and compared with the program mean. Official SRTLE outcomes for 202 KSU graduates (2023–2025) were integrated as a third evidence source. A weighted coverage ratio was calculated for each blueprint section and gap classifications were assigned using a novel three-tier risk typology: coverage gap, recognition gap, and borderline. The computed tomography (CT) domain had the lowest curriculum coverage ratio (0.74) and the lowest domain average mark (84.82%, − 1.54% points below the program mean of 86.36%). CT Techniques (RAD 472) declined from 86.46% in 1445-S2 to 68.30% in 1446-S2 and 76.92% in 1447-S1. A gender performance gap of 4–5% points (male versus female students) was observed across CT, magnetic resonance imaging (MRI), and ultrasound courses. SRTLE pass rates were 88.89% in 2023, 76.00% in 2024, and 87.95% in 2025, with the 2024 cohort — which partially overlapped with the CT performance decline — achieving the narrowest score margin above the passing cutoff (+ 30 points above 550/1000). CT was classified as the strongest convergent evidence. Angio and fluoroscopy were classified as dual-confirmed recognition gaps owing to the absence of dedicated standalone courses. Triangulating three independent evidence sources identified CT as the domain with the strongest convergent evidence across all three sources, with a below-threshold coverage ratio, the lowest domain student performance, and a temporal programme-level association with SRTLE outcome deterioration (Source 3 is corroborative only). The proposed three-source framework offers a replicable methodology for continuous curriculum quality assurance in health professions education programs that are regulated by national licensure examinations.