Mediation Analysis of Academic Performance Between Self-Efficacy in STEM Health Studies and Basic Clinical Competence

Mediation Analysis of Academic Performance Between Self-Efficacy in STEM Health Studies and Basic Clinical Competence

John Paul A. Reponte, Edna A. Cenita

Basic Education Department, Cor Jesu College, Inc, Philippines

DOI: https://dx.doi.org/10.47772/IJRISS.2025.90600090

Received: 04 May 2025; Accepted: 16 May 2025; Published: 01 July 2025

ABSTRACT

Curriculum modification has become vital in educational research, addressing students’ diverse and evolving needs in content knowledge and skill development. Revising existing general curricula has proven effective in creating more accessible learning environments that support students and educators across various contexts. This study investigates the mediating effect of academic performance in supplementary subjects on the relationship between students’ self-efficacy in the STEM curriculum under Health Studies and their basic clinical competence. Specifically, the study aims to assess self-efficacy, academic performance, and clinical competence levels and determine whether academic performance mediates the relationship between self-efficacy and clinical competence through mediation analysis. The respondents consisted of 12th-grade students from a private institution in Davao Region. Data were collected via validated survey questionnaires and academic records from the school registrar. Statistical analyses, including a series of regression tests, were conducted to examine correlations among the variables. Results indicate significant but low positive correlations between self-efficacy and clinical competence (r = .223), self-efficacy and academic performance (r = 0.250), and academic performance and clinical competence (r = 0.181). Mediation analysis using the Sobel test revealed that academic performance positively mediates the relationship between self-efficacy and clinical competence. These findings contribute to a deeper understanding of how academic factors influence the development of clinical competence and self-efficacy among students in modified STEM Health Studies curricula.

Keywords: self-efficacy, academic performance, clinical competence, STEM education, health studies, senior high school, Philippines

INTRODUCTION

Curriculum modification has emerged as a critical area of education research, addressing students’ diverse and evolving needs in both content and skills. Modifying the existing general curricula has proven to be an effective strategy for creating more accessible learning environments that support all students and teachers in various educational contexts. Modifications involve substantive adjustments to the curriculum, conceptual difficulty, academic goals, and instructional strategies, making the curriculum more tailored to meet local and global standards and prepare students for higher education, work, or business.

In Australia, Kaur et al. (2023) highlighted the importance of curriculum modification by introducing the concept of the Einstein-First project in the science curriculum. The project aims to address the gap between the science in schools that are more likely based on the 20th century and modern science by integrating the concepts of Einsteinian physics in primary and secondary (years 3-10) levels. Additionally, another research has concluded in the United States that redesigning the curriculum by choosing relevant topics, defining the skills needed by the students, setting clear learning goals, and using appropriate teaching methods ensures students’ learning and skills development required for the fast-developing industries (Goorney et al., 2023).

In some private schools in the Philippines, the senior high school curriculum is modified to better prepare students with advanced learning and skills necessary for higher education or work. According to DepEd Order No. 88 s. 2010, as stated in section 4, paragraph 13, academic freedom shall be enjoyed in all institutions of higher learning. Furthermore, in section 9, paragraph 1 in the same DepEd Order, curriculum programs are designed to be inspiring patterns and models to guide field workers and teachers. These can be adapted, supplemented, or modified to the learners’ needs and the school’s conditions, provided that the Department of Education approves any radical deviation from the established subjects and curricula.

In the local context, a private catholic school in Davao del Sur offers a modified STEM curriculum in senior high school. The school aims to provide excellent education and training and equip the students with the skills necessary for work immersion and in college. One of the programs in the modified STEM curriculum is Health Studies. In this program, students are exposed to a more focused learning process and environment to gain advanced knowledge and concepts and develop basic clinical competence through the addition of pre-medical subjects in the curriculum and exposure to hospitals and clinics during work immersion.

Health studies education is an academic field that focuses on studying health-related concepts and prepares students for careers in the healthcare sector. According to the report of JBI (2023), the shortage of registered nurses and other medical practitioners has emerged as a global concern in the healthcare industry, affecting the quality and accessibility of healthcare services. Flaubert et al. (2021) highlighted the lack of emphasis on research training as a contributing factor to the shortage of nurses. Nursing education must also equip the students with the skills and knowledge to conduct research. In this context, health studies serve as a strong preparatory foundation for students pursuing higher education in medical and allied health fields.

Clinical competence is a cornerstone of effective healthcare delivery, encompassing technical expertise and the professional judgment required in complex clinical environments. It involves integrating knowledge, practical skills, attitudes, and ethical values, all essential for providing safe and high-quality patient care. Hui and Zakeri (2023) described clinical competence as integrating knowledge, skills, attitudes, and values into a clinical situation. Moreover, recognizing clinical competency is essential for medical education, evaluation, and licensure examinations and for society’s obligation to ensure healthcare quality (Amaral & Norcini, 2023). Lastly, Alavi and Ajorpaz (2022) emphasize that clinical competence is directly related to patient safety, patient satisfaction, and care quality.

Despite the growing emphasis on clinical competence in healthcare courses and programs, increasing complaints about the inadequacy of clinical competence among medical students in college highlight a significant gap in training effectiveness (Offiah et al., 2019). Furthermore, according to the study, 55% of the students were incompetent in 3 or more skills, and 4% were deficient in 5 or more. This study seeks to address the issue by exploring the impact of the modified STEM health studies curriculum on the development of clinical skills among senior high school or incoming college students. This study investigates the mediating effect of academic performance in supplementary subjects on the correlation between self-efficacy and clinical competence among Health Studies students in the STEM program. This research aims to elucidate how curriculum improvements and individual psychological characteristics influence the development of clinical competence by examining their interconnections.

Objectives of the Study

This study investigated the mediating effect of academic performance in additional subjects on the relationship between self-efficacy and basic clinical competence among students under the Modified STEM-Health Studies Curriculum.

In more specific terms, the study sought to answer the following questions to:

1. describe the level of students’ self-efficacy in the modified STEM–Health Studies curriculum;
2. ascertain the level of basic clinical competence of the students and the modified STEM curriculum;
3. measure the student’s academic performance in the additional subjects in the STEM curriculum;
4. examine the significant relationships among students’ self-efficacy in the modified STEM curriculum, academic performance in additional subjects, and basic clinical competence.
5. test whether academic performance in additional subjects significantly mediates the relationship between students’ self-efficacy in the modified STEM curriculum and their basic clinical competence.

LITERATURE REVIEW

Curriculum as Response to Global Competitiveness

Basic education in the Philippines used to take ten (10) years to complete: six (6) years of elementary education and four (4) years of secondary education before the shift to the K-12 educational curriculum. With the globalization of other countries, the Philippines has implemented massive educational changes to transition and shift its 10-year basic education into a K-12 curriculum.

According to Dizon et al. (2019), the K-12 Basic Education Program is the Department of Education’s flagship program, providing a curriculum relevant to the twenty-first century. This is in line with the reform goals of the Basic Education Sector Reform Agenda, a set of policy reforms aimed at improving important regulatory, institutional, structural, financial, physical, cultural, and information circumstances that affect basic education access and delivery on the ground. Moreover, Esther and Ethel (2012) noted that this policy reform is projected to bring about significant improvements that will help the department broaden, deepen, and sustain its efforts to improve the quality of basic education.

The Second Congressional Commission on Education is a Philippine commission tasked to undertake a comprehensive and systematic national assessment of the country’s education system. On January 23, 2024, the commission released its first report, “Miseducation: The Failed System of Philippine Education”. This report highlights the education sector’s challenges, problems, and issues. These concerns result from ineffective agency coordination, excessive teacher workloads, and low-quality assurance in teacher education and board exams (EDCOM 2 Communications, 2024).

According to Dabbay et al. (2024), students in the K to 12 curricula in the Philippines spend more time on academics than international ASEAN standards. Students are vulnerable to academic burnout, stress, and diminished overall well-being. Moreover, Robertson et al. (2021) pointed out the congestion of the curricula in the Philippines, which is more focused on content and instructional time. With these findings in area 7, the curriculum and instruction, the Department of Education revised the curriculum to decongest the design. It focused the curriculum on big ideas or key concepts in different learning sectors to prevent information overload.

One of the key principles of the K-12 curriculum is creating a senior high school. In the context of SHS, science, technology, engineering, and mathematics (STEM) are two strands under the academic tract. Students inclined toward, or have an aptitude for, Mathematics, Science, Health, and Engineering studies can enroll in the STEM curriculum. This curriculum is critical in preparing students for higher education, especially engineering, medical, and health-related programs. According to Halawa et al. (2024), in today’s education system, STEM education is the top priority to prepare students’ capabilities for the workplace to face sophisticated technologies and a competitive economy. Hence, the Department of Education of the Philippines designed the STEM curriculum not only to develop student’s skills and potential but also to possess the following key features within the area of the curriculum: specialized subjects, focus on practical application, preparation for STEM-related careers, and holistic development under the Republic Act No. 10533 known as Enhanced Basic Education Act of 2013. Below is the suggested set of subjects for a senior high school STEM curriculum:

Table 1. The DepEd Curriculum Design for the STEM Strand

All SHS students must take a total of 15 core subjects. Communication, Languages, Literature, Math, Philosophy, Science, and Social Sciences are among the subjects covered. Table 2 shows how much time each of the 15 core subjects is allotted.

Table 2. The Senior High School Core Subjects

Moreover, the applied track disciplines shown in Table 3 are divided into four categories: academic track, technical-vocational-livelihood (TVL) track, sports track, and arts and design track. The following are the subjects for each of the four tracks, each of which has an 80-hour semester:

Table 3. Applied Subjects with Corresponding Time Allotment

According to DepEd (2019), students interested in Math, Science, and Engineering studies can enroll in the Science, Technology, Engineering, and Mathematics (STEM) strand. Furthermore, under the STEM strand, students can become pilots, architects, astrophysicists, biologists, chemists, engineers, dentists, nutritionists, nurses, doctors, and other medical-related programs (Malayan Colleges Mindanao, 2021). This strand covers the following specialized subjects:

Table 4. The SHS Specialized Subjects in the STEM Strand

According to Nikita (2024), the STEM curriculum serves as the foundation of innovation across the globe. She also argued that the STEM program can develop students’ critical thinking, problem-solving, and cognitive skills. Similarly, the National Inventors Hall of Fame (2023) also concluded that the STEM curriculum enables students to develop 21st-century skills, including media and technology literacy, social skills, and communication, essential in today’s increasingly technological world. Lastly, through the curriculum, students can effectively interact and comprehend the world and be trained to be responsible members of society (Scott, 2024).

The success of the country’s economy largely depends on its ability to innovate. Hence, STEM learning has emerged as a strategic priority of the country, as it equips the students with the necessary skills to navigate the fast-growing technological world. Norris (2022) noted that STEM education provides learners with skills that make them employable and ready for work. More so, STEM education plays a crucial role in developing the economic status of a country and fostering sustainable development by equipping learners with skills to create and manage technological advancement (Blotnicky, 2019). During the Harvard-sponsored talk in the United States, O’Rourke (2021) pointed out the need for STEM professionals in STEM-related fields. It was also argued that employment in STEM occupations has grown 79% in the past three decades and is projected to grow by up to 11% in the year 2040. In the Philippines, there are insufficient STEM graduates; hence, the country does not have sufficient scientists (Anito et al., 2019). The current number of scientists in the Philippines (189 per million) is lower than UNESCO’s recommendation, which is 380 per million (Rafanan & Guzman, 2020).

Some private schools in the Philippines have exercised their academic freedom as stipulated in DepEd Order No. 88 series of 2010 in modifying the structure of the senior high school curriculum. In the research locale, the senior high school tracks, particularly the STEM strand, are further categorized into three (3) specializations or more focused disciplines: Associate Engineering, Computer Studies, and Health Studies. Below is the outline of the Modified STEM – Health Studies Curriculum:

Table 5. The Additional Subjects for the STEM Strand

New and advanced subjects were also introduced to each specialization or sub-discipline of the STEM strand (CJC- BED Handbook, 2018). Lee et al. (2010) describe curriculum modification as an educational strategy that improves access to knowledge and resources for students with special needs. It is also a process of changing a curriculum to make it more accessible to children with special needs. Furthermore, Silva et al. (2014) noted that curriculum modification involves altering resources and programs to change various educational components, such as content knowledge, instructional methods, and students’ learning outcomes.

School Supplementary Subjects in DepEd-Based STEM Curriculum

In the evolving landscape of science education in the Philippines, the Department of Education (DepEd) continues to refine the STEM strand in senior high school to better prepare students for careers in the health, medical, and biological sciences. A key aspect of this preparation involves including supplementary subjects beyond the core curriculum—subjects such as pharmacology, human anatomy and physiology, and zoology. While traditionally viewed as specialized disciplines taught in higher education, these fields are increasingly recognized as essential components at the secondary level. Their integration broadens students’ scientific understanding and supports the development of practical skills and critical thinking abilities aligned with the demands of modern science and healthcare professions.

Pharmacology, for instance, offers students a foundational understanding of how drugs interact with biological systems and how the body responds to these substances. According to the American Society for Pharmacology and Experimental Therapeutics, this field involves examining drugs’ origins, chemical characteristics, and therapeutic applications. Its relevance is particularly evident in health-related disciplines such as nursing, where a strong grasp of pharmacology is critical for safe and effective patient care (Khan & Hood, 2018). Understanding pharmacology also encourages students to explore how new therapeutic agents are developed, promoting a research-oriented mindset early in their academic journey. While often associated with pharmacy, pharmacology is a distinct scientific discipline focused on drug mechanisms and physiological responses rather than drug preparation and dispensing (HCA Editorial, 2020).

Parallel to this, human anatomy and physiology provide students with an in-depth understanding of the structure and function of the human body. As noted by the University of Otago (2021), this subject explores how the body develops from a single cell to a complex organism composed of multiple organ systems. It also addresses how skeletal features indicate age and developmental changes from childhood to adulthood. A strong background in anatomy and physiology allows future healthcare professionals to understand better the interactions among body systems, which is essential for diagnosing and treating medical conditions. Furthermore, this subject opens various career pathways in clinical practice and biomedical research, emphasizing its value within the STEM track (Corexcel, 2017).

Zoology, while often associated with animal biology, is equally relevant to students in the medical and life sciences. It covers a broad spectrum of topics, including animal anatomy, physiology, evolution, and behavior, making it an ideal subject for students interested in the natural world and biological systems (Lawlor, 2021). The North Carolina Association for Biomedical Research (2021) highlights that zoology can be both a descriptive and analytical discipline, offering insights into pure science and practical applications. Moreover, its contribution to medical education is well recognized. The British Medical Journal highlights that zoology helps develop a scientific mindset and provides a strong foundation in biological principles, both essential for medical studies. Applied zoologists often use their knowledge to contribute directly to human and animal health, reinforcing the practical value of this subject within the broader scope of medical and biological education.

Integrating these supplementary subjects into the DepEd-based STEM curriculum offers several educational advantages. First, it enriches the standard science curriculum by connecting theoretical knowledge to real-world applications. Second, it promotes interdisciplinary learning, helping students see the connections among biological, chemical, and physiological systems. Third, it provides early career orientation, allowing students to explore specific fields before entering college, which can improve their academic performance and motivation. These subjects also contribute to developing transferable skills such as critical thinking, problem-solving, data analysis, and ethical reasoning—skills highly valued in both academic and professional settings.

Self-Efficacy of Students in Education

In an educational setting, the student’s belief in their capacity and ability to succeed in activities or attain particular academic goals is called self-efficacy. This concept is based on the cognitive theory of Albert Bandura, which highlights the impact of one’s beliefs on motivation and behavior. Students with high self-efficacy are more likely to engage in demanding academic tasks, exhibit persistence when confronted with difficulties, and generally produce better academic results than students with low self-efficacy.

Academic self-efficacy refers to the learners’ attitudes and beliefs towards their capacities to attain success in academics. According to Hayat et al. (2020), students’ performance is developed through beliefs in self-efficacy by fostering commitment, effort, and perseverance. Additionally, students with a high self-efficacy rate are more likely to rely on themselves when faced with academic obstacles. They are expected to find solutions to the problems, as well as be patient during the process of learning and solving problems. More so, a study showed that self-efficacy can also affect students’ point of view of their potential. When students strongly believe in succeeding with their abilities, they tend to set challenging goals and employ effective learning strategies (Transforming Education, 2024).

Students develop a sense of purpose and direction when they establish clear and achievable goals. A study by Artino (2021) showed that when students set clear and specific goals or are given by teachers with learning objectives, they are more enthused to perform than students with no goals or who are told to try their best. Goal setting affects students’ motivation to learn and participate and influences their decision-making (Macklem, 2021). In addition, Sides and Cuevas (2020) argued that goals are important in improving academic achievement as they provide the attention and effort required to obtain success, positively impact persistence, and encourage students to learn new skills and strategies.

Developing self-efficacy in students is a cornerstone of effective education, and teachers play a pivotal role in molding students’ perceptions of competence. Timmo (2022) noted that when teachers employ an interactive and collaborative learning approach, students are likelier to achieve a high self-efficacy score than in a strict or closed classroom learning condition. Furthermore, teachers’ frequent, detailed, positive feedback on students’ learning and highlighting their progress and personal capacities can boost their self-efficacy. Feedback should focus on the students’ learning rather than simply evaluating their outputs and answers as good or bad, correct or wrong (Pajares, 2020).

Academic Performance

Developing students’ academic performance is one of the top priorities of every educational institution. Academic performance talks about how students are accomplishing their academic tasks and studies. Albarico et al. (2023) have explained that students’ achievement in all academic subjects is the basis of academic performance. Teachers conduct regular assessments through classroom performances, graduation scales, and results from standardized exams. In addition, a study by Malinao et al. (2023) highlighted that academic performance is the outcome of education; it is the extent to which the students, teachers, and school have achieved their goals.

A study conducted by Mappadang et al. (2022) confirmed that academic interest is correlated with academic performance, and students with a higher academic interest tend to have higher academic performance. Meanwhile, medical research in Ethiopia revealed that reducing and discontinuing smoking and other vices common to students can impact good academic achievements (Tadese, 2022). In addition, Kohl and Cook (2019) stated that a healthy mind through physical activity, such as exercise, is positively related to academic performance. Incorporating physical activity into students’ routines can improve memory, concentration, cognitive function, and overall mental well-being, which is essential for academic success.

Developing academic performance is essential in enhancing a wide range of skills among students. Research conducted in Vietnam showed that high academic performance results in developing soft skills. “soft skills” are based on personal competencies and interpersonal skills such as communication, teamwork, self-awareness, self-motivation, decision-making, critical thinking, and problem-solving (Ngo, 2024). In addition, Tusyanah et al. (2022) argued that students with soft skills and academic performance should be concerned with the learning process that requires interaction among students, teachers, learning resources, and learning environments. More so, another study showed three elements in learning based on Garrison’s community of inquiry (CoI) framework: social presence, cognitive presence, and teaching presence that affect students’ learning outcomes. This framework plays a crucial role in developing academic performance. Critical thinking, motivation, and problem-solving result from strong CoI, which is essential to students’ academic success (Fiock, 2020).

Basic Clinical Competence

For health studies students, mastering clinical competence is a must as it lays the groundwork for their future careers in the medical field. Clinical competence refers to assimilating the learned knowledge, attitudes, skills, and values into clinical situations, nursing management, and crises (Hui et al., 2023). According to Wu and Huang (2019), the ultimate goal of clinical competence is to provide care for patients by applying theoretical and clinical knowledge, incorporating problem-solving ability and psychomotor skills. The researchers emphasized that clinical competence develops as students and medical practitioners advance various proficiency levels. More so, Alavi et al. (2022) argued that there are five areas of clinical competence in nursing education: holistic practice, ethical-professional practice, communication, care organization, and individual-professional development. Similarly, another study showed that the clinical competence of medical practitioners has four areas: professional responsibility, care management, interpersonal relationships and care, and quality improvement (Greiner and Knebel, 2019).

It is believed that students under the STEM curriculum are highly likely to develop basic clinical skills such as problem-solving, communication, critical thinking, and positive attitudes that help them prepare for medical studies in higher education (Zhu et al., 2020). Additionally, good clinical competence increases care quality, patient safety, and satisfaction. Limited or low clinical competence rate is associated with increased mortality rates and the risk of medical errors (Gharghozar et al., 2020).

Clinical communication is one of the key components of strong clinical competence. A study by Franca et al. (2019) showed that effective communication is the core of quality healthcare service because it promotes shared decision-making and improves therapeutic instructions among medical practitioners and patients. Good clinical communication skills also develop patient care by effectively communicating patients’ diagnoses, care plans, and treatment options. Therefore, the importance of clinical communication is directly correlated to the patient’s safety, satisfaction, and outcomes (Allenbaugh et al., 2019).

Research conducted in Australia highlighted that clinical communication also includes activities such as active listening, clearly giving instructions related to diagnosis and treatment, and empathy for patients’ feelings and points of view (Haghighi, 2022). More so, the ability of medical students and practitioners to establish strong clinical communication increases awareness of patients’ issues and problems, improves patients’ assessment and evaluation, and develops rapport and cooperation in the treatment team among medical practitioners and staff. On the other hand, poor communication can lead to medical errors, increased health risks, and longer hospital stays for patients (Mehralian et al., 2023).

Correlation of Academic Performance and Clinical Competence

Academic performance and basic clinical competence are the two main factors in evaluating the abilities of healthcare students and professionals. Kim et al. (2021) state that clinical competence is directly related to students’ academic achievements. Academic scores in the fundamentals of nursing and other specialized subjects directly affect clinical competence. In addition, a student’s health status, major suitability, class satisfaction, and personality affect a student’s confidence in clinical performance. The study conducted at West Visayas State University by Soriano et al. (2022) revealed that students’ academic performance in lecture and theoretical classroom settings was significantly related to their clinical grades and performance.

Similarly, Oducado et al. (2019) predicted that lecture grades in class significantly impact clinical grades and performance. A study by Rosario et al. (2022) revealed that academic achievement and clinical competence are statistically correlated. It is perceived that students who perform well in the classroom perform well in clinical exposure and internship. These findings suggest the importance of adequate theoretical and content preparation before students’ pre-clinical exposure in school laboratories, clinics, hospitals, and other health sectors in the community.

METHODOLOGY

Research Design

This study employed a quantitative correlational (mediation analysis) research design. According to Baron and Kenny (1986), mediation analysis is a statistical technique to investigate whether the mediating variable explains the relationship between the independent and dependent variables. To establish mediation, this approach requires a series of regression analyses. Moreover, using this method, the researcher can estimate the magnitude and significance of connections between variables. The process of acquiring, evaluating, interpreting, and writing a study’s findings is known as quantitative research (Creswell, 2002).

The researcher collected the quantitative data over several months. A quantitative approach was necessary to provide statistical evidence concerning the mediating effect of academic performance in the additional subjects in STEM Health Studies between the students’ self-efficacy in the modified curriculum and basic clinical skills.

Research Locale and Respondents

The study was conducted in a sectarian institution in Digos City. The total number of respondents in the study was determined to be 288 grade 12 STEM–Health Studies students, with 265 being chosen as the study’s sample size with a margin of error of 5% and a confidence level of 95%. The sample size calculator Raosoft was used to calculate the sample size of the respondents. Further, stratified random sampling is employed in this study. According to Siegel et al. (2022), stratified random sampling is a method of obtaining samples separately from groups or segments (strata) of the population. In this technique, all students from the different population strata are given equal chances and probability to be selected and participate in the study.

Table 6. The Distribution of Population and Sample Sizes

The respondents are Grade 12 students taking the STEM academic track specializing in Health Studies who are currently in their on-the-job training or work immersion in hospitals and clinics. Through this subject, students are expected to translate the theories and knowledge learned in lectures and discussions into practical applications in real work environments. More so, students are expected to render 80 hours of duty in the second semester and comply with the requirements, such as portfolio, return demonstrations, etc. Furthermore, respondents who chose not to participate in the study were free to stop and withdraw from the study at any moment.

Research Instrument

This study utilized an adapted survey questionnaire from Gafoor and Ashraf (2006). Before the final data collection, this questionnaire underwent a pilot test using Test-Retest and Split-Half Reliability. Based on the results, the items on the self-efficacy questionnaire are reliable, with a Test-retest correlation coefficient of r=0.85 and a Split-Half reliability coefficient of r=0.90. This questionnaire measures the students’ self-efficacy in the modified STEM curriculum in senior high school (IV). On the other hand, the basic clinical competence of the students (DV) was measured using the adapted questionnaire from Liou and Cheng (2013) in the School of Nursing in Taiwan. This clinical competence questionnaire underwent a pilot test using Cronbach’s alpha, with an alpha of 0.98, asserting the validity and reliability of the survey instrument.

Furthermore, the questionnaire employed a five-point Likert scale for self-efficacy and clinical competence, with response options ranging from “Very High” to “Very Low.” For the students’ performance, the researcher used primary data to assess the student’s academic performance in the additional or supplementary subjects. The student’s grades in the three supplementary subjects were added and divided by three to obtain the mean average of the student’s academic performance. The students’ numerical grades are classified and interpreted based on the DepEd Order No. 8, series of 2015.

Data Gathering Procedure

The researcher followed a systematic procedure in gathering data for this study. Permission to conduct the research was first sought from the President of the selected school, followed by the approval of the Principal of the Basic Education Department, who provided an endorsement letter based on the initial consent. Upon approval, the researcher selected 228 Grade 12 STEM-Health Allied students for 2024–2025 using a stratified random sampling method to ensure representative distribution. These students were then provided with a survey questionnaire designed to assess their level of self-efficacy within the modified STEM curriculum. An adapted questionnaire developed by Liou and Cheng (2013) was administered to measure the students’ basic clinical competence. With the necessary letters of consent and approval from the students and the school administration, the researcher obtained the students’ numerical grades in the additional or supplementary STEM subjects from the registrar’s office. These grades served as secondary data in evaluating the student’s academic performance. The quantitative data were analyzed using appropriate statistical treatments, including mean, standard deviation, Pearson’s r, and mediation analysis. All data collected was treated with the highest level of confidentiality. Results were reported using pseudonyms or generalized identifiers during public presentations or panel defenses to ensure adherence to ethical research standards and to protect the participants’ identities.

Data Analysis

To analyze the data, the researcher employed several statistical tools, including Mean, Standard Deviation, Pearson’s r, and Mediation Analysis, to ensure a comprehensive and robust interpretation of the results. The mean was calculated to determine the average responses from the survey, providing a measure of central tendency that allowed for comparisons across groups and helped establish baseline levels for each variable. The standard deviation was used to assess the variability or dispersion of the data, offering insight into how closely clustered or spread out the responses were, which is essential for standardizing variables and facilitating comparison across different constructs. Pearson’s r was applied to evaluate the strength and direction of the relationship among the students’ self-efficacy in the modified STEM curriculum (Independent Variable), their basic clinical competence (Dependent Variable), and their academic performance in supplementary subjects (Mediating Variable). Lastly, mediation analysis was conducted to determine whether the student’s academic performance was a mediating variable in the relationship between self-efficacy and clinical competence, thereby offering insight into the indirect effects of self-efficacy on clinical skills through academic achievement. This method is particularly valuable in understanding complex causal pathways in educational research (Hayes, 2017).

RESULTS AND DISCUSSION

Level of Students’ Self-Efficacy in the Modified STEM-Health Studies Curriculum

The table below summarizes the students’ responses from the students’ self-efficacy questionnaire conducted by the researcher. The table includes the question items, mean scores, and remarks. The overall level of students’ self-efficacy in the modified STEM health studies curriculum is very high, with a mean of 4.25. Self-efficacy refers to an individual’s belief in their capacity and ability to perform and complete a task with confidence and controlled motivation and behavior.

Table 7: The Level of Students’ Self-Efficacy in the Modified STEM-Health Studies Curriculum

Among the items in the survey, the highest mean scores were recorded in items 1 and 5, both receiving a mean score of 4.43. A high mean score for applying learned concepts to real-life situations suggests that students develop transferable skills important in personal, academic, and professional contexts. The level of self-efficacy assessed aligns well with the STEM curriculum’s objective, which emphasizes applying theoretical knowledge to real-world problems and evidence-based clinical decision-making. In contrast, the lowest mean score was observed in item 2, with a value of 4.06. While the score still falls in the “very high” category, students may still rely on group work or collaboration to complete their tasks. In general, the scores across the items in the survey reflect a positive learning atmosphere and a curriculum design that supports and develops students’ autonomy, goal-setting, and resilience.

The study’s findings support Meera and Jumana’s (2015) idea of building positive self-efficacy among students. According to the study, students with established self-efficacy gain better results and grades. Additionally, teachers play crucial roles in helping students develop their self-efficacy through reinforcements and techniques. Further, according to Meng and Zhang (2023), academic efficacy is a good predictor of academic achievement. Their study revealed a favorable and strong correlation among academic performance, self-efficacy, and engagement.

Level of Students’ Basic Clinical Competence

The overall level of students’ basic clinical competence is very high, with a grand mean of 4.80. This suggests that the students have acquired and applied important clinical skills during their work immersion stage, reflecting positively on their training. Basic clinical competence refers to the fundamental skills of a pre-medical student. The competencies may include the student’s medical behavior and relationship, communication with the patients and with co-workers or classmates, and basic skill competencies such as the skill of getting the patient’s personal information, blood pressure, body temperature, blood oxygen level, and body mass index (BMI).

Table 8: The Level of the Students’ Basic Clinical Competence

Among the items in the survey, the highest mean score was recorded in item 3, with a mean of 4.96, and was closely followed by item 2, with 4.95 as the mean score. These results suggest that students value communication, dignity, and ethical behavior in the work immersion site. These ratings illustrate how respect and professionalism are strongly instilled in the students. In contrast, item 14 was recorded to have the lowest mean score, though still classified as “very high”, with a mean of 4.63. This finding suggests that, in contrast to ethical and interpersonal aspects, students feel slightly less confident or less competent in making clinical measurements like blood pressure, body temperature, etc. Further, this also means that students need more hands-on practice or training to reinforce their learned skills. In general, the mean scores across the items in the survey indicate that the students are not only technically prepared but also show a strong foundation of interpersonal skills and professional values, which are The survey result is congruent with the study of Alghamdi et al. (2024), which states that students with high clinical skills exhibit better academic performance and develop strong confidence. More so, a study conducted by Saud and Chen (2018) revealed the effectiveness of competency-based education (CBE) to pre-medical students in improving their performance and acquiring the competencies required in medical programs in college. Further, the study conducted by Soriano et al. (2020) revealed a significant positive relationship between clinical competence and students’ academic performance, provided that learning and clinical training were done in a setting conducive to medical students.

Students’ Academic Performance in Additional Subjects

The student’s overall academic performance level is outstanding, with a mean score of 91.70. Academic performance refers to a student’s overall performance in the educational endeavor. This may include skills, knowledge, content, and academic behavior. Similarly, this study refers to the numerical average grade of the students in the additional specialized subjects in the STEM Health Studies curriculum, namely Zoology, Anatomy and Physiology, and Pharmacology.

Table 9. Students’ Academic Performance in the Additional Subjects in STEM Curriculum

Among the three subjects, Pharmacology had the highest mean score of 92.19, indicating that students perform well in understanding the basic concepts of drugs like classification, proper medication, and mechanisms of functions and actions. This high grade or score may be attributed to the concrete foundation of knowledge and practical exposure of students in different classroom settings. In addition, the Anatomy and Physiology subject had the second highest score, with a mean of 91.69. This suggests that students deeply understand human body structure and functions, an essential component in health studies education. Meanwhile, the lowest mean was recorded in Zoology with a score of 91.23, while still under an “outstanding” rating; this suggests that students find some concepts in Zoology slightly challenging or less connected to the direct clinical practice. In general, the grand mean of the subjects is 91.70, which is translated as outstanding. This means that students are competent in clinical skills, academics, and other curricular-related activities.

Good academic status is a strong indicator of readiness in college or the workforce. According to Innab et al. (2024), self-efficacy and clinical competence are closely interrelated and used as indicators for work readiness in the medical industry. More so, the study of Buljan et al. (2022) revealed that academic grades in science and health-related subjects at the undergraduate level are good predictors of students’ academic success in higher education. Likewise, grades in entrance exams in medical institutions or undergraduate grade point average (GPA) are reliable data that can be used to predict the performance of the students (Kim et al., 2018).

Correlation Analysis Among Self-Efficacy, Clinical Competence, and Academic Performance

Understanding the relationships among self-efficacy, basic clinical competence, and academic performance, the following data are calculated and presented:

Table 10. Significant Relationships Among Self-Efficacy, Basic Clinical Competence, and Academic Performance of Grade 12 Students

All three correlations are statistically significant but very weak. A very low positive correlation (Pearson’s r = 0.223) exists between self-efficacy and clinical competence. Since the p-value of 0.001 is less than 0.05, the correlation is statistically significant. This suggests that the effect is weak, while higher self-efficacy might be linked to better clinical competence. Self-efficacy has a very low positive correlation (Pearson’s r=0.250) to academic performance. Though the relationship is statistically significant (p = 0.000), it confirms that self-efficacy has some influence on academic performance but a low correlation. This implies that while students with higher self-efficacy may perform slightly better academically, the effect is minor.

A very low positive correlation exists between academic performance and clinical competence (Pearson’s r=0.181). The p-value of 0.003 is less than the default 0.05 significance level; hence, the correlation is statistically significant, implying that academic performance does have some effect, even if it is small.

The result of the study supports the idea of Innab et al. (2024), which revealed the impact of a comprehensive evaluation of clinical competence, self-efficacy, and work readiness of the students. The study also revealed a positive correlation among the three variables, highlighting the mediating ability of self-efficacy between the relationship between clinical competence and work readiness. Further, the result was also anchored to the study of Ibrahim et al. (2023), which revealed the factors affecting the development of academic performance through self-efficacy and strong digital competence. Nurturing medical students’ self-efficacy and digital skills helps them advance their clinical competence and achieve academic success.

Mediation Analysis of Academic Performance in the Relationship Between Self-Efficacy and Clinical Competence

Understanding the mediating effect of academic performance in the additional subjects in STEM–health studies between self-efficacy and clinical competence, the following data are calculated and presented:

Table 11. Mediating Effect of Academic Performance Between Self-Efficacy and Clinical Competence

As illustrated in Table 11, the mediation analysis explored the relationships among students’ self-efficacy in the modified SHS–STEM Health Studies curriculum, academic performance in additional subjects (Zoology, Anatomy and Physiology, and Pharmacology), and their basic clinical competence. The total effect of self-efficacy on clinical competence yielded a beta coefficient of 0.107 (p = .002), indicating that for every unit increase in self-efficacy, clinical competence increases by 0.107. This confirms a significant total effect. Additionally, self-efficacy significantly impacted academic performance in the additional subjects, with a beta coefficient of 1.604, suggesting that students with higher self-efficacy also tend to perform better academically in specialized subjects. Academic performance, in turn, had a significant effect on clinical competence, with a beta coefficient of 0.012 (p = .030), implying that improvements in academic performance are associated with enhanced clinical competence. The structural equation model showed a beta coefficient of 0.019 and a p-value of 0.050 for the overall indirect effect, suggesting that academic performance partially mediates the relationship between self-efficacy and clinical competence.

Moreover, the direct effect of self-efficacy on clinical competence remained significant (β = 0.126, p = .001), indicating partial mediation. This suggests that while academic performance is a mediating factor, self-efficacy independently contributes to students’ clinical competence. These findings are consistent with existing literature. Alosaimi (2021) emphasized that nursing students’ self-efficacy—encompassing cognitive, psychomotor, and affective domains—is crucial in developing their clinical competence and technical skills. Likewise, Albagawi et al. (2019), in a study conducted at the University of Hail in Saudi Arabia, found a direct relationship between students’ self-efficacy and clinical competence, concluding that students with high self-efficacy demonstrate stronger performance in clinical and technical tasks. Similarly, Kim et al. (2021) reported that clinical competence is closely linked to academic achievement, with performance in foundational and specialized nursing subjects directly contributing to students’ clinical capabilities. Overall, the current study reinforces the importance of fostering self-efficacy and academic success to support the development of clinical competence in health-related education.

Figure 1. Mediating Effect of Academic Performance in the Relationship of Self-efficacy and Clinical Competence

The Sobel test was employed to check whether the mediation exists and is significant, and the result is presented in Table 12. It is shown that the indirect effect of self-efficacy on academic performance of 1.604 (SE = 0.382) and academic performance on clinical competence of 0.012 (SE = 0.005) resulted in a p-value of 0.030. This is less than the 0.05 significance level, and the null hypothesis was rejected. This further implies that the academic performance of the three additional health studies subjects significantly mediates the relationship between self-efficacy and clinical competence.

Table 12. Summary of the Sobel Test of Mediation

The result of the study also supports the findings of Oducado et al. (2019), who predicted that lecture grades in class significantly impact the clinical grades and performance of the students. Additionally, a study revealed that academic achievements and clinical competence are statistically correlated. It is perceived that students who perform well in the classroom are also good in clinical exposure and internships. These findings suggest the importance of adequate theoretical and content preparation before the students’ pre-clinical exposure in school laboratories, clinics, hospitals, and other health sectors in the community (Rosario et al., 2022).

SUMMARY, CONCLUSION, AND RECOMMENDATION

Summary

This study aimed to assess the self-efficacy of Grade 12 students in the STEM-health studies curriculum, focusing on their confidence in academic tasks, performance, and practical applications in health education. Data were collected through a self-efficacy survey, and academic performance was evaluated using students’ grades in specialized STEM subjects—Zoology, Anatomy and Physiology, and Pharmacology—based on the DepEd senior high school grading system. These grades served as indicators of mastery and overall performance. Basic clinical competence was assessed through students’ work immersion experiences in hospitals and clinics, where they applied skills under the supervision of medical professionals. A validated survey measured competence in medical behavior, communication, and skills proficiency.

The study found significant positive correlations among self-efficacy, academic performance, and clinical competence. Specifically, there were low positive correlations between self-efficacy and clinical competence (Pearson’s r = 0.223), self-efficacy and academic performance (Pearson’s r = 0.250), and academic performance and clinical competence (Pearson’s r = 0.181). The Sobel test confirmed that academic performance positively mediates the relationship between self-efficacy and clinical competence. These findings highlight the importance of academic performance in shaping students’ clinical competence and self-efficacy development.

Conclusions

The study concluded several key points. First, students in the STEM health studies curriculum showed high self-efficacy, reflecting confidence in their ability to complete tasks and manage challenges. Second, students demonstrated strong basic clinical competence, indicating that the modified curriculum effectively combines theoretical knowledge with practical skills. The students also performed well in supplementary subjects, showing strong academic engagement. Additionally, the study found positive relationships between self-efficacy, academic performance, and clinical competence. Higher self-efficacy was linked to better academic performance and stronger clinical skills. Academic performance also played a key role in developing clinical competence, acting as a pathway through which self-belief enhances practical abilities.

Recommendations

Based on the study’s findings, it is recommended that the Department of Education consider the results in future curriculum reviews and support school-based curriculum modifications. Private schools should use the findings to design programs that better prepare students for college. Junior high students aiming for medical courses are advised to take the STEM-health strand due to its positive impact on clinical and academic readiness. Schools should promote good study habits and enhance learning resources. STEM programs should also focus on building basic clinical skills through expert-led activities. Lastly, during work immersion, schools should value industry feedback and encourage partners to provide additional support and training to improve students’ competence.

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