A course in paediatric surgery, which was part of a nursing programme, was evaluated for the integration of the contents of several previously taught courses. Nineteen students participatedin the study and their learning outcomes were characterisedon 16 cognitive structure measures by a concept mapping task and Link Strength Matrices. It was found that students' knowledge was neither mastered nor integrated at the beginning of the course. After the course, there were minor improvements in a few of the cognitive structure measures and stability of many of the rest, students' misconceptions persisted, integration of the whole domain improved slightly, and the students tended to preserve their relative standing on the correctness of the cognitive map. The failure of the course to attain its major objectives and aims were discussed in the context of student learning in university settings and in relation to its preceding course in children's diseases. This evaluation led to the substantial revision in the curriculum and minor changes in teaching practices. Generalisations are proposed as to new knowledge-oriented evaluation methodology.