How well do UK assistantships equip medical students for graduate practice? Think EPAs.

The goal of better medical student preparation for clinical practice drives curricular initiatives worldwide. Learning theory underpins Entrustable Professional Activities (EPAs) as a means of safe transition to independent practice. Regulators mandate senior assistantships to improve practice readiness. It is important to know whether meaningful EPAs occur in assistantships, and with what impact. Final year students at one UK medical school kept learning logs and audio-diaries for six one-week periods during a year-long assistantship. Further data were also obtained through interviewing participants when students and after three months as junior doctors. This was combined with data from new doctors from 17 other UK schools. Realist methods explored what worked for whom and why. 32 medical students and 70 junior doctors participated. All assistantship students reported engaging with EPAs but gaps in the types of EPAs undertaken exist, with level of entrustment and frequency of access depending on the context. Engagement is enhanced by integration into the team and shared understanding of what constitutes legitimate activities. Improving the shared understanding between student and supervisor of what constitutes important assistantship activity may result in an increase in the amount and/or quality of EPAs achieved.

Medical students experience in working in a public COVID-19 telehealth program: a descriptive study.

BACKGROUND: Given the health and social needs generated by the COVID-19 pandemic, the Telehealth Network of Minas Gerais, Brazil, implemented a teleconsultation and telemonitoring program to assist patients with suspected or confirmed COVID-19, the TeleCOVID-MG program. The telemonitoring service was conducted by medical students, under the supervision of a physician. The main goal of this study was to analyze the experience of the students while collaborating on the aforementioned telemonitoring program. METHODS: A questionnaire with 27 questions was developed to address the participation of the students in the telehealth program. The questionnaire included questions about the student's profile, the system usability, and the satisfaction in participating in such a telehealth program. The questionnaire was generated on Google Forms® platform and sent via email to each student who was part of the telemonitoring team. RESULTS: Sixty students were included in the analysis (median age 25 years-old [interquartile range 24-26], 70% women). Of those, 61.6% collaborated on the telehealth program for more than 6 months, 65.1% performed more than 100 telemonitoring calls, 95.2% reported difficulties in contacting the patient through phone calls; 60.3% believe some patients might have felt insecure about being approached by medical students and not by graduate professionals; and 39.6% reported eventual system instabilities. The main strengths reported by the students were related to the system usability and to the self-perception of the quality of healthcare delivered to the patients. Even though 68.3% of the students mentioned technical difficulties, 96.6% reported that they were promptly solved. Finally, 98.3% believed that the program was useful and would recommend it to an acquaintance. CONCLUSION: This study reports a successful experience of undergraduate medical students in a COVID-19 telemonitoring program. Overall, the medical students were satisfied with their participation, especially considering the continuity of clinical practice remotely during a period of classes suspension during the COVID-19 pandemic and their important role in the assistance of patients from low-income regions, which has minimized the health system burden in an emergency context.

Self-efficacy of medical students in a hybrid curriculum course (traditional and problem-based learning) and associated factors.

Self-efficacy consists of the judgment of one's abilities to perform actions required to achieve a given performance, which has been considered predictive of performance. In academics, it means personal convictions in accomplishing a task to a defined degree of quality. Numerous studies have investigated medical students' self-efficacy in traditional and PBL curricula. However, few studies have addressed the hybrid PBL scenario (Hpbl) that simultaneously contemplates PBL, traditional teaching, and practical activities. An even smaller number have evaluated the factors associated with this entity. With these considerations, we aimed to investigate the self-efficacy belief in the hPBL curriculum and the factors associated with this entity. This quantitative observational cross-sectional study was held between August 2022 and November 2022 in Fortaleza, a city in Northeast Brazil with almost 3 million inhabitants. The medical course has 12 semesters. The first two semesters use traditional teaching and cover the basic cycle, followed by the third to eighth semesters which correspond to the pre-clinical and clinical cycle. From the third semester onwards, traditional teaching and PBL are used simultaneously, which we call a hybrid model of PBL. The scale "Scale of Self-efficacy in Higher Education" was applied, a questionnaire validated for the Portuguese language consisting of 34 questions, with answers on a Likert-type scale with ten points, divided into five dimensions. To verify the association between sociodemographic factors and self-efficacy, simple and multiple linear models with robust errors were used. In total, 412 students participated in this study, most of them women (70.1%). The average age of students was 22.9 years. All domains had medians greater than 8, which means strong self-efficacy. The following factors were associated with higher self-efficacy scores in general after the multivariate analysis: female gender (8.6 vs. 8.3, p-value = 0.014), working (8.8 vs. 8.5, p-value = 0.019) and participating in extracurricular activities (8.7 vs. 8.1, p-value = 0.019). We conclude that medical students studying in hybrid learning models showed strong levels of self-efficacy. In addition, participating in extracurricular activities was associated with higher self-efficacy scores and males presented lower levels of self-efficacy.

Teaching medical students ultrasound-guided needle aspiration of synthetic cysts: effect of a formalin-embalmed cadaver simulation model.

BACKGROUND: Standard training for ultrasound-guided cyst needle aspiration is currently performed on live patients during residency. This practice presents risk of iatrogenic injury to patients and provides a high-stress learning environment for medical trainees. Simulation training using synthetic cysts in a formalin-embalmed cadaver model may allow for realistic, practical, and effective training free from patient risk. METHODS: Thirty first-year medical students viewed an orientation video, then attended a skills workshop to perform cyst needle aspiration in formalin-embalmed cadaver tissue under ultrasound guidance. Participants were randomly assigned to one of three ultrasound-trained instructor-types which included a medical student, clinical anatomist, or an ultrasound fellowship trained emergency medicine physician. After training, participants underwent a 5-min skills test to assess their ability to drain a synthetic cyst independently. Pre- and post-training self-confidence surveys were administered. RESULTS: Ultrasound images of synthetic cysts in formalin-embalmed tissue were clear and realistic in appearance, and sonographic needle visualization was excellent. Participants took an average of 161.5 s and 1.9 attempts to complete the procedure. Two of the 30 participants could not complete the procedure within the time limit. Participants' self-reported confidence with respect to all aspects of the procedure significantly increased post-training. Mean confidence scores rose from 1.2 (95% CI 0.96 to 1.39) to 4.4 (95% CI 4.09 to 4.53) (P < 0.0001) Procedure time, number of attempts, performance scores, and self-confidence outcomes were not significantly affected by instructor type. CONCLUSIONS: The use of synthetic cysts in formalin-embalmed cadaveric tissue is feasible, realistic, and efficacious for the teaching of ultrasound-guided needle aspiration to novice medical trainees. This simulation training method can be delivered effectively by multiple instructor types and may allow medical trainees to increase their tactical skill and self-confidence prior to performing ultrasound-guided cyst needle aspiration on live patients.

Assessing the attitudes and knowledge of medical students towards Patient-Centred Care across different study years: A cross-sectional study.

OBJECTIVE: To determine how medical students viewed the importance of patient-doctor communication, to assess their knowledge about patient-centred care, and to compare the attitudes of medical students in their pre-clinical and clinical years of study towards patient-centred care. METHODS: The cross-sectional study was conducted from April to September 2023 at Federal Medical and Dental College, Islamabad, and Rawalpindi Medical University, Rawalpindi, Pakistan, and comprised medical students of either gender from 2nd to 5th academic year. Data was collected using the Patient-Practitioner Orientation Scale. Data was analysed using SPSS 27. RESULTS: Of the 322 students, 178(55.3%) were males and 144(44.7%) were females. The mean score was 3.60±0.47, while the sharing and caring sub-scores were 3.23±0.66 and 3.99±0.52, respectively. The attitude of students overall was slightly patient-centred. Different study years showed variance in patient-centred scores which were also affected by cultural, demographic and gender parameters (p<0.05). CONCLUSIONS: The attitude of the students leaned slightly towards patient-oriented behaviour.

Experiences of French medical students during their clerkship in adolescent psychiatry: a qualitative study.

The epidemiology of adolescent psychiatric disorders and the relational complexity of their management make exposure to adolescent psychiatry essential during medical school. However, some clinical particularities can complicate the students' learning experiences. Our work aimed to explore the experience of being a medical student during clerkships in adolescent psychiatry. Following the Interpretative Phenomenological Analysis qualitative approach, 20 semi-structured face-to-face interviews were conducted with medical students at the end of their clerkship in adolescent psychiatry. Three super-ordered themes emerged to describe their experience: in-depth self-exploration calling on emotions, thoughts and experiences; changes in the view of adolescent mental health; better understanding of the role and meaning of adolescent psychiatric care and how to approach it. Identification between students and patients could result from time-related factors (the end of adolescent brain remodeling, long, demanding studies, and financial and material dependence). In addition, the predominant use of non-analytical clinical reasoning processes-less valued in the rest of the graduate curriculum-poses a challenge for students. Indeed, for a student to find his or her place in adolescent psychiatry requires the student to reinvent him or herself, because the codes are different (no gown, less well-defined tasks, etc.). Finally, the excess prevalence of mental disorders among medical students requires increased vigilance on the part of tutors. For all these reasons, close, attentive tutoring seems essential to support students, while these clerkships afford a real opportunity for students to broaden their interpersonal skills.

Differences in medical education before, during, and in the post-peak period of the COVID-19 pandemic-exploring senior medical students' attitudes.

BACKGROUND: The burden that COVID-19 has brought to the economy, healthcare systems, and education is unmatched. Public health and social measures were implemented to halt transmission. Thus, social gathering and in-person learning, core aspects of medical education, were interrupted. Studies have documented the detrimental impact students graduating during the pandemic have had on their confidence and skills. However, data comparing pre-pandemic, pandemic, and post-peak students still lack. This study aimed to identify senior medical students' attitudes regarding their education and compare them according to the three previously described periods. METHODS: In this cross-sectional study, the survey employed was designed based on a previous questionnaire and applied to senior medical students before graduating between January 2018 and June 2022. Answers were collected using a three-point Likert scale and Yes/No questions. Associations between variables were examined using Chi-squared, Fisher's Exact tests, and ANOVA, employing logistic regression to calculate odds ratio (OR) when appropriate. RESULTS: A total of 679 responses were analyzed. Most students (59%) were women. Up to 383, 241, and 55 senior medical students answered the survey before, during, and in the post-peak period of the COVID-19 pandemic, respectively. There was a staggering decrease in the percentage of students in the post-peak compared to the pre-pandemic period that considered certain factors such as being taught about the doctor-patient relationship (62% vs 75%), practicing teamwork (33% vs 54%), preclinical & clinical subjects (44% vs 63%), and being taught to conduct research (22% vs 32%) as "very useful" to their professional traineeship. There was a significant difference between pre-pandemic, pandemic, and post-peak students when asked if the study curriculum accomplished the goal of training a professional with integrity (89% vs 66% vs 64%, p < 0.001), respectively. In a multivariate analysis graduating during the pandemic (OR 3.92; 95% CI, 2.58-5.94) and in the post-peak period (OR 4.24; 95% CI, 2.23-8.07) were independent factors for the appreciation that the study curriculum did not meet its objective. CONCLUSIONS: The pandemic has hindered medical education. Students' appreciation of their instruction has deteriorated. Urgent interventions that halt the negative impact on training, ensure readiness for future problems and improve schooling worldwide are needed.

HPV Knowledge Retention and Concurrent Increase in Vaccination Rates 1.5 Years After a Novel HPV Workshop in Medical School.

Comprehensive education regarding human papillomavirus (HPV) pathogenesis, vaccination, and patient counseling are not routinely included in the medical school curriculum; consequently, student and provider knowledge, especially concerning head and neck pathology, remains low. The objective of this study was to demonstrate long-term retention of HPV knowledge and positive attitudes towards HPV vaccination after attending our novel HPV workshop, with a focus on knowledge of oropharyngeal cancer. A follow-up survey was administered to medical students 1.5 years after the initial completion of the workshop. HPV vaccination records from the student-led clinic were collected from the immunization information system. Awareness that HPV causes oropharyngeal cancer was present in 33% of medical students pre-curriculum; immediate and long-term post-curricular awareness of this association remained at 90% or higher (p < 0.0001). Comfort with HPV counseling, having enough information to recommend the vaccine, and knowledge of HPV malignancies, symptoms, transmission, and vaccination schedule remained persistently elevated over pre-curriculum scores (p < 0.05). Long-term knowledge scores were also higher than a control group of medical students at the same stage of training who had never participated in the workshop (p < 0.05). HPV vaccination rates at the medical school's student-run clinic also increased after the curriculum, from an average of 1.89 HPV vaccines given per clinic to 3.55 (p = 0.001). This study demonstrates that knowledge and positive attitudes were maintained 1.5 years after participating in this HPV curriculum during students' preclinical years of medical school. Additionally, an increase in HPV vaccination rates occurred at a student-led clinic, indicating a positive clinical impact on the curriculum.

An overview of the capabilities of ChatGPT for medical writing and its implications for academic integrity.

The artificial intelligence (AI) tool ChatGPT, which is based on a large language model (LLM), is gaining popularity in academic institutions, notably in the medical field. This article provides a brief overview of the capabilities of ChatGPT for medical writing and its implications for academic integrity. It provides a list of AI generative tools, common use of AI generative tools for medical writing, and provides a list of AI generative text detection tools. It also provides recommendations for policymakers, information professionals, and medical faculty for the constructive use of AI generative tools and related technology. It also highlights the role of health sciences librarians and educators in protecting students from generating text through ChatGPT in their academic work.

Medical students and residents appreciate ebooks' convenience, but prefer the print book reading experience.

BACKGROUND: Increasingly, libraries buy medical monographs as ebooks, but that may not be what medical students and residents want. Some studies have shown that they prefer print books for some types of reading. On the other hand, for participants in distributed medical programs, ebooks are more accessible. OBJECTIVES: To determine whether medical students and residents at an institution with a distributed medical education program prefer medical ebooks or print books. METHODS: In February 2019, 844 medical students and residents were invited to complete an online questionnaire on their format preferences. RESULTS: Two hundred thirty-two students and residents responded. Most preferred electronic format for reading a few pages, but print for entire books. Respondents preferred ebooks because they were immediately available, searchable and could be used on the go, and print books because they strained users' eyes less, facilitated absorption of the text and could be held in users' hands. The location of respondents and year of study had little effect on responses. DISCUSSION: Libraries should consider buying quick reference and large, heavy textbooks as ebooks and pocket-sized or shorter, single-topic titles, in print format. CONCLUSIONS: Libraries have a responsibility to make both print and ebooks available to their users.

Integrating diversity, equity, and inclusion principles into instruction: Case studies from the University of Florida's Health Science Center Libraries.

Librarians at the University of Florida Health Science Center Libraries have begun to intentionally incorporate diversity, equity, and inclusion (DEI) principles into teaching during design, implementation, and evaluation. This article uses four case studies to provide an overview of the librarians' approaches to inclusive teaching (1) an annual workshop for Physical Therapy students on the intersection between DEI, health literacy, and patient education; (2) a librarian-taught one-credit course for public health students, which was revised to create a more inviting syllabus and integrate elements of universal design; (3) an annual project for first year medical students highlighting health disparities and community resources; and (4) piloting the application of critical librarianship principles in library standalone sessions on database searching and reference management. Suggestions are provided for other librarians who are interested in developing a culture of inclusive teaching in their own libraries.

Self-Directed Learning And Approach To Seeking Medical Evidence: Perceptions Of Students From A Private Medical University Of Karachi.

Objectives: To assess self-directed learning among medical students and their approach towards seeking medical evidence. METHODS: The cross-sectional study was conducted from November 30, 2021, to June 30, 2022, at the Baqai Medical University, Karachi, and comprised first to fifth year medical students of either gender. Data was collected using a structured online questionnaire which also included questions from the self-directed learning instrument. Data was analysed using SPSS 21. RESULTS: Of the 250 students who approached, 159(63.6%) responded were received; 102(64.2%) females and 57(35.8%) males. The overall mean age was 21.78±1.72 years, with 88(54.1%) subjects aged >21 years. Majority 127(79.9%) participantsscored above average on the self-directed learning instrumentscale, while 131 (84.2%)showed satisfactory approach towards evidence-based medicine. Students with better attitude towardsself- directed learning were more likely to have satisfactory approach towards evidence-based medicine, but this relationship was not significant (p=0.136). CONCLUSIONS: Medical students were found to be keen to adopt self-directed learning and practice evidence-based medicine though they have not been formally exposed to it.

Advocacy in Action: a Comprehensive Student-Led Proactive Outreach to Patients at Highest Risk.

INTRODUCTION: COVID-19 disrupted access to critical healthcare and resources for many, especially affecting patients at safety-net hospitals who rely on regular care for multiple complex conditions. Students realized they could support patients from the sidelines by helping navigate abrupt healthcare changes and proactively addressing needs at home. AIM: To comprehensively identify and meet the clinical and social needs of Atlanta, Georgia's patients at highest risk, left without their usual access to healthcare, through proactive telephonic outreach. SETTING AND PATIENTS: Medical and Physician's Assistant students from Emory and Morehouse Schools of Medicine partnered with Grady Health System, Atlanta's safety-net hospital. Artificial intelligence prioritized over 15,000 patients by risk of morbidity and mortality from COVID-19. PROGRAM DESCRIPTION: In this novel program, students performed telephonic outreach to thousands of patients at highest risk of poor outcomes from COVID-19. Students used a custom REDCap form that served as both a call script and data collection tool. It provided step-by-step guidance to (1) screen for COVID-19 and educate on prevention; (2) help patients navigate health system changes to fill gaps in care; and (3) identify and address social needs. Based on patients' responses, the form prompted tailored reminders for next steps and connections to medical and social resources. PROGRAM EVALUATION: In the program's first 16 months, students made 7,988 calls, of which 3,354 were answered. Over half (53%) of patients had at least one need requiring action: 48% health and 16% social. DISCUSSION: This proactive, novel initiative identified substantial clinical and social need among patients at highest risk for poor outcomes and filled a pressing health system gap exacerbated by COVID-19. Simultaneously, interprofessional students gained applied exposure to health systems sciences. This program can serve as a model for rapid, cost-effective, high-yield outreach to promote patient health at home both during and beyond the pandemic.

Evaluation of interprofessional student teams in the emergency department: opportunities and challenges.

BACKGROUND: Interprofessional education opportunities are commonly university-based and require further development during clinical practice. Many clinical contexts offer the potential for meaningful learning of both collaborative and discipline-specific practice. The emergency department (ED) demands efficient teamwork, so presents a logical location for interprofessional learning. METHODS: An interprofessional clinical placement program was implemented with the aim to enhance students' capacity and self-efficacy for collaborative practice. Fifty-five medical and nursing students participated as interdisciplinary pairs in a two-week clinical placement in the ED. Students' perceptions of the learning environment were measured pre- and post-placement with the Self-efficacy for Interprofessional Experiential Learning Scale and the Interprofessional Clinical Placement Learning Inventory was completed post-placement. Non-parametric tests were used to establish change differences. RESULTS: The Placement Learning Inventory revealed positive outcomes; the majority (16/19) agreed/agreed strongly that the placement provided sufficient learning opportunities, was interesting, and made them feel as if they belonged and most (14/19) reported they achieved the discipline specific learning objectives set by the university. Self-efficacy improved significantly (p = 0.017), showing promise for future use of the placement model Challenges were identified in the organisation and supervision of students. In the absence of additional dedicated student supervision, this model of interprofessional student pairs in the ED was challenging. CONCLUSIONS: Interprofessional clinical placements in ED are an effective clinical learning approach for final year undergraduate medicine and nursing students. Recommendations for improvements for students' clinical supervision are proposed for the placement model.

Academic integrity among medical students and postgraduate trainees in the teaching hospitals of South Punjab Pakistan.

This study investigated the topic of the academic integrity among medical students and postgraduate trainees in the teaching hospitals of South Punjab, Pakistan. A cross-sectional survey was conducted involving 318 medical students and postgraduate trainees of teaching hospitals. The results found that medical students of pre-clinical years engaged in unethical behaviour, that is, exam cheating and plagiarism to cope with internal and external evaluation and the range of subjects needed to be studied. For postgraduate trainees, results showed trainees unintentionally engaged in the practice of plagiarism due to lack of understanding about what constitutes plagiarism, coupled with externally perceived pressures associated with expectations of research publication, promotions and tenured positions. To address these concerns, it is recommended that information literacy sessions for undergraduate and postgraduate medical students on plagiarism prevention and ethical practice be designed and facilitated by medical librarians in collaboration of faculty members.

Spiritual Beliefs and Hastened Death: A Study on Medical Students.

This study focuses on the impact of common spiritual beliefs regarding metaphysical questions in agreeability with the practice of hastened death. A sample of 497 Portuguese medical students was collected. Differences between genders and religions, predictors for agreeability with hastened death and the association between spiritual beliefs and opinion towards hastened death cases were assessed. Respondents were mostly favourable to the practice of hastened death. Formal religious affiliation and higher levels of religiosity significantly associated with lesser agreeability with hastened death. Statistically significant association was found between every hastened death scenario and multiple of the spiritual beliefs used. A number of spiritual beliefs were predictors of agreeability. We discuss the implications of religion and spirituality in agreeability with hastened death. Further research is required to better understand the true weight of spirituality in one's opinion towards this ethical dilemma.

Development and validation of scale for measuring attitudes towards e-professionalism among medical and dental students: SMePROF-S scale.

BACKGROUND: Social media permeated everyday life and consequently it brought some changes to behaviour of health professionals. New form of professionalism emerged called e-professionalism depicting professional behaviour while using social media. There are a number of studies conducted in the past several years measuring behaviour of different populations of health professionals on social media and social media sites. Many studies have investigated aspects of e-professionalism of medical or dental students as future health professionals, but there are no validated instruments made for assessing attitude towards e-professionalism of those two populations. Objective of this paper is to validate a newly developed scale for measuring attitudes towards e-professionalism among medical and dental students. METHODS: The original 32-item scale was developed and administered to 411 medical students (RR 69%), and 287 dental students (RR 49.7%). Exploratory factor analysis was used to investigate the existence of underlying factors. Principal component analysis was used as an extraction method with oblimin as selected oblique rotation method. Cronbach's alpha was used to assess reliability. RESULTS: Total of 698 student answers entered analysis. The final scale had 24 items that formed seven factors named: ethical aspects, dangers of social media, excluding physicians, freedom of choice, importance of professionalism, physicians in the digital age, negative consequences. Cronbach's alpha indicating scale reliability was .72. Reliability conducted on each factor ranged from .570 to .877. CONCLUSIONS: The scale measures seven factors of attitude towards e-professionalism and exhibits satisfactory reliability. Based on insights from validation, some possible improvements are suggested.

Who is blocking access to PubMed? Educational 'Escape Room' for medical residents.

Teaching students how to conduct bibliographic searches in health sciences' databases is essential training. One of the challenges librarians face is how to motivate students during classroom learning. In this article, two hospital libraries, in Spain, used Escape rooms as a method of bringing creativity, teamwork, communication and critical thinking into bibliographic search instruction. Escape rooms are a series of puzzles that must be solved to exit the game. This article explores the methods used for integrating escape rooms into training programmes and evaluates the results. Escape Rooms are a useful tool that can be integrated into residents' training to support their instruction on bibliographic searches. This kind of learning stablishes competences like logical thinking and deductive approaching. These aspects aid participants to make their own decision and to develop social and intellectual skills.

Assessing learning styles of medical students using Kolb's learning style inventory and their association with preferred teaching methodologies.

OBJECTIVE: To determine the frequency of learning styles of medical students and their association with preferred teaching methodologies. METHODS: The cross-sectional study was conducted at Baqai Medical College, Gadap, Karachi, form July to October 2019, and comprised medical students regardless of age, gender and academic year. David Kolb's learning style questionnaire, along with another questionnaire, was used to collect data. Data was analysed using SPSS 23. RESULTS: Of the 523 students, 213(40.7%) were males and 310(59.3%) were females. The overall mean age was 21.5±1.69 years. Of the total, 268(51.7%) students were divergers, 118(22.8%) assimilators, 86(16.6%) accomodators and 46(8.9%) were convergers. There was a significant association between learning styles and selected teaching methodologies (p<0.05). CONCLUSIONS: Majority students were found to be divergers and assimilators. Aligning instructional strategies with learning styles will improve learning and academic performance.

Identification and comparison of factors related to academic failure in medical colleges; A Bi-centre, comparative study.

OBJECTIVE: To evaluate student's perceptions related to their academic failure, and to compare these perceptions with their nationality. METHODS: The non-interventional, bi-national, comparative study was conducted in medical colleges of Pakistan and Saudi Arabia from 2015 to 2017 and comprised medical students who had scored less than 50% in their professional examinations. Data was collected using a pre-designed 22-item questionnaire that was scored by the students on a 5-point scale. Data was analysed using SPSS 23. RESULTS: Of the 210 students, 115(55%) were Pakistanis and 95(45%) were Saudis. Common reasons of failure identified were information overload 114(50%), difficult examination 101(48%), poor teaching skills of teachers 82(39%), system of education 75(36%) and unfair examination 78(37%). In terms of nationality, 11 items were found significant (p<0.05). CONCLUSIONS: Regardless of cultural and environmental differences in factors contributing towards failure in students of different countries, the risk factors were found to be common, with most students blaming external factors rather than internal ones.