An insight into the clinical learning environment of dental institutes: a study in the twin cities of Pakistan.

OBJECTIVE: To assess the perceptions of dental students regarding their clinical learning environment in an urban setting. METHODS: This descriptive, cross-sectional survey was conducted from March 2020 to May 2021 after approval from the ethics review committee of Islamic International Dental College, Islamabad, Pakistan. It comprised of clinical year students, house officers and postgraduate trainees from 6 dental teaching hospitals of Rawalpindi and Islamabad. Data was collected using a pre-validated instrument assessing the dental clinical learning environment. Data was analysed using SPSS 24. RESULTS: Of the 1030 students approached, 561(54.4%) responded. Of them, 448(80%) were girls, 234(41.7%) were 3rd year students, 110(19.6%) were 4th year students, 120(21.4%) were house officers and 97(17.3%) were postgraduate trainees. Female students had a better patient attitude and were more confident in their abilities to keep up with their peers (p<0.05). The students were content with the performance of their clinical teachers, with a mean score of 70.99+/-16.0, while the lowest score of 54.67+/-22.9 was for clinical infrastructure and materials. Students of Islamabad pointed out the lack of clinical materials and maintenance of equipment but noted better research opportunities compared to their Rawalpindi counterparts (p<0.05). CONCLUSIONS: The clinical learning environment for Islamabad and Rawalpindi cities individually was good. Overall, students were satisfied with their clinical teachers, learning and training experience. Dental materials, infrastructure and maintenance factors scored the lowest.

Impact of emotional intelligence in resolving clinical conflicts among postgraduate residents of surgery.

Background & Objective: Emotional intelligence (EI) can become a vital tool for resolving clinical conflicts (CC) in surgery. The postgraduate residents focus on the technical skills and undermine the soft skills required for their better training. Our aim was to determine the EI of postgraduate resident (PGR) years one & two in General and Orthopedic Surgery. The CC in their workplace and how they use their EI to resolve these conflicts. Methods: This mixed-method study was conducted from March 10, 2019 to May 28, 2020 at Departments of General and Orthopedic Surgery, Mayo Hospital, Lahore. The study was conducted in two phases 1 & 2. In Phase-1, one hundred PGR years one & two were administered the Mayor-Salovey-Caruso Emotional Intelligence test (MSCEIT) to measure EI. In phase-2, semi-structured in-depth interviews of 10 PGRs five with high and five with low EI were conducted to determine the CC and use of EI to resolve the CC at the workplace. A thematic analysis was done. Results: Out of 100 PGR, the mean EI score was 46.25±14.8 with a maximum score of 75.4, and a minimum score of 18.16 (p-value =0.775). Ninety-one (91%) have not improving EI, and 09 (09%) have considered developing EI. Five themes in four settings, including emergency, ward, elective operation theatre, and outpatient department (OPD) were determined. The emerged themes for the CC were nepotism, gender biases, burnout, lack of professionalism, and toxic culture. The following were CC management strategies: self-study, deceit, gender affinity, performing attention-attaining work, aggrieved reaction and being disgruntled when alone. Conclusion: None of the PGR was emotionally intelligent in overall grades, as well as a particular aspect of MSCEIT.

Questionable research practices of medical and dental faculty in Pakistan - a confession.

PURPOSE: Intellectual honesty and integrity are the cornerstones of conducting any form of research. Over the last few years, scholars have shown great concerns over questionable research practices (QRPs) in academia. This study aims to investigate the questionable research practices amongst faculty members of medical and dental colleges in Pakistan. METHOD: A descriptive multi-institutional online survey was conducted from June-August 2022. Based on previous studies assessing research misconduct, 43 questionable research practices in four domains: Data collection & storage, Data analysis, Study reporting and Collaboration & authorship were identified and investigated. Descriptive (Frequencies, Percentages, Mean, SD) and Inferential (chi square) statistics were calculated. RESULTS: A total of 654 faculty members responded. Every respondent reported committing at least one QRP in their career. The most common QRPs included deliberately failing to mention funding, publishing program evaluation data not meant for research purposes or approved by an ethical body, inappropriately storing identifiable information and non-disclosure of any conflicts. There was significant association of age, gender and academic rank with QRPs in 'Data collection and storage' and 'Data Analysis' domains. CONCLUSION: Medical and dental faculty members participating in this study are involved in a range of questionable research practices (QRPs) in Pakistan. Their confession might have contributed to the faculty developing self-awareness and reinforcing academic integrity. There is a need for reviewing policies and practices to improve research culture. Future research should explore the factors resulting in such practices.

Burnout among Dental Students of Private and Public Dental Colleges in Pakistan - A Cross-Sectional Study

ABSTRACT Objective: To assess the prevalence of burnout among dental students of public and private institutions in Khyber Pakhtunkhwa and Punjab, Pakistan. Material and Methods: A cross-sectional descriptive survey was conducted at five public and private dental institutions from June 2021 to May 2022. A validated twelve-item closed-ended Burnout Clinical Subtype Questionnaire was distributed among the dental students of two private and two public institutes in Pakistan. The research questions focused on demographic information and students' academic experiences. Data analysis is presented through tables and descriptive methods. Results: A total of 274 dental undergraduate students - second (42.3%), third (35.4%), and final (22.3%) academic year participated in this study. The mean age of the respondents was 21.9, with the range of 20-26 years. Most participants were females (74.1%) compared to the males (25.9%). The findings for burnout syndrome among dentistry students and students in the private and public sectors were not significant. Conclusion: In the current study, burnout levels among dental undergraduates, both private and public, were low.

'We work together as a group': implications of jigsaw cooperative learning.

BACKGROUND: Modern clinical practice increasingly relies on collaborative, cooperative and team-based approaches for effective patient care. Recently, Jigsaw cooperative learning has gained attention in medical education. There is a need for studies in Southeast Asian context to establish its effectives in developing various core competencies expected of health professionals such as interpersonal, communication, collaborative, and teamwork skills. This current study explores the impact of using Jigsaw Cooperative Learning on undergraduate medical students. METHOD: An explanatory mixed method research design was carried out on first year medical students at a private university in Malaysia. In Phase I, a survey was conducted to explore the effectiveness of jigsaw learning. Descriptive and inferential statistics were calculated using SPSS. In Phase II, a focus group interview was conducted to explore their in-depth experiences. Qualitative data were thematically analysed. RESULTS: Fifty-seven students participated in the survey and seven students took part in the focus group interview. Quantitative data analysis showed a statistically significant improvement in the student's individual accountability, promotive interaction, positive interdependence, interpersonal skill, communication skill, teamwork skill, critical thinking and consensus building after jigsaw learning sessions. Qualitative data explained their experiences in-depth. CONCLUSION: Jigsaw cooperative learning improves collaboration, communication, cooperation and critical thinking among the undergraduate medical students. Educators should use jigsaw learning methods to encourage effective collaboration and team working. Future studies should explore the effectiveness of the jigsaw cooperative learning technique in promoting interprofessional collaboration in the workplace.

Survival in general surgery: The female surgeons' perspective.

Objective: Specialty choices in health profession has long been influenced by gender. The field of General Surgery remains the least preferred specialty by females, especially in Pakistan. The objective of this study was to identify the factors leading to success and retention of females in General Surgery in Pakistan. Methods: Qualitative case study was conducted from February to May 2020 at Khyber Medical University, Peshawar. Ten semi-structured interviews were conducted with purposive sample of female surgeons at various academic position in different tertiary care hospitals of Pakistan. Data were thematically analyzed. Results: Participants were driven by their passion for surgery, which led them to choose this specialty in the beginning. Their survival in male dominant workplace was made possible by their own personality traits and conducive environment provided by the supervisors and peers. However, a structured mentorship program for females was found lacking. Conclusion: The necessary ingredients for success are passion and personality traits in any field but attention to nurturing and supportive environment for females in the General Surgery is paramount in determining success. Due consideration to the factors identified in the current study will enhance the retention and success of females in General Surgery.

Use of situational judgment tests for assessing non-cognitive attributes of final year dental students.

OBJECTIVE: Situational judgment tests (SJT) have been previously used in the admission process of medical and dental undergraduate programs, but their utilization as an assessment tool is fairly new. The objective of this study was to explore essential non-cognitive attributes of dental graduates. We also aimed to assess the attributes of final year dental students utilizing SJT and later collected participants' reactions on the test. METHODS: A mixed-method exploratory sequential study was conducted. One-on-one and group discussions were done with subject matter experts (SMEs) to explore the essential attributes of fresh dental graduates. Based on the thematic analysis, 10 SJT items per domain were constructed by one group of SMEs and expert validated by a different group of SMEs and vice versa. The final dental-SJT was piloted online on final year dental students and their perceptions were collected using a five-point Likert scale questionnaire. Descriptive statistics and Cronbach's alpha were calculated for the test. RESULTS: The consultation with SMEs generated three main themes, namely, Conventional skills, Tribal skills, and Occupational skills. The 70-item dental-SJT piloted on 150 final year dental students revealed data were normally distributed. The internal reliability of test was good (0.738). Students scored highest in "management skills" (>70%) and lowest in "professional ethics" (56%) and "diverse experiences" (58%). The overall student perception about the test was good. CONCLUSION: SJT is an effective tool to assess non-cognitive attributes of dental students. It has an overall positive perception about perceived predictive validity, perceived fairness, face and content validity.

Exploring challenges and mitigation strategies towards practicing Teledentistry.

BACKGROUND: Since the beginning of the COVID-19 pandemic, many dentists have opted for Teledentistry as a mechanism for patient consultation, oral lesion evaluation, diagnosis, and monitoring. The current study explores the challenges faced and potential solutions proposed by dentists practicing Teledentistry in a developing country like Pakistan. METHODS: A qualitative case study was carried out from January to December 2021. A purposive maximum variation sample of 10 dentists was interviewed in two focus groups. The interview guide was developed using the technology-organization-environment framework. The data was transcribed verbatim using otter.ai. The analysis involved immersion in the data and open coding. The conceptually related codes were synthesized into themes and subthemes. FINDINGS: The study found various Personnel, Technological and Organizational challenges, and potential solutions from those practicing Teledentistry. The challenges included operational cost, minimal financial returns, lack of awareness, hardware and software support, and other challenges related to the availability of specialization, accessibility, and institutional encouragement. They suggested Institutional Based Practice, staff training, hiring, development of government regulations, and supporting infrastructures such as designated space, central registry, internet, and using/building software to provide 3D images as solutions. CONCLUSION: Teledentists face Personnel, Technological and Organizational challenges and related potential solutions from those practicing Teledentistry in Pakistan. Government should encourage Teledentistry to reduce long-term costs, encourage preventive services and enable rural access to dental care. They should also involve all stakeholders to develop regulations for practicing Teledentistry in Pakistan.

From text to e-text: perceptions of medical, dental and allied students about e-learning.

Objective: More than a year ago, Pakistan like the rest of the word, was hit by a global pandemic, due to which students of higher education had to accept the new era and adapt to the electronic learning environment for the very first time. This study aims to analyze the perceptions of medical, dental, and allied health students about e-learning in Pakistan. Methods: A descriptive, cross-sectional study was conducted throughout the country. A pre-validated, anonymous online questionnaire regarding demographics, past-experience of e-learning, advantages disadvantages of e-learning, and general perception of students towards e-learning was distributed. Descriptive statistics were computed for all demographics. Chi-square test was used to compare the differences of perceptions between pre-clinical year and clinical years students. Chi-square was used to compare overall category-wise positive and negative responses of students. The association between participant demographics and their perception towards e-learning was also calculated using chi square. Results: A total of 1200 students participated in the study of which 797 (66.4%) were from pre-clinical years and 403 (33.6%) were from clinical years. The major advantage identified by all students was the 'comfortable environment' (70%) and 'technical problems with IT equipment' was listed as the biggest disadvantage (89%) of e-learning. For preclinical year students, 'anxiety due to social isolation' was selected as the biggest issue (p < 0.05) whereas, for clinical year students, it was 'lack of patient interaction' (p < 0.05). Overall, 72% of students had a negative perception of e-learning. Conclusion: After more than a year of online studying, medical and allied students of Pakistan have expressed dissatisfaction towards e-learning. Student-teacher training, student counselling sessions, and innovative techniques need to be introduced to enhance student engagement and reduce pandemic stress.

The Perceptions of Non-native Medical Students Towards Language Barrier on Clinical Teaching and Learning: a Qualitative Study from Saudi Arabia.

Background: Patient-doctor communication is essential for achieving the best healthcare quality for the patients. Saudi Arabia hosts a variety of healthcare providers from diverse cultures and languages, making language barriers distinctive towards effective communication for a predominantly Arab population. There is limited research on the challenges associated with language barriers among non-native medical students. The current qualitative study aims to explore the perceptions and experiences of non-native medical students during clinical encounters with Arabic speaking patient population at a private university in Riyadh, Saudi Arabia. Methods: This is a qualitative case study employing non-native medical students in clinical years to explore their perceptions and experiences towards language barriers. Participants attended four focus group discussions, following a brief regarding the concept of the challenges that language barriers pose. All interviews were recorded and transcribed verbatim. A thematic framework analysis was employed to analyze the data. Results: Twenty-two non-native medical students participated in the study. We identified four broad themes constituting problems in patient interaction, development of clinical skills, managing and overcoming language barriers, and student recommendations to overcome language barrier. Participants suggested improvements in available Arabic language courses and the introduction of a professional skills course in Arabic for non-native students. Conclusion: Non-Native medical students perceived language barriers as an obstacle to a meaningful clinical experience. They identified implications for clinical learning environment, professionalism, empathy, and patient care. Recommendations for advanced occupation-related Arabic language courses to facilitate doctor-patient interactions were made to improve patient-student interactions between native patients and non-native medical students.

How does postgraduate diploma in Family Medicine impact on primary care doctors?

BACKGROUND: Over the last decade, the emphasis on improving the education and training of family physicians has increased. World Health Organization has also emphasized the importance of a trained primary care workforce. In 2017, Khyber Medical University (KMU) Peshawar initiated a one-year Postgraduate Diploma in Family Medicine for doctors working in primary care, to upgrade their skills and knowledge as Family Physicians. To justify the allocation of resources, there is a need for research on the impact of such programs. This study explores the impact of Diploma in Family Medicine (DFM) on primary care doctors in Khyber Pakhtunkhwa. It also identifies the barriers associated with learning and its translation to practice. METHODS: A mixed-method explanatory study was conducted from February 2019-2020. Forty-five graduates from the DFM program at KMU were invited to participate in this study. The quantitative data was collected through questionnaires (n=30) and the results were then explained further through qualitative focus group interviews (n=24). Descriptive statistics were calculated for the quantitative data and thematic analysis was performed for the qualitative data. RESULTS: The respondents (n=30/45) were satisfied from the course content and delivery. They agreed that the course is useful (93.3%), relevant to their learning needs (86.7%) and they were able apply it to their clinical practice (100%). The qualitative findings also corroborated that the course improved both the clinical and consultation skills of the participants. The learning environment encouraged them to identify their learning needs and attain new competencies. They reported being more patient-centered and evidence-based, which increased patients' satisfaction. The program also resulted in increased career opportunities and other monetary benefits. Despite the blended nature of the program, the participants found it challenging to balance training with the provision of services. CONCLUSION: One-year Postgraduate Diploma in Family Medicine is focused, practical and relevant to the learning needs of primary healthcare physicians. The policymakers should consider provision of such training opportunities in both public and private-sector. Future research should explore the long-term impact of such programs on healthcare outcomes.

Impact of implementing multisource feedback on behaviors of young doctors.

OBJECTIVES: Multisource feedback (MSF) is a workplace-based assessment tool that offers 360-degree evaluation of the trainee doctor. Little is known about its receptiveness among stakeholders in Pakistan. This study explores house officers' perceptions regarding MSF since its implementation in Eye Unit-II, Institute of Ophthalmology, King Edward Medical University/ Mayo Hospital, Lahore. METHODS: A qualitative case study was conducted from July 2019 to February 2020 in Eye Unit II. A purposive (maximum variation) sample of 12 house surgeons was taken. Two focus group discussions were conducted. Data were transcribed and analyzed thematically. RESULTS: The study identified the impact of MSF on house surgeons. Most participants reported positive experiences. The feedback they received increased their motivation, management skills and team working. A number of factors affecting the receptiveness of MSF were also identified which mainly included characteristics of raters and emotional response to MSF. CONCLUSION: Multisource Feedback is a useful tool for feedback that impacts the young doctors in many ways. It contributes to increasing their sense of responsibility, management skills and self-directed learning. The improvement in individual abilities and teamwork also helped in improving patient care.

Educational Environment In The Transition Phase Of Curriculum At Ayub Medical College Abbottabad, Pakistan.

BACKGROUND: Evaluation of the educational environment is key to the delivery of high-quality medical education. Especially, when an institute is in the transition phase of curriculum. In curriculum transformation phase of Ayub Medical College Abbottabad, no such evaluation has been done. This study aimed to find the direction of Educational environment in the transition phase curriculum of Ayub Medical College Abbottabad and compare different domains of educational environment with gender, residency, pre-medical education's medium of instruction, and doctors among sibling or parents. METHODS: This descriptive cross-sectional survey was conducted among students of integrated and traditional curriculum of Ayub Medical College, Abbottabad from 1st December 2019 to 29th February 2020. By Non-probability convenience sampling technique, pre-validated Dundee Ready Educational Environment Measure questionnaire was used. Descriptive and inferential statistics were calculated in SPSS v22. RESULTS: A total 149 (100%) participants, 66 (44.3%) males and 83 (55.7%) females with mean age of 20.5±1.07 years responded. Among total, 76 (51%) were from integrated curriculum and 73 (49%) were of traditional curriculum. Significant difference was found among different aspect of education environments and both classes. CONCLUSIONS: The current transitional phase of curriculum at Ayub Medical College Abbottabad is more positive than negative. Some areas like student social-self-perception still need improvement. Moreover, gender and place of birth affect student's perception about their learning environment.

Setting Agenda for Medical Education Research in Pakistan.

OBJECTIVE: To justify the allocation of human and financial resources, this study aims to identify multiple stakeholders' views of medical education research priorities in Pakistan for the next five years. METHODS: This two-stage exploratory mixed-method study was conducted from Jan 2018 to Jun 2019. A purposively selected sample of 250 faculty members, research supervisors, postgraduate students, undergraduate students and policymakers actively involved in improving Medical Education were included. In Stage-I: An exploratory open-ended questionnaire asking about Medical Education Research (MER) priorities in Pakistan for the next five years was emailed. Data were thematically analyzed to identify MER areas. In Stage-II: Another questionnaire was developed based on MER areas. The participants were asked to rate their importance on a scale of one to five. Descriptive statistics were calculated using SPSS.v.24. RESULTS: In Stage-I, 140 participants and in Stage-II, 130 participants from different stakeholder groups responded. We identified 20 research priorities grouped under eight themes: curriculum organization, content, delivery, assessment, workplace, students, faculty and educational management. Top three research priorities were identifying needs and developing effective provisions for continuous professional development of the faculty, improving assessment and communication skills. CONCLUSION: The study identified top MER priority areas as continuous professional development, assessment and communication skills. Some areas unique to the current study include admissions, fostering critical thinking, Islamic values in professionalism and ethics. The study provides evidence-base for decision-making about allocating time and funds for MER in Pakistan.

Assessment of burnout and associated factors among medical educators.

OBJECTIVE: To assess burnout in medical educators and to identify factors associated with it. METHODS: A sequential mixed methods research study was conducted over eight months from July 2018 until February 2019. Participants included medical educators, who are studying for or graduated with a postgraduate qualification in medical education. An online questionnaire was developed using Maslach Burnout Inventory to collect quantitative data. The findings were explored in-depth qualitatively. Descriptive and inferential statistics were calculated for the quantitative data using SPSS 20. For qualitative data, we performed thematic analysis. RESULTS: Of total 160 medical educationists, 101 responded giving 63.1% response rate. Mean age was 41.4 years and majority 53.5% were females. Overall aggregate mean burnout level was 12.34 ± 7.36 whereas sub-domains of Maslach burnout inventory (MBI) like i) emotional exhaustion, ii) depersonalization and iii) personal accomplishment were found out to be 19.59, 10.42 and 11.21 respectively. Most respondents had moderate 71 (70.3%) emotional exhaustion and 8 (8.9%) had severe emotional exhaustion. Average level of depersonalization was suffered by 73 (72.3%) respondents and severe level was observed in 20 (19.8%) respondents. Personal accomplishment was found low in all 101 (100.0%) respondents. Selective in-depth interviews revealed that coping mechanisms like social gatherings, indoor and outdoor game facilities and outings and leisure time should be strategized for faculties. CONCLUSION: In this study medical educators were found to have quite high level of burnout. The early career medical educators feels emotionally exhausted, with low sense of personal accomplishment.

Medical Students' and Trainees' Country-By-Gender Profiles: Hofstede's Cultural Dimensions Across Sixteen Diverse Countries.

PURPOSE: The global mobility of medical student and trainee populations has drawn researchers' attention to consider internationalization in medical education. Recently, researchers have focused on cultural diversity, predominately drawing on Hofstede's cross-cultural analysis of cultural dimensions from general population data to explain their findings. However, to date no research has been specifically undertaken to examine cultural dimensions within a medical student or trainee population. This is problematic as within-country differences between gender and professional groups have been identified within these dimensions. We address this gap by drawing on the theoretical concept of national context effects: specifically Hofstede's six-dimensional perspective. In doing so we examine medical students' and trainees' country profiles across dimensions, country-by-gender clustering, and differences between our data and Hofstede's general population data. METHODS: We undertook a cross-cultural online questionnaire study (eight languages) containing Hofstede's 2013 Values Survey. Our questionnaire was live between 1st March to 19th Aug 2018, and December 2018 to mitigate country holiday periods. We recruited undergraduate medical students and trainees with at least 6-months' clinical training using school-specific methods including emails, announcements, and snowballing. RESULTS: We received 2,529 responses. Sixteen countries were retained for analyses (n = 2,307, 91%): Australia, Chile, China, Hong Kong, India, Indonesia, Ireland, Israel, Japan, Malaysia, New Zealand, Pakistan, South Africa, South Korea, Sri-Lanka, Taiwan. Power distance and masculinity are homogenous across countries. Uncertainty avoidance shows the greatest diversity. We identified four country clusters. Masculinity and uncertainty are uncorrelated with Hofstede's general population data. CONCLUSIONS: Our medical student and trainee data provides medical education researchers with more appropriate cultural dimension profiles than those from general population data. Country cluster profiles stimulate useful hypotheses for further research, especially as patterning between clusters cuts across traditional Eastern-Western divides with national culture being stronger than gendered influences. The Uncertainty dimension with its complex pattern across clusters is a particularly fruitful avenue for further investigation.

Academic experiences of undergraduate post-registered BS nursing students in Islamabad, Pakistan.

OBJECTIVE: To assess the academic experiences of undergraduate post-registered BS (Bachelor of Science) nursing students in Islamabad. METHODS: This multisite cross-sectional study was conducted from February to May 2018. It included undergraduate nursing students from one public and three private-sector institutes of Islamabad. A pre-validated Undergraduate Nursing Students' Academic Satisfaction Scale (UNSASS) was used to collect data. Descriptive and Inferential statistics were calculated using SPSS 21, p< 0.05 was considered as significant. RESULTS: Out of 220 nursing students, 198 responded. Nursing students from public-sector were significantly more satisfied than those in private. This satisfaction was significant for classroom teaching and clinical teaching. The students from private institutes reported significantly greater satisfaction towards institutional support and resources. Female students from private colleges were significantly more satisfied with the clinical education (p<0.042) and programme design and delivery (p<0.018) than their male counterparts. First year students from public-sector were significantly more satisfied from classroom teaching (p<0.003), support and resources (p<0.036), while those in private from clinical teaching (p<0.002). Students aged 31 years and above were generally more satisfied. CONCLUSIONS: Post-registered BS nursing students are satisfied from their academic experiences during undergraduate training. Students in public-sector institutes are comparatively more satisfied.

Learning Based On Principles Of Cognitivism.

Sometimes, knowledge or information becomes difficult to understand and/or memorize. Cognitive load theory aids a learner to gain information effectively. It provides a scientific roadmap to the design of learning materials. Through a complex set of mental processes, information is acquiring, process, retain, and comprehend information. Applying mental effort for remembering is a very crucial phenomenon. The core of memory process is apprehending and saving of information into long term memory. Because of limited capacity of working memory, delivering or acquiring of information should not be overloaded with irrelevant materials. Based on cognitive load theory dozens of strategies can be intervened at different loci of cognitive process and every piece of information is easily remembered. Not only learners, but teachers can also get benefits from them. In this commentary, John Sweller ideology is further discussed and strategies are presented for better comprehension and memorization of difficult information.

What problems make students struggle during their undergraduate medical education? A qualitative exploratory study.

OBJECTIVE: To explore problems faced by struggling undergraduate medical students and their impact on student's academics. METHODS: A qualitative case study was carried out from March to August 2019. Semi-structured interviews were conducted with a purposive sample of sixteen struggling students. The interview questions were validated and then piloted to ensure clarity. All interviews were audio recorded and transcribed verbatim. Due to sensitive nature of the data, confidentiality and anonymity was ensured. Thematic analysis was employed to get meaning with in the data set. All authors ensured analytical triangulation by independently analyzing the data before developing consensus on the codes and themes. RESULTS: Eleven sub-themes under four major themes emerged from the transcripts. Participants were found to be struggling with emotional, academics and family related problems. Psychological distress was caused by factors such as fight with friends, one-sided love, and hard financial times. Time management, lack of attention and commitments at home were few of the other problems. Problems had an impact on students as they were demotivated, lost focus in their studies, could not perform good and few participants even failed in examinations. CONCLUSIONS: Students were struggling more with emotional and family related problems and less with academics related problems. They were impacting student's academics. The study site had a robust mentoring program however, struggling students need timely identification and more dedicated time to help them manage their problems. Stress relieving activities and counselling sessions may frequently be added, and academically underachieved students should also be given extra care, support, and guidance.