Coping Strategies of Failing International Medical Students in Two Chinese Universities: A Qualitative Study.

Phenomenon: China hosts a large number of international medical students from low-income countries, and some fail examinations in the early stage of the Bachelor of Medicine and Bachelor of Surgery (MBBS) program. Little is known about how failing international medical students cope to recover their academic performance. It would be beneficial to investigate the coping strategies they use to help them recover their academic performance and progress. Approach: Semi-structured interviews were conducted with 21 international medical students at two universities in China from September 2020 to January 2021. These students had passed make-up exams or re-sits and progressed academically. A thematic analysis approach was used to identify major themes in the interview data. Findings: After failing initial exams or re-sits, students were found to adopt seven coping strategies to help them pass future examinations and recover their academic performance: (i) increased help-seeking behaviors, (ii) improved learning motivation and attitudes, (iii) improved learning strategies, (iv) improved exam preparation, (v) utilization of library resources, (vi) enhanced time management, and (vii) enhanced English language skills. Of the seven strategies, seeking help from friends, peers, seniors, and teachers was the strategy reported most frequently. Insights: The results of this study provide insights into the coping strategies that international undergraduate medical students adopt to recover from poor academic performance in Chinese universities. Host institutions should recognize the resilience and agency of such students to make positive changes. Furthermore, institutional efforts should be made to develop contextualized intervention plans that stimulate students' learning motivation and encourage them to adopt self-help strategies by incorporating useful resources (e.g., help from peers, seniors, and teachers). Enrollment should integrate specific English language proficiency criteria, and interviews and entrance exams should be conducted. For some failing students, it may be necessary to provide academic remediation.

Challenges facing international students at Iranian universities: a cross-sectional survey.

BACKGROUND: This study examines the challenges faced by international students at Tehran University of Medical Sciences (TUMS) and provides insights into their experiences and needs. METHODOLOGY: A self-developed structured questionnaire was administered to international students who completed their first year at TUMS. Data were collected from 165 participants (76% response rate) and analyzed using SPSS 22.0. RESULTS: The study reveals that international students encounter various challenges, including difficulties accessing information, language barriers, ineffective communication, administrative inefficiencies, cultural issues, financial constraints, and limited scholarship opportunities. Analysis of students' characteristics indicates that the length of study at TUMS is significantly associated with the challenges experienced. The findings highlight the importance of enhancing support services and resources for international students, such as language classes, academic counseling, scholarships, and cultural exchange programs. CONCLUSION: Addressing these challenges can foster a more supportive environment, contributing to the academic success and well-being of international students at TUMS and similar universities.

Crossing horizons: unraveling perspectives on enhancing medical students' success through at-risk factor exploration.

BACKGROUND: Medical universities often face the ongoing challenge of identifying and supporting at-risk students to enhance retention rates and academic success. This study explores a comprehensive analysis of perceived at-risk factors impeding academic and career aspirations and compares the perspectives of students and faculty in a medical school. METHODS: We focused on first and second-year medical (MBBS) students and teaching faculty in an international medical college offering a twinning program in India and Malaysia. Our investigation involved a comprehensive assessment of 25 at-risk factors through Likert-type questionnaires distributed to 250 MBBS students and 50 teaching faculty. RESULTS: Our findings revealed distinct disparities in perceptions between faculty and students regarding mean scores of classroom engagement (p = 0.017), procrastination (p = 0.001), unrealistic goals (p = 0.026), emotional/behavioral problems (p = 0.008), limited key social skills (p = 0.023), and a non-supportive home environment (p = 0.001). These differences underscore the need for increased communication and understanding between faculty and students to address these risk factors effectively. In contrast, no significant disparities were observed among faculty and students' perceptions concerning mean scores of various potential at-risk factors, including academic unpreparedness, cultural/language barriers, individual guidance/mentoring, limited communication skills, racism/sexism, self-confidence, self-respect, self-concept, motivation, underprepared for current academic challenges, self-discipline, negative social network, negative peer culture, transportation time, college financial cost, college evaluation culture bias, broken college relationships, teaching methodology, and learning disabilities. However, varying degrees of influence were perceived by faculty and students, suggesting the importance of individualized support. CONCLUSION: This study contributes to the academic community by shedding light on the multifaceted nature of at-risk factors influencing student success. It underscores the need for proactive measures and tailored interventions to enhance student retention in higher education and academic achievement, fostering a sustainable foundation for lifelong learning and growth.

Effect of anatomical studies prior to medical school on medical school anatomy study success and residency choice.

INTRODUCTION: There is little research on how medical school matriculants' experiences prior to medical school effects their choice of specialty or performance in medical school. This research attempts to fill that gap in research in regards to surgical and radiological fields. METHODS: An anonymous survey was sent to fourth year medical students asking them their background in anatomy studies prior to medical school and their anatomy grades in medical school and interest in surgical and radiological fields. Students were also asked whether they identified with under-represented demographic groups in those specialties. RESULTS: Prior anatomy experience did not significantly affect performance in anatomy courses or Step 1 and Step 2 scores. However, students who applied to surgical specialties had higher performance in anatomical courses and higher Step 1 scores compared to those who did not apply to surgical specialties. There was interestingly no difference in under-represented and not under-represented student application to these fields. DISCUSSION: For shareholders interested in increasing medical student performance, or interest in specific specialties, more information needs to be gathered.

Assessing the predictive validity of pre-admission criteria on dental students' academic performance: a cross-sectional study.

BACKGROUND: This study examines the multifaceted factors influencing academic performance among dental students in Saudi Arabia, exploring the complex relationships between demographic, educational, and psychological variables and students' Grade Point Averages (GPAs) to enhance global dental education admission strategies. METHODS: Data on demographics, academic performance indicators (including GPA, high school grades, test scores), accommodation type, parental education, suspension history, and English proficiency were collected through an English-language electronic questionnaire from 900 dental students across multiple institutions in Riyadh. The study employed Pearson's correlation analysis to examine relationships between GPA and various academic and demographic factors. A detailed regression analysis, using a stepwise selection based on Akaike's information criteria (AIC), identified significant GPA predictors and evaluated the average marginal effects of pre-admission variables on GPA, alongside rigorous diagnostic checks to validate the model's robustness. RESULTS: The study revealed a complex interplay of factors impacting GPA among dental students. High school grades, achievement, and aptitude test scores showed moderate positive correlations with GPA, while negative correlations were observed with age and number of times suspended. Regression analysis highlighted age, marital status, high school grades, and test scores as key predictors, with complex interaction effects demonstrating the layered influences of these factors. For instance, the negative impact of age on GPA was moderated by high school grade and aptitude test score. The analysis also highlighted the significant marginal effects of various pre-admission variables on GPA, such as the negative average impact of age and the positive impact of high school grades. CONCLUSIONS: This study provides valuable insights into the multifaceted determinants of academic success in dental education. Our findings underscore the significant roles of high school grades, achievement, and aptitude test scores, as well as the nuanced influence of age and marital status on GPA. These results advocate for a holistic approach in evaluating candidates for dental programs and have broader implications for global dental education, emphasizing the need for comprehensive admission strategies.

Self-reported neurostimulant use among university students in Santa Maria, Rio Grande do Sul, Brazil.

University students frequently resort to psychostimulants to enhance their physical and mental performance and manage academic pressures. However, these substances can lead to dependence and other undesired symptoms, and little empirical data are available for relevant stakeholders, raising significant concerns in health care. Therefore, this study aims to characterize neurostimulant use among university students in Rio Grande do Sul, Brazil. We collected from 880 students' data using anonymous self-administration. The questionnaire included consumption patterns of caffeine, nicotine, ecstasy, methamphetamine, "merla" (coca base), methylphenidate, cocaine, crack, and ketamine. Additionally, participants shared information on demographic and socioeconomic factors. Use of at least one neurostimulant was reported by89.2% of the participants. Among nonusers, the most frequently cited reason was "previous information about harmful effects of these drugs." Caffeine, followed by nicotine, ecstasy, and methylphenidate were the most consumed substances, with main reasons being "improving academic performance" and "recreation." Women more often consumed caffeine (72.7%), while other psychostimulants were more consumed by men (42.2%) and individuals of other genders (0.5%). Students who consumed other substances had higher family incomes than that of families of caffeine users. In addition, 60.4% of caffeine users resided with family members, whereas 63.3% of users of other substances did not. Our findings can offer essential data on the reasons and symptoms associated with the use of neurostimulants among university students. This information could aid in raising awareness among students, universities, and health-care agencies about this often-neglected subject.

Academic motivation decreases across adolescence for youth with and without attention-deficit/hyperactivity disorder: Effects of motivation on academic success.

BACKGROUND: This longitudinal study examined growth trajectories of academic motivation in youth with and without attention-deficit/hyperactivity disorder (ADHD) across the important developmental transition from middle school to high school, and associations with academic success. Consistent with self-determination theory (SDT) of motivation, trajectories of amotivation, extrinsic motivation, and intrinsic motivation were modeled. METHODS: The study included a robust multi-method, multi-source assessment of academic outcomes, including homework performance ratings; reading and mathematics standardized test scores; and grade point average (GPA) obtained from school records. Participants included 302 adolescents (ages 12-14; Mage = 13.20) in eighth grade who were specifically recruited so that approximately half (n = 162) were diagnosed with ADHD and 140 adolescents comprising a comparison sample without ADHD. The sample was predominantly White (81.80%), with 7.90% identifying as bi/multiracial, 5.30% identifying as Black/African American, 4.60% identifying as Asian, and 0.30% identifying as Indigenous/Alaskan. RESULTS: Adolescents with ADHD had worse academic motivation at all timepoints. Growth curve analyses indicated the academic motivation of adolescents without ADHD decreased at faster rates across the transition to high school compared to adolescents with ADHD. However, for adolescents with ADHD, amotivation, extrinsic motivation, and intrinsic motivation each predicted GPA, with higher extrinsic and intrinsic motivation also predicting better homework performance and different aspects of math performance, whereas for youth without ADHD, only amotivation and extrinsic motivation predicted GPA. CONCLUSIONS: Intervention and school policy implications are discussed, including the importance of fostering autonomy and internal motivation, and consideration of whether current ADHD interventions primarily foster extrinsic motivation.

The influence of occupational therapy students' preferred language on academic and clinical performance in a Canadian university program.

The Occupational Therapy Program at this Canadian university is a French program however, students must be bilingual to function in English or French clinical fieldwork settings. An understanding of the role of language in successful completion of program requirements was needed to effectively support students' education. The study objectives were to identify the role of linguistic factors in students' academic and clinical performance and to provide recommendations for strategies to address areas of learning difficulty. A multimethod approach used 4 data sources: (1) Multiple Mini Interview (MMI) informal language assessment scores, (2) grade point average (GPA), (3) fieldwork evaluation reports, and (4) an online survey of program graduates. The GPA on admission and MMI scores of 140 students predicted respectively only 20% and 2% of the variation in GPA on program completion. The areas of poorest performance in failed clinical fieldwork reports were in clinical reasoning and communication competencies. Among survey respondents (n = 47), 44.5% reported that a clinical placement in their second language with related charting (51.6%) and client communication (40.9%) were the most significant difficulties encountered in the program. Clients with mental health issues (45.4%) were the most challenging population to work with, attributed to communication barriers in the students' second language. Strategies are proposed to support occupational therapy students' academic and clinical language proficiency, including conversational training courses, problem-based learning activities in students' second language, focussed teaching on the clinical reasoning process and reflective skills, and language coaching to address early signs of difficulty in clinical fieldwork.

Clinical experience can compensate for inferior academic achievements in an undergraduate objective structured clinical examination.

BACKGROUND: Practical and non-cognitive skills are essential to medical professions; yet, success in medical studies is primarily assessed with cognitive criteria. We show that practical exams can benefit students who have only average high school final grades, but working experience in medical professions. METHODS: With a cross-sectional study, we compare the performance of undergraduate medical students with working experience in adjacent health-care professions (and below-average school leaving-grades) with students who entered medical school directly based on their excellent school records in an Objective Structured Clinical Examination (OSCE). For a sample of more than 1,200 students, we use information on OSCE scores in medical and practical skills, doctor-patient communication/interaction, performance in MC-exams, and core sociodemographic variables. RESULTS: Waiting list students outperformed their classmates in the demonstration of practical skills. Students admitted via their excellent school grades scored best overall. This difference vanishes once we control for school-leaving grade and age, the two main factors separating the analysed groups. Students from the waiting list have a significantly smaller overall chance to reach excellent grades in the first two years of study. CONCLUSIONS: Students who gathered experiences in health-care professions before enrolling at medical school can benefit from an expanded role of practical elements in medical studies. Student selection instruments should take these different starting positions and qualities of applicants into account, for example with a quota for the professionally experienced.

Relationship between academic success, distance education learning environments, and its related factors among medical sciences students: a cross-sectional study.

BACKGROUND: Academic success is among the most important criteria for determining students' competence. Hence, one of the concerns of education system researchers has always been investigating its associated factors. Therefore, this study aimed to determine the relationship between academic success, distance education learning environments, and its related factors among Shahroud University of Medical Sciences students. METHODS: This cross-sectional study was conducted on 208 medical sciences students who completed at least two online and two in-person academic semesters. Participants were selected through the convenience sampling method and filled out three questionnaires, including the demographic information form, the Academic Success Inventory for College Students, and the Distance Education Learning Environments Survey. Finally, the data were analyzed using descriptive statistics and inferential tests (t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression). RESULTS: In this study, students reported moderate levels of academic success (107.81 ± 10.72). Moreover, they assessed their distance education learning environment as the positive points were more than the negative points (74.10 ± 14.89). Distance education learning environment (ß = 0.233 and P < 0.001) and field satisfaction (ß = 9.797 and P = 0.001) were also mentioned as factors related to students' academic success. CONCLUSION: According to the present results, it is suggested to improve the learning environment of distance education and increase students' satisfaction to enhance their academic outcomes such as academic success.

Selection tests and their predictive value in university nursing students' success in the first year of study.

BACKGROUND: Academic performance factors, such as school-leaving grades and other academic indicators for selection, play a significant role in student success. The study aimed to determine the best predictors of academic success in the first year of study for nursing studies at a South African university using three National Benchmark Test (NBT) domains and four National Senior Certificate (NSC) subjects. METHODS: We conducted a retrospective review of the admission data of first-time students (n = 317), enrolled on the Bachelor of Nursing between 2012 and 2018. Hierarchical regression was used to explore important variables predicting success in the first year of study. Cross tabulations were used to determine the association between progression outcome, proficiency levels of the NBT and school quintiles. RESULTS: All predicting variables explained 35% of the variance in the first year of the study. The NBT MAT (Mathematics), Academic literacy (AL), and NSC's Life Sciences were statistically significant predictors for passing the first year. Analysis of progression outcomes by the NBT proficiency levels suggests that most students begin studies with lower entry-level skills than required, which hinders academic progress. No major differences in academic performance were observed for the students who attended different quintiles. CONCLUSION: Selection test results predict areas where students are likely to encounter difficulties and inform the interventions needed to achieve academic success. There may be serious implications for students admitted with low entry-level skills in variables predicting academic success and they would need tailored academic interventions to improve their grasp of mathematical and biological concepts and their ability to read, think and reason.

Emotional intelligence weakly predicts academic success in medical programs: a multilevel meta-analysis and systematic review.

BACKGROUND: Emotional intelligence (EI) is a predictive factor of academic success in undergraduate Doctor of Medicine (MD) programs. Although some research suggests a positive association between EI and academic success in MD programs, other research reports neither an association nor a negative correlation between the two variables. The current study aimed to resolve these contradictory findings by conducting a systematic review and a meta-analysis using research from 2005 to 2022. METHODS: Data were analyzed using a multilevel modeling approach to (a) estimate the overall relationship between EI and academic success in MD programs and (b) determine whether the mean effect size varies according to country (United States vs. non-United States countries), age, EI test, EI task nature (ability-based vs. trait-based), EI subscales, and academic performance criteria (grade point average vs. examinations). RESULTS: Findings from 20 studies (m = 105; N = 4,227) indicated a positive correlation between EI and academic success (r = .13, 95% CI [.08, - .27], p < .01). Moderator analyses indicated that the mean effect size significantly varied according to EI tests and EI subscales. Moreover, three-level multiple regression analyses showed that between-study variance explained 29.5% of the variability in the mean effect size, whereas within-study variance explained 33.5% of the variability in the mean effect. CONCLUSIONS: Overall, the current findings show that EI is significantly, albeit weakly, related to academic success in MD programs. Medical researchers and practitioners can therefore focus on integrating EI-related skills into the MD curriculum or target them through professional development training and programs.

Effect of solution-focused approach on problematic internet use, health behaviors in schoolchildren.

BACKGROUND: Problematic internet use negatively affects adolescents' health behaviors and school success. PURPOSE: This study evaluated the effects of a solution-focused approach (SFA) on adolescents' problematic internet use, health behaviors, and perceived academic success. METHODS: A randomized controlled experimental design was used with pre-test-post-test. The sample comprised 128 middle school students, with 64 in the intervention group and 64 in the control group. Data were collected using an information form, Young's Internet Addiction Test, the Nutrition-Exercise Behavior Scale, and the Nutrition-Exercise Attitude Scale. The intervention group attended six SFA group meetings. RESULTS: "The intervention group's, mean pre- and post-test internet addiction scores were 35.65 ± 4.43 and 17.07 ± 5.01, respectively. There were statistically significant differences between the post test groups (p < 0.05) for mean internet addiction, total nutrition-exercise attitude, and total nutrition-exercise behavior and subdimension (except regular meals) scores and perceived academic success. IMPLICATIONS FOR PRACTICE AND RESEARCH: SFA may prevent students' uncontrolled internet use, help them gain positive health behaviors, and increase perceived academic success. The school nurse, on the other hand, may support the adolescent and their families with solution-focused interview strategies.

Rise Above the Competition: How Do Plastic Surgery Residency Applicants with NCAA Experience Fare in the Residency Match?

BACKGROUND: The integrated plastic surgery residency match continues to be highly competitive. Every year, some candidates are former NCAA athletes. While it is challenging to balance academic and athletic responsibilities, participation in NCAA sports may be predictive of continued success. OBJECTIVES: This study aimed to evaluate the impact of participation in collegiate athletics on applicant anticipated rank and academic success. METHODS: All applications received from 2017 to 2020 at a single institution were reviewed for participation in NCAA athletics (Division I-III). Our primary outcome of interest was applicant anticipated rank by letter of reference writers. Applications were also examined for demographic information, membership in AOA, number of research publications, and USMLE board certification examination scores. RESULTS: After reviewing 885 applications, 61 applicants (6.89%) were former NCAA athletes. Former NCAA involvement was associated with the highest effect on anticipated ranking (- 0.22, p=0.001). Former NCAA involvement demonstrated the highest odds of receiving an anticipated ranking in the top 5 (OR 1.83, p=0.025). We found no significant difference in research productivity between the two groups, including first authorships or USMLE Step 1 board certification exam scores. A significant difference was seen in race distribution, with forty-five (80.4%) of athlete applicants identifying as Caucasian, while 430 (56.5%) of non-athletes identified as Caucasian (p=0.012). CONCLUSION: Former athletes applying to become integrated plastic surgery residents overcome the challenges of balancing athletic and academic pursuits with a higher anticipated rank in the integrated plastic surgery match while having comparable academic achievement. Former collegiate athletes have demonstrated greater success in and after residency. Former NCAA participation demonstrated the highest odds of receiving a top-5 rank. Former NCAA applicants showed no difference in academic productivity LEVEL OF EVIDENCE V: Case series study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Clinical experience improves academic outcomes in dental Oral surgery education.

INTRODUCTION: This paper aimed to determine if the level of a dental student's clinical experience in oral surgery influences the student's oral surgery academic outcomes. MATERIALS AND METHODS: The oral surgery clinical activity and academic outcomes for all students who completed their dental training in 2017, 2018, 2019 and 2020 from the University of Sydney were analysed for correlation. RESULTS: The clinical activity performed by 313 students was recorded. There was a weak, but statistically significant, Pearson correlation between total dental extractions and academic outcomes (r = .243, p = <.001). The total number of dental extractions performed was the only statistically significant variable on academic outcomes with linear regression analysis (ß = .227, p = .005; model R2  = .077). The increase of a student's clinical experience from less than 45 to more than 65 dental extractions raised their oral surgery academic results by an average of 6.4%. There were no academic benefits to earlier clinical experience. CONCLUSION: An increase in experience with dental extractions resulted in an increase in oral surgery academic outcomes, plateauing at 65 dental extractions. There was no academic advantage to dental student's having earlier clinical experience.

A multisite transition to nursing program: an innovative approach to facilitate incoming nursing students' academic success.

OBJECTIVES: Evaluate effectiveness of a multisite program promoting the successful transition of baccalaureate and graduate entry (with a prior degree) students into pre-licensure curricula. Faculty concern around nursing students' successful completion of nursing programs and passage of the nursing licensure exam stems from challenges students encounter in core courses, study habits, and civility. METHODS: One hundred eighty-five students participated in a quasi-experimental pre-post-test mixed-methods study. Students completed content modules and open-ended surveys. RESULTS: Most students found the program helpful. Statistically significant improvements were shown in medication calculation, reading comprehension, and medical terminology. No statistically significant improvement was shown in anatomy and physiology. CONCLUSIONS: Our Transition to Nursing program shows promise and adds to proactive strategies in preparing students for a successful transition into nursing programs. Our innovative approach may serve as a model to nursing schools and colleges around the world to promote student success.

Causal attributions of failure among post graduate medical residents in exit fellowship examination in Pakistan: A qualitative study.

Background and Objective: Causal attributions are reasons given to certain events in life including failure and success. The objective of this qualitative study was to explore the attributions perceived as the cause of failure by post graduate residents, failing the final clinical exit examination of Fellowship of College of Physicians and Surgeons Pakistan (FCPS). Methods: This exploratory study was conducted from July 2021 to July 2022, at Jinnah Hospital, Lahore. Study population was selected by purposeful maximal variation sampling. A total of ten post graduate residents from four specialties, failing in FCPS part two clinical examination were included. After written informed consent, semi structured face to face, in depth interviews were conducted. Data saturation was achieved after eight interviews after which two more interviews were carried out. All interviews were recorded and transcribed verbatim. Thematic analysis of the data was done by synthesizing codes into categories and themes. Results: A total of 17 attributions noted were grouped into five categories namely 'Inadequate exam preparation', 'Personal factors,' 'Exam related factors,' 'Training related factors and 'Luck'. Two main themes of External and Internal factors emerged from these. Common attributions were; lack of effort (8/10), inadequate knowledge (8/10), family commitments (7/10), luck (8/10) and examiner's attitude (5/10). Conclusions: Most of the residents attributed internal, unstable and controllable factors like inadequate knowledge and lack of effort. In addition, external uncontrollable factors of bad luck and harsh attitude of examiners were considered as contributory factors towards failure.

Examining associations between intelligence mindset, mental health symptom severity, and academic self-efficacy and performance.

Individuals possess different beliefs regarding the malleability of intelligence, also known as intelligence mindsets. Despite evidence demonstrating a link between a growth mindset of intelligence-the belief that intelligence can develop through effort-and academic achievement, this link has not been closely examined from a mental health perspective. Given the increasing prevalence of mental health conditions, such as anxiety and depression, among undergraduate students, an important question is whether the well-established link between mental health symptom severity and academic outcomes depends on the intelligence mindset beliefs that individuals possess. A growth mindset of intelligence might buffer the negative impact of anxiety and depression on academic outcomes, whereas a fixed mindset-the belief that intelligence cannot be changed-might exacerbate this negative relationship. The present study examined data collected from 660 undergraduate psychology students in the United States to test whether intelligence mindset beliefs moderated the relationship between mental health symptom severity and various indicators of academic outcomes: academic self-efficacy, GPA, and perceived academic standing. Results revealed that intelligence mindset beliefs did not moderate the observed negative association between mental health symptom severity and academic outcomes. Findings indicate that promoting a growth mindset of intelligence might not be a particularly effective strategy for buffering university students from the negative impact of anxiety and depression on academic outcomes. However, this conclusion is limited by the cross-sectional design of the study, and future prospective research is necessary to further clarify the relationship between intelligence mindset, mental health, and academic outcomes.

Perceptions of factors that facilitate and impede learning among twice-exceptional college students with autism spectrum disorder.

This qualitative comparative case study explored the personal perceptions and institutional factors that facilitated academic success, as well as challenges, in college among a sample of 40 academically talented students with autism spectrum disorder (2e/ASD) who were enrolled in highly competitive colleges and universities in the United States. Findings from the study included that the majority had excellent reading and writing skills, but struggled with mathematics. The personal trait that most enabled them to be successful in college, described by 26 of the 40 students, was a driving passion for learning. Half of the participants were motivated to succeed academically by the independence college offers, as well the flexibility to take advantage of a range of opportunities, and the development of their personal autonomy. The majority of the participants indicated that faculty members' instructional practices were their greatest barriers to learning.

Translation and Cultural Adaptation of NIH Toolbox Cognitive Tests into Swahili and Dholuo Languages for Use in Children in Western Kenya.

OBJECTIVES: Performing high-quality and reliable cognitive testing requires significant resources and training. As a result, large-scale studies involving cognitive testing are difficult to perform in low- and middle-income settings, limiting access to critical knowledge to improve academic achievement and economic production in these populations. The NIH Toolbox® is a collection of cognitive, motor, sensory, and emotional tests that can be administered and scored using an iPad® tablet, reducing the need for training and quality monitoring; and thus, it is a potential solution to this problem. METHODS: We describe our process for translation and cultural adaptation of the existing NIH Toolbox tests of fluid cognition into the Swahili and Dholuo languages for use in children aged 3-14 years in western Kenya. Through serial forward and back translations, cognitive interviews, group consensus, outside feedback, and support from the NIH Toolbox team, we produced translated tests that have both face validity and linguistic validation. RESULTS: During our cognitive interviews, we found that the five chosen tests (one each of attention, cognitive flexibility, working memory, episodic memory, and processing speed) were generally well understood by children aged 7-14 years in our chosen populations. The cognitive interviews informed alterations in translation as well as slight changes in some images to culturally adapt the tests. CONCLUSIONS: This study describes the process by which we translated five fluid cognition tests from the NIH Toolbox into the Swahili and Dholuo languages. The finished testing application will be available for future studies, including a pilot study for assessment of psychometric properties.