The repeated exam failure might affect further underachievement of MD students, especially first-year females – the single-centre observation based on selected yearlong courses

In order to address the uneven academic performance of MD students, the study focused on the potential association between the results of midterm assessment and students’ further underachievement. The authors addressed two research questions: (1) If a student fails the first attempt of the midterm test, can this result be considered as a risk factor of failing the first attempt of final exam as well?; (2) Is there a long-term effect of exam failure experience on academic performance on the third year of the curriculum? The retrospective cohort study involved anonymized MD student records containing: (A) 1737 first-year examinees who attended Biostructure and Development of the Human Body course; (B) 1206 third-year examinees who attended Pathology course; (C) subgroup of 621 students who participated in both courses in the analyzed period. Students who failed the first midterm assessment were at significantly higher risk of failing the first attempt of final exam in both analyzed courses (Biostructure and Development of the Human Body: risk ratio 3.76, 95% confidence interval 2.59–5.48, p < 0.001; Pathology: risk ratio 1.89, 95% confidence interval 1.44–2.48; p < 0.001). The risk of failing the first attempt of final Biostructure and Development of the Human Body exam was higher in females who failed the first attempt of midterm test (risk ratio 5.30, 95% confidence interval 3.29-8.52) than males (risk ratio 2.35, 95% confidence interval 1.28-4.32, p=0.04). Moreover, examinees who failed the first attempt of final Biostructure and Development of the Human Body exam in the first year of their studies had significantly higher risk of failing the first attempt of final Pathology exam as well (risk ratio 2.95, 95% confidence interval 2.20-3.94; p<0.001). The point score at the first attempt of final Biostructure and Development of the Human Body exam was a negative predictor of the outcome of the first attempt of final Pathology exam (logistic regression estimated coefficient -0.09, 95% CI -0.11-(-0.07); p<0.001). The analysis of students’ underachievement at midterms may help educators to identify the students who are at risk of entering the cycle of repeated failure and who should receive support to improve their academic performance.