Association between concurrent military training and academic achievement in dental education: a mixed-methods study

Karary University is the only institution in Sudan integrating military and civilian cohorts within dental education. Military dental students face a “dual-track” curriculum, balancing rigorous clinical studies with mandatory tactical training. This study aimed to examine the association between concurrent military training and academic achievement and to identify reported barriers to success. A convergent parallel mixed-methods study was conducted involving an initial screened population of 572 male dental students, yielding a final stratified sample of 538 students (114 military, 424 civilian) after predefined exclusions. Quantitative academic data, specifically Grade Point Average (GPA), were analyzed using Mann-Whitney U tests and multivariable logistic regression adjusting for academic year and clinical rotation blocks. Qualitative data were collected via five focus group discussions (FGDs; n = 55) and 15 semi-structured interviews with senior faculty to explore facilitators and barriers. Civilian students achieved a significantly higher mean GPA compared to military students (3.21 ± 0.48 vs. 3.07 ± 0.43; P < 0.001), demonstrating a modest effect size (Cohen’s d = 0.31). High-tier achievement (Grade B or higher) was nearly threefold higher in the civilian cohort (19.6% vs. 6.1%). Qualitative analysis identified “Time Poverty” and “Perceived physical and cognitive fatigue” as primary barriers. A “Discipline Paradox” emerged: while military students were described as punctual and compliant, reported cognitive and physical fatigue was associated with a possible “Performance ceiling” for higher academic tiers. Military student status was associated with lower dental academic achievement in this institutional cohort. The mean GPA difference was modest, while the proportion achieving Grade B or higher was substantially lower among military students. Qualitative findings identified perceived time constraints and physical and cognitive fatigue as contextual themes. These findings do not establish that military training caused the observed academic differences. Potential scheduling and academic-support strategies, including a proposed interval between intensive training and clinical sessions, should be treated as hypotheses for prospective evaluation rather than established interventions.