Impact and copying mechanisms towards retakes: A case study of five health training institutions in Sub Saharan Africa.

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Academic examination retakes are significant challenges in health professions education. With rigorous clinical assessments and high-stakes examinations, many students struggle to meet academic requirements, resulting in retakes. The voices and experiences of such students have often been absent within the broader discussion of health professions education. This study aimed to assess the impact and copying mechanisms of medical and nursing students with retakes across five Sub-Saharan African universities. Methods This was a mixed-methods explanatory sequential study, integrating quantitative surveys and qualitative interviews. The study involved 764 medical and nursing clinical students from five universities across Sub Saharan Africa: Busitema University (Uganda), Mzuzu University (Malawi), University of Ibadan (Nigeria), Kwame Nkrumah University of Science and Technology (Ghana), and the University of Zambia. Quantitative data were analyzed using descriptive statistics. Qualitative data were explored through thematic analysis based on in-depth interviews with 15 purposively selected students who had experienced retakes. Results Overall, the proportion of students who had ever had a retake in clinical assessments was 12.6%. Thematic analysis revealed emotional and psychological challenges, such as shock, anxiety, fear and suicidal thoughts particularly due to insufficient institutional support and lack of feedback. Many students also reported a perceived sense of unfairness in their assessments. Conclusions The study highlights the multifaceted nature of retakes in health professions education in Sub-Saharan Africa. Recommendations for improvement include providing detailed feedback, transparency in assessments, and enhancing both academic and psychological support systems for students, particularly those at higher risk, such as older students and males. Further research is needed to investigate long-term academic and career outcomes and effective remediation strategies for students experiencing retakes.