Exam Failure Research Articles

Predicting Student Academic Performance by Means of Associative Classification

The Learning Analytics community has recently paid particular attention to early predict learners’ performance. An established approach entails training classification models from past learner-related data in order to predict the exam success rate of a student well before the end of the course. Early predictions allow teachers to put in place targeted actions, e.g., supporting at-risk students to avoid exam failures or course dropouts. Although several machine learning and data mining solutions have been proposed to learn accurate predictors from past data, the interpretability and explainability of the best performing models is often limited. Therefore, in most cases, the reasons behind classifiers’ decisions remain unclear. This paper proposes an Explainable Learning Analytics solution to analyze learner-generated data acquired by our technical university, which relies on a blended learning model. It adopts classification techniques to early predict the success rate of about 5000 students who were enrolled in the first year courses of our university. It proposes to apply associative classifiers at different time points and to explore the characteristics of the models that led to assign pass or fail success rates. Thanks to their inherent interpretability, associative models can be manually explored by domain experts with the twofold aim at validating classifier outcomes through local rule-based explanations and identifying at-risk/successful student profiles by interpreting the global rule-based model. The results of an in-depth empirical evaluation demonstrate that associative models (i) perform as good as the best performing classification models, and (ii) give relevant insights into the per-student success rate assignments.

Student employment in France: Hindrance rather than help for higher educational success?

ABSTRACT In this study, we examine how student employment impacts higher educational trajectories in France. Focussing on undergraduates’ educational outcomes, we show the consequences of different intensities and levels of recurrence of student employment on perseverance in higher education. We use data from a nationally representative four-year longitudinal survey, descriptive analysis and logistic regression are performed to control for student characteristics. Our results suggest that student employment, especially when intensive and during periods of exams, increases exam failure. When it is recurrent over time, student employment often leads to university dropout. Furthermore, even for those who do manage to reconcile work and study, it lengthens the time spent in higher education. This consequence is particularly costly in France, where success in higher education is often judged by time-to-completion, encouraging strategies that lead to finishing degree requirements as quickly as possible. This approach is difficult to follow for students who must combine work and study, leading to particularly pronounced costs.

Do Learning Styles Enhance the Academic Performance of University Students? A Case Study

Higher education models appear to be not entirely designed to support students in facing severe challenges, such as failure in exams and dropping out of school. To solve these challenges, several models of learning styles have been proposed, under the premise that these studies contribute to improving the student's learning experience. This research aims at quantifying the impact of learning styles (learning preferences/dimensions) on students' academic performance from a higher education institution. Ninety-six undergraduate students were surveyed during the 2018-2019 school year and randomly divided into two groups: control (CG) and experimental (EG). The learning preferences of the students were identified using the Unified Learning Style Model (ULSM) instrument. Subsequently, the level of students’ knowledge concerning the course was determined employing a pre-test exam. As a following step, the students of the EG consulted the learning objects designed considering different learning styles. The CG attend their lessons in a face-to-face environment; both groups answered a post-test exam to assess their learning. The learning styles' effect -learning objects were designed to cover several learning styles- on academic performance is quantified employing an ANOVA analysis. The results differ from those postulated in previous researches based on the ULSM since there is no statistical evidence that learning styles influence students' academic performance. Therefore, it is necessary to explore other cognitive and affective factors that make the student's learning experience efficient and effective.

Examining the Gap Between Medical School Matriculation and Graduation Rates Amongst Self-Identified Minorities

PurposeDespite increasing diversity, data indicates that there is a gap between the matriculation or admission of and graduation rates amongst medical students who identify with racial or ethnic minority groups. The purpose of this study was to identify barriers experienced by minority medical students that may account for this gap. MethodsAn IRB approved online survey was created, and distributed electronically to minority medical students, residents, and practicing physicians. Information on demographics, family dynamics, academic struggles, health issues, financial difficulties and faculty diversity was collected via self-report. ResultsParticipants (n = 167) who completed the survey identified as Black/African/African American (60%), Hispanic/Latinx (26%), Asian (8%), and as Other racial or ethnic minority (6%). The majority of survey participants graduated within the traditional 4 years of medical school (83%) and 17% did not. The most frequently reported reason was to pursue academic advancement (42%) which included completing a research year, dual degree, or PhD. The second reason was due to academic deficiencies (38%), either course failure or failure of a board exam. The majority of respondents (59%) also reported not having enough faculty members who were members of racial or ethnic minority groups at their medical school. ConclusionsOur data suggests the majority of racial and ethnic minority medical students graduate within the traditional 4 years of medical school. However, if they do not, it is either due to academic advancement to become a more successful residency applicant, or due to academic issues. The majority of respondents reported that they perceive a lack of racial and ethnic minority faculty members in academics.

Financial difficulties and student health: Results from a National Cross-Sectional Survey of Norwegian college and university students

To examine financial circumstances among Norwegian higher education students and investigate associations between financial difficulties and health, academic outcomes and self-destructive behaviours, we used data from a recent national health survey from 2018 for higher education in Norway (the SHoT study). 50,054 full-time students (69.1% women; 30.9% men) aged 18–35 years participated and reported work status, income and experience of financial difficulties, self-reported mental health problems, deliberate self-harm and suicide attempts, somatic health complaints and exam failures in higher education. Students often experiencing financial difficulties (n = 3933, 7.9%) reported more mental health problems (HSCL-25; M = 2.1 vs 1.6), depression (24% vs 7.2%), anxiety (20.8% vs 6.7%), deliberate self-harm (12.2% vs 4.9%), attempted suicide (3.1% vs 0.5%), somatic health complaints (SSS8; M = 13.1 vs 7.4), having ever failed exams (45.5% vs 28.4%) and higher average number of failed exams (M = 1.1 vs 0.6) compared to peers not experiencing financial difficulties. These associations were robust to adjustments for age, gender, relationship status, immigrant background and study program. Strategies to alleviate problems associated with financial difficulties may be to improve the existing financial support to students, strengthen student mental health services, and expand services for financial counselling and guidance.

Red Flags, Geography, Exam Scores, and Other Factors Used by Program Directors in Determining Which Applicants Are Offered an Interview for Anesthesiology Residency.

ObjectiveThe goal of this study was to measure the most important factors in candidate applications that anesthesiology program directors (PDs) use to decide who to invite for an interview, and how that might change once the United States Medical Licensing Examination (USMLE) Step 1 is only reported as pass/fail.DesignBased on a literature review, a comprehensive list of 27 factors used by PDs to select candidates for the interview was developed. An anonymous survey link was emailed to PDs of all Accreditation Council for Graduate Medical Education (ACGME) accredited Anesthesiology residencies. The survey asked PDs to rank order the top 10 factors they currently consider for making interview invitation, and then to repeat the rank ordering as if the USMLE Step 1 score was instead reported as pass/fail as will be done beginning in 2022.ResultsForty-five of 159 (28%) PDs responded, with 82% disagreeing with changing the Step 1 score to pass/fail. 84% consider the Step 1 score (77% for Step 2) moderately or very important for selecting an applicant for an interview. The most frequently mentioned “red flags” were failure of a licensing exam, failure of a medical school course, gaps in education without explanation, and criminal history. 69% of PDs agreed that applicants coming from the medical school affiliated with their program would have an advantage over other applicants. Although, the three factors most commonly ranked in the top 10 in importance were the Step 1 score, followed by letters of recommendation, and then the Medical School Performance Evaluation, variability exists in how PDs ranked factors. For example, of the PDs that had Step 1 in the top 10, 27% had it ranked between the 6th and 10th most important. 9% of PDs did not have Step 1 score in the top 10. Core clinical clerkship grades were one of the top 5 factors by 49% of PDs, yet overall was the 6th most common top 10 factor as 36% of PDs did not have core clerkship grades at all in the top 10. Once Step 1 is reported only as pass/fail, PDs had letters of recommendation, Step 2, and the Medical School Performance Evaluation as the most frequently ranked factors in the top 10. 64% of the PDs supported restricting the number of programs a candidate can apply to, with the majority suggesting a limit of 15 to 20 programs per applicant.ConclusionVariability exists among anesthesiology PDs in the key criteria for offering an applicant an interview. Once Step 1 is reported as pass/fail, there will be an increased emphasis on Step 2 scores.

Role of formative assessment in predicting academic success among GP registrars: a retrospective longitudinal study

ObjectivesThe James Cook University General Practice Training (JCU GPT) programme’s internal formative exams were compared with the Royal Australian College of General Practitioners (RACGP) pre-entry exams to determine ability to...

Near-Peer Learning During the Surgical Clerkship: A Way to Facilitate Learning After a 15-Month Preclinical Curriculum

To investigate the performance and perspectives of third-year medical students (MS3s) participating in near-peer learning (NPL) sessions during their core surgical clerkship following a 15-month preclerkship curriculum. An evaluation study of 7 NPL sessions developed and implemented by fourth-year medical students (MS4s) held from March 2019 to February 2020. MS4s taught 1-2 sessions per rotation that included test taking strategies, illness script development, radiology review, case-based multiple-choice questions, and rapid review. Participants completed a questionnaire with 11 seven-point Likert and open-ended questions after each session. Analyses included quantitative comparison of shelf score averages between NPL participants and nonparticipants and qualitative content analysis for open-ended questions. Surgical clerkship at the University of California, San Francisco. Forty-eight (32%) MS3s participated, with an average attendance of 10 students per rotation. Thirty-three (69%) participants completed the questionnaire. MS3s enjoyed the session (6.9 ± 0.4), improved their knowledge (6.8 ± 0.5), and felt more prepared for the surgery shelf examination (6.5 ± 0.6). MS4 leaders found that MS3s always wanted radiology review, and their interest in test taking strategies and illness script development declined across the clerkship year. Participants had lower shelf exam scores compared to nonparticipants (68.1 vs 71.4, respectively; p = 0.04, ES = 0.03). Shelf exam scores increased over time in both cohorts. Each group had 2 shelf exam failures. Qualitative analysis suggests that MS3s appreciated the NPL's tailored approach and exam demystification, with a desire for increased NPL integration into the clerkship. Students participating in NPL were satisfied with the sessions. Participants may have been students who struggled as indicated by shelf exam scores and appreciated the support. The shift in preferred topics across the blocks reflects the students' development during clerkships. Near-peer teachers should adjust sessions over time to fit students' evolving needs.

58. ENTER THE MATRIX; A STANDARDIZED, ACCOUNTABLE APPROACH TO RESIDENT BOARD PREPARATION

Background Balancing clinical and board relevant education is a common struggle for residency programs. The ACGME mandates that programs maintain a > 70% first-time board pass rate but does not dictate how this is achieved. In-training exam (ITE) scores are reliable predictors of certifying board scores, but remediation success remains variable within and across institutions. Our program developed an educational aide, “the Matrix”, to guide and hold residents accountable for board preparation with flexible study activities based on individual learning preferences. It provides a starting point for determining remediation need and activities for those at risk of board failure. Objective Develop an educational aide based on adult learning theory to improve board pass rates of categorical pediatric residents. Methods Beginning intern year, pediatric residents completed the intervention “Matrix” throughout the academic year, with learning activities including practice question banks, article reviews and didactic attendance (Exhibit A). Residents discussed “Matrix” compliance with advisors every 3 months over 3 years. Board pass rate of residents for the 3 years after institution of the matrix is compared to prior 5 years of pass/fail data. Results First-time board pass or failure data was obtained for 60 residents over an 8-year period and divided into a pre- and post-intervention group (36 control and 24 intervention subjects). Pre-intervention had a composite pass rate of 70% compared to the intervention group with a pass rate of 92%, which is statistically significant (p value 0.01). Conclusion Our program has early success in increasing yearly board pass rates. Fewer have failed in the past 3 years post-intervention than in the 1 year prior. Adult learners require self-driven, relevant methods of study. Those at risk for exam failure need accountability. Applying these concepts to resident education improved pass rates with a small resident cohort taking the certifying boards. Our aide is easily adapted by other intuitions looking for a flexible but standardized method of board preparation.

Technical success rate of MR elastography in a population without known liver disease.

MR elastography (MRE) has a low technical failure rate in patients with chronic liver disease. The failure rate in an unscreened population is unknown. The purpose of this study was to determine the technical failure rate of MRE in patients with no known liver disease. In this prospective trial, 633 patients received 673 scans on a 1.5 T MRI using a standard gradient recalled echo MRE protocol. Four MRE images were acquired and repeated as necessary. Two investigators in consensus categorized each failure: 1. Anatomical masking failure; 2. Iron deposition; 3. No waves (connection problem); 4. Poor wave propagation; 5. Poor passive driver placement; 6. Patient breathing problems. Full exam failure was defined as no usable data in all slices. Partial failure was no usable data on at least one slice. 1.0% (7/673) were full failures and 7.0% (47/673) were partial failures per patient. Full failures: iron deposition-71.4% (5/7); no waves-28.6% (2/7). 4.0% (108/2733) slice failure rate: Anatomical masking failure-31.5% (34/108); Iron deposition-25.0% (27/108); No waves-13.0% (14/108); Poor wave propagation-7.4% (8/108); Poor passive driver placement-11.1% (12/108); Patient breathing problems-12.0% (13/108). The failure rate of 1% is lower than for a screened population. Iron overload was implicated in most full failures. This study demonstrates the high technical success rate of MRE in an unscreened population laying the foundation for MRE as a possible screening tool for the general public.

From school to employment; the dilemma of youth in Sub–Saharan Africa

ABSTRACT The present study compares the educational attainment level among the youth in two Sub-Saharan African countries, namely; the Democratic Republic of the Congo (DRC) and Madagascar, with their status in work. The study employed data from the school-to-work transition survey of the International Labour Office, 2015. This study reveals that in the two countries investigated, that youths face several challenges when negotiating their move to employment because the educational attainment of the majority of them is deplorable. Financial burdens and exam failures are the critical reasons why the youth of these two countries leave school early and engage in low-quality jobs to secure their living. Besides, young wage workers are most likely to be exposed to exploitation, since their employment is usually based on an oral contract.

Profile of Personality and Psychopathology Dimensions of Indonesian Medical Students who Failed in Medical Doctor Competency Exams (UKMPPD)

Abstract
 Introduction
 Medical doctor competency exams (UKMPPD) in Indonesia is a final test that should be followed by medical student before being declared worthy of a medical doctor’s degree. This exam is certainly intended with good intentions, in order to improve the standards and quality of graduates of Indonesian doctors. However, each policy turns out to have two opposite sides of the situation, on the one hand it is profitable but on the other it often creates new problems. Students’ fear of the competency test often causes new psychological problems for students. No doubt the failure of the competency exam causes students to experience prolonged disappointment and sadness, which in turn will cause depression. This research is the first research that aim to present a description of personality and psychopathology dimension data from UKMPPD participants who failed the test.
 
 Method
 This study was an exploratory descriptive study by presenting narratives of personality and psychopathology dimensions of unsuccessful UKMPPD participants. This research was conducted at the Faculty of Medicine, Universitas Sriwijaya Palembang, Indonesia. Each participant was assessed personality and psychopathology dimensions using MMPI-2 (Minnesota Multiaxial Personality Inventory-2). The results of analysis with MMPI-2 present data in the form of clinical psychic conditions, the work capacity, interpersonal relationships, the work abilities and the ability to change the self potential of the research subjects.
 
 Result
 The research subjects were UKMPPD participants who did not successfully pass the first exam. From 7 research subjects, there were 2 subjects who successfully passed the second exam (28.5%) and there were 3 people who successfully passed after the third exam (43%). Meanwhile, 2 research subjects have not successfully passed the UKMPPD exam until the fifth exam (28.5%). The results are quite surprising that of the 7 participants who failed to pass the UKMPPD exam, all of them felt depression.
 
 Conclusion
 Medical students who experienced UKMPPD failures have an inability to develop their own potential which result in depression due to failure of the exam

Improving Understanding of Immunology for First Year Medical Students

BackgroundImmunology is a complex field of basic science. Understanding numerous concepts and details is necessary for pre‐clinical medical students to be able to apply immunological concepts to clinical cases and patient care. Faculty in the Hematology and Lymphatics course collaborated to change the way primary immunodeficiencies were taught in an effort to increase comprehension and integration of basic and clinical sciences.MethodsIn previous years, all immunology in the course was taught by basic sciences faculty. To change this approach, we added a lecture by a clinical faculty member which covered important/notable manifestations of primary immunodeficiencies. The basic sciences faculty member continued to emphasize underlying cellular defects that give rise to clinical presentations. We also included a new integrated event (a TBL session) taught by both clinical and basic sciences faculty, in which students were presented with clinical cases and asked to come up with differential diagnoses, explain their rationale and defend their choices, and explain the causes of patient symptoms.ResultsThe average score on immunology exam items increased by more than 10 percentage points. Average scores on the exam which included this material increased, while number of exam failures decreased. Student feedback also indicated that this approach was helpful for understanding the material.ConclusionsEmphasizing clinical correlations in teaching immunology to pre‐clinical medical students resulted in course improvements indicated by both quantitative and qualitative measures.

Evaluation of Effectiveness of Digital Technologies During Anatomy Learning in Nursing School

The disciplines of biosciences included in the curricula of a nursing degree represent a daunting but crucial type of knowledge that a well-prepared nurse should acquire. Given the importance and the objective difficulties of these courses, nursing students experience anxiety, especially for the anatomy course. This anxiety and the related rate of exam failures lead professors to analyze their teaching approach, by diversifying the lecturing methods. The aim of our study was to test the use of a virtual dissection table (DT) during the anatomy lectures of a nursing course, evaluating the anxiety level before the exam and evaluating the exam score. The feedback of the evaluated student population was positive overall. The integration of the DT in anatomy lectures improved the learning performance and mostly enhanced the self-confidence of the first year nursing students.

A REVIEW STUDY ON TRAMADOL ABUSE AMONG EGYPTIAN UNIVERSITY STUDENTS

Tramadol, which is a medication used for moderate and severe pains, has caused drug abuse and addiction to the Egyptian community. This study aimed to observe the prevalence of tramadol abuse among Egyptian university students. By following the PRISMA reporting guideline, a systematic review of evidence was conducted. Search strategy was conducted through PubMed-NCBI to yield appropriate published literature between 2014-2019, as well as performed literature screening, eligibility criteria, and data extraction. The process of selection yielded a total number of 2 studies to be eligible for the review inclusion criteria. The characteristics evaluated that correlate to tramadol were classified into four groups: gender, smoking, alcohol consumption, and failure in exams before. In general, tramadol showed positively associated with other prevalence characteristics. Tramadol is the second most commonly abused drug among university students in Egypt. The review highlights that tramadol abuse has become a common phenomenon among Egyptian university students which necessitates for ample attention. Future research is recommended to identify the causal effects of tramadol abuse and its role as a potential gateway drug.
 Peer Review History: 
 Received 2 January 2020; Revised 22 February; Accepted 1 March, Available online 15 March 2020
 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency.
 Received file 
 
 Average Peer review marks at initial stage: 5.5/10
 Average Peer review marks at publication stage: 7.0/10
 Reviewer(s) detail:
 Name: Hebatallaha A Moustafa
 Affiliation: Ain Shams University, Egypt
 E-mail: anasweety2003@yahoo.com
 
 Name: Dr. Hassan A.H. Al-Shamahy
 Affiliation: Sana'a University, Yemen
 E-mail: shmahe@yemen.net.ye
 
 Name: Dr. Ali Abdullah Al-yahawi
 Affiliation: Al-Razi university, Department of Pharmacy, Yemen
 E-mail: alyahawipharm@yahoo.com
 Comments of reviewer(s): 
 
 Similar Articles:
 A CROSS-SECTIONAL STUDY ON BENZODIAZIPINE (BZD) ABUSERS OF DHAKA CITY: A SOCIO-PSYCHOLOGICAL CONDITION OF BANGLADESH
 AWARENESS AMONGST YOUTH ABOUT USE AND ABUSE OF STEROIDS IN KARACHI, PAKISTAN
 ALCOHOL INFLUENCES AGGRESSIVE BEHAVIOUR THAT INCREASES LIKELIHOOD OF INITIATING DATING VIOLENCE AMONG MALE YOUTH IN COLLEGES WITHIN WESTERN COUNTRIES: A SCOPING REVIEW

Sleep Quality among Medical Students of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Medical students are under constant stress due to demanding academic load, fear of exam failure and hectic schedules. These factors can lead to poor sleep quality among medical students. Sleep quality of medical students not only determine their academic performance but is also important in determining long term effect on cognitive, psychosocial, behavioural as well as physical health of individuals. Although there are not enough recent studies to assess sleep quality of students, it is necessary to evaluate the condition of sleep among students. This study aims to find out the prevalence of poor sleep quality among medical students. This descriptive cross-sectional was conducted among undergraduate medical students of Kathmandu Medical College from October to November 2019 after taking ethical clearance from Institutional Review Committee of a tertiary care hospital before collecting data from participants. Subjects were recruited by simple random sampling from students of first, second, third and final years and were asked to fill the self-reported questionnaires, using Pittsburgh Sleep Quality Index. Descriptive statistical analysis was done using Statistical Software for Social Sciences version 24. Out of 217 selected medical students, 96 (44.23%) of students have poor sleep quality with prevalence among male and female students as 41 (39.8%) and 55 (48.2%) respectively. The mean duration of sleep among students was 6.7±1.6 hours. Significant numbers of medical students have poor sleep quality which may affect their academic performance and may have long term impact on their health. Efforts must be directed towards educating about the sleep hygiene as well as proper time management skills.

大学生考试失败归因的结构及问卷编制

大学生考试失败归因的结构及问卷编制

Factors associated with depression among medical students in a private tertiary care hospital in South India

Background: Undergraduate medical training is perceived more stressful compared to other undergraduate program. Medical students to undergo strenuous curriculum and evaluation added to that other factors like homesickness, heavy workload, sleep deprivation, financial concern, environment not ideally suited for learning, information over load and career planning make them more susceptible to depression compared of students of other profession. Objectives: to estimate the prevalence of depression and assess the factors associated with depression among medical students. Methodology: A cross-sectional study was conducted among medical undergraduate students of a tertiary care hospital in Tamil Nadu situated in the suburban area of Chennai. A total of 232 students was studied to estimate the prevalence of depression using Beck’s Depression Inventory (BDI) questionnaire was used. Results: A total of 232 medical students were included in the study based on the inclusion criteria, of which 49.5% (115/232) were males while 50.5% (117/232) were females. Prevalence of severe depression was 12.5% and very severe depression was 3.4%.. Higher number of students in the age group 17 -19 years were with severe and very severe depression compared to 20-22 years of age group and it was found statistically significant(p=0.001). Compared to males higher number of females were having severe and very severe depression and it was found statistically significant (p=0.04) severe and very severe depression was higher in first year students compare to final year students and it was found statistically significant (p=0.000). Significance association was found between higher BMI, consuming alcohol, previous exam failure and do not do regular exercise with depression. Conclusion: The burden of depression among medical Students found to be common that do more in the first year of college life compared to final years an effective counseling of the students at the time of induction will reduce the burden of depression in medical colleges.

نوجوانوں میں خودکشی کا بڑھتا ہوا رجحان، اسباب اور اس کا حل سیرت طیبہ کی روشنی میں

Suicide is strictly forbidden in Islam. But now a days we can see that ratio of suicide is increasing day by day in our society and this increasing ratio of suicide is mostly among youngsters. Being an Islamic country and being Muslims, it is an alarming situation for all of us and a moment to stop and think that why our youth is involving in this haram act .We conducted a survey among youngsters. We constructed a questionnaire. We asked about the causes, factors increasing this trend, main cause and steps to reduce this ratio. Our respondents were young girls. So after filling questionnaire we came to know that one of the biggest cause of increasing trend of suicide is gap from Islamic Teachings. And some other causes are poverty, unemployment, laziness of parents in supervision of children, use of social media, and failure in exam. So at end we concluded that we follow Islamic teachings properly and spend our life according to the teaching of Islam then this ratio can be decreased. We used SPSS statistical package for the social sciences for analysis of this data.

PAEA End of Rotation™ Exams Accurately Identify Students at Risk of Physician Assistant National Certifying Exam Failure.

Physician Assistant Education Association (PAEA) End of Rotation™ exams are used by programs across the country. However, little information exists on the predictive ability of the exams' scale scores and Physician Assistant National Certifying Exam (PANCE) performance. The purpose of this study was to evaluate End of Rotation exam scores and their relationship with poor PANCE performance (PPP). In an IRB-approved, multi-center, multi-year study, associations between PAEA End of Rotation exam scale scores and PANCE scores were explored. A taxonomy of nested linear regression models with random intercepts was fit at the program level. Fully adjusted models controlled for year, timing of the exam, student age, and gender. Fully adjusted linear models found that 10-point increases in End of Rotation exam scores were associated with a 16.8-point (95% confidence interval [CI]: 14.1-19.6) to 23.5-point (95% CI: 20.6-26.5) increase in PANCE score for Women's Health and Emergency Medicine, respectively. Associations between exams did not significantly vary (P = .768). Logistic models found End of Rotation exam scores were strongly and consistently associated with lower odds of PPP, with higher exam scores (10-point increase) associated with decrements in odds of PPP, ranging between 37% and 48% across exams. The effect estimate for the Emergency Medicine exam was consistently stronger in all models. PAEA End of Rotation exam scores were consistently predictive of PPP. While each End of Rotation exam measures a specialty content area, the association with the overall PANCE score varied only by a change in odds of low performance or failure by a small percentage. Low End of Rotation exam scores appear to be consistent predictors of PPP in our multi-center cohort of physician assistant students.