Understanding Academic Difficulties Among Undergraduate Medical Students

  • David Kirtchuk

Student thesis: Doctoral Thesis


This thesis takes a sequential design consisting of a mixture of study methods was used to explore the underlying predictors and drivers of academic underperformance to better inform future curriculum design, the development of support services and make medical schools more equitable spaces.

There are three components. 1) A scoping review of existing literature that explored the students’ experiences of academic difficulties. 2) A retrospective cohort analysis of the demographic and early assessment performance data between 2013-2017 at a single UK medical school to identify predictors of decile placement at the end of the third year. 3) An interpretative phenomenological analysis study that explored the students’ experiences of academic difficulty.

Medical students are often under-prepared for and lack the tools to manage their experiences of academic difficulties. This tends to negatively impact their self-worth and mental well-being, leading to the utilisation of maladaptive coping strategies. However, failure, particularly in assessments considered by students to reflect their future roles as doctors, can drive self reflection, the development of improved learning strategies and can strengthen engagement with support. Early performance data can predict ongoing academic performance and adds to the growing literature that non-White students, students with disabilities and students who enter medical school from access courses are over-represented in the lower spectrum of results. The process of ranking students in deciles based on their performances during the course, a component of foundation job applications, was identified by students as particularly problematic due to its contributions to the competitive environment, reducing shared learning and adding to mental stress and anxiety.

Students who face academic difficulty find self-analysis challenging and welcome the provision of tools that may help identify their needs early in the course. Combining predictive assessment data analytics in a longitudinal mentorship support model has the potential to fill this role, and help faculty deliver individualised, tailored support to students. The student experience is not felt to be equitable, with financial pressures, the presence of mental health difficulties, the sense of a lack of belonging and the lack of access to socialised learning being identified as barriers to academic performance and potential contributors to differential attainment. Improving financial support, making mental health services more accessible, developing peer mentorship programs, increasing faculty diversity and developing institute-student partnerships may help combat this. Finally, this thesis questions the continued use of ranking students as part of the foundation job application process in the UK and calls for the UKFPO to consider alternative strategies.
Date of AwardSept 2023
Original languageEnglish
Awarding Institution
  • University of Brighton
SupervisorThomas Levett (Supervisor), Clare Casteldine (Supervisor) & Richard de Visser (Supervisor)

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