Retakes Affect One in Eight Health Professions Students in Five African Universities

More than one in ten medical and nursing students across five Sub-Saharan African universities have had to retake a clinical assessment, and the examinations causing the most trouble are the practical, station-based tests designed to measure hands-on clinical skill. A cross-sectional study published in BMC Medical Education surveyed 764 medical and nursing clinical students at Busitema University in Uganda, Mzuzu University in Malawi, the University of Ibadan in Nigeria, Kwame Nkrumah University of Science and Technology in Ghana, and the University of Zambia. The study team, led by Ronald Kibuuka and colleagues across the five participating institutions, used a self-administered questionnaire and analyzed the responses in SPSS version 25.

Descriptive statistics summarized who the students were and how often retakes occurred, while bivariate and multivariable logistic regression identified which factors were statistically associated with having taken a retake. The researchers reported crude and adjusted odds ratios with 95 percent confidence intervals, setting the threshold for statistical significance at p < 0.05. This design captures a snapshot in time across the five universities, so it can identify associations but cannot establish that any factor causes a student to fail an assessment.

Two demographic patterns emerged. Students aged 25 and above showed a higher likelihood of retakes than their younger counterparts, with an odds ratio of 2.45 (95 percent confidence interval 1.06 to 5.64, p = 0.036), meaning older students in this sample had roughly two and a half times the odds of having retaken a clinical assessment. Male students were also more likely than female students to have retakes at the bivariate stage, with an odds ratio of 1.91 (95 percent confidence interval 1.21 to 3.00, p = 0.005).

However, the authors note that this gender association did not remain statistically significant once other variables were accounted for in the multivariable analysis, a distinction that matters for interpreting which characteristics independently track with retake risk. The most striking finding concerned examination format. The Objective Structured Clinical Examination, or OSCE, was the assessment format most frequently associated with retakes, accounting for 47.7 percent of them, a proportion the authors report as highly significant at p < 0.001.

The authors frame the findings as an extension of their earlier work. While a previous publication from the group focused on how students perceive the OSCE as an assessment tool, the present study moves beyond perception to quantify how common retakes are and to identify demographic and institutional predictors of academic failure. The practical implications the researchers draw are targeted rather than sweeping.

They argue that the results highlight the need for institutional interventions aimed at at-risk populations: older students, male students, and those struggling with the particular demands of different clinical skills assessment modes. In their view, ameliorating these factors through appropriate support systems could reduce the proportion of students who must retake modules and create a more supportive academic environment. The authors do not specify in the abstract what those support systems should look like, and the study was not designed to test whether any particular intervention works.

Context matters for reading these numbers. Health professions education in Sub-Saharan Africa operates under conditions the authors describe as demanding: rigorous clinical assessments, limited training resources, and high-stakes examinations that students must pass to progress. The study also carries limitations worth keeping in view.

As a cross-sectional survey relying on self-administered questionnaires, it depends on students accurately recalling and reporting their own retake history, and it captures a single point in time at five selected universities rather than a nationally representative sample. The multivariable models adjust for measured confounders, but the reported confidence intervals, particularly the wide interval around the age effect, indicate uncertainty that larger samples could narrow. The gender association that disappears after adjustment illustrates how easily a bivariate signal can reflect the influence of other variables rather than an independent effect.

What the study establishes is a baseline. The authors suggest that building support systems around the identified at-risk groups, and paying particular attention to how clinical skills are assessed, could lower the retake burden. Whether such interventions actually reduce retake rates remains a question for future research, but the prevalence and predictor data now exist to measure that progress against.

Subject of Research: Prevalence and predictors of examination retakes among medical and nursing students at five Sub-Saharan African universities

Article Title: Factors associated with retakes in health professions courses: a case study of five selected universities in Sub-Saharan Africa

Article References: Kibuuka, R., Mpasa, F., Atuhairwe, I., Agaba, B., Nakattudde, P., Owusu-Sekyere, S., Amponsah, A., Chizoma, N., Adenike, O., Kennedy, K., Baker, O. S., Kaminga, A., Epuitai, J., Chimbe, E., Baluwa, M., Munthali, G., Phiri, T., & Katuramu, R. (2026). Factors associated with retakes in health professions courses: a case study of five selected universities in Sub-Saharan Africa. BMC Medical Education. https://doi.org/10.1186/s12909-026-10272-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10272-0

Keywords: medical education, nursing education, examination retakes, OSCE, Sub-Saharan Africa, cross-sectional study, clinical assessment, logistic regression, academic failure, health professions, Uganda, Malawi