{"id":70981,"date":"2021-09-13T14:36:12","date_gmt":"2021-09-13T06:36:12","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=70981"},"modified":"2022-01-04T07:41:41","modified_gmt":"2022-01-03T23:41:41","slug":"exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success\/","title":{"rendered":"\u2018Exam preparedness\u2019: Exploring non-academic predictors of postgraduate exam success"},"content":{"rendered":"<p>Submitted: 19<span lang=\"EN-GB\"> October 2020<\/span><br \/>\r\nAccepted: 12 April 2021<br \/>\r\nPublished online: <span lang=\"EN-GB\">5 October, TAPS 2021, <\/span><span lang=\"EN-GB\">6(4), 80-91<\/span><br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2021-6-4\/OA2456\">https:\/\/doi.org\/10.29060\/TAPS.2021-6-4\/OA2456<\/a><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Balakrishnan Ashokka<sup>1,2<\/sup>, Tat Leang Lee<sup>1<\/sup> &amp; Dani\u00eblle M.L. Verstegen<sup>3<\/sup><\/span><\/p>\r\n<p style=\"text-align: justify\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Department of Anaesthesia, National University Health System, National University Hospital, Singapore; <sup>2<\/sup>Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; <sup>3<\/sup>Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Netherlands<\/span><\/i><\/p>\r\n<p style=\"text-align: center\"><b><span lang=\"EN-GB\">Abstract<\/span><\/b><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Introduction:<\/span><\/b><span lang=\"EN-GB\"> There are certain factors in exam preparedness that are not well studied in the postgraduate medical education context. Non-academic predictors have been extensively researched but usually in isolation. <\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Methods:<\/span><\/b><span lang=\"EN-GB\"> The study involved a sequential explanatory mixed methods research design. The study was conducted among anaesthesia postgraduates appearing for high-stake nation-wide primary examination. Data obtained by a questionnaire assessing pre-examination attributes were compared with the students\u2019 reflections through focus group discussions (FGD) after the formal declaration of results. The examination had an overall pass rate of 42.9% (18 out of 42). <\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Results:<\/span><\/b><span lang=\"EN-GB\"> The study showed that pre-examination questionnaire could identify attributes and study behaviours in the postgraduates who passed. Passers procrastinated three times lesser, pursuing a timetable-based study (conscientiousness); had higher metacognitive self-regulation (p value&lt;0.05) applying concentrated self-directed learning &amp; effective group study and higher self-efficacy compared to those who failed. The focus group discussions affirmed of these attributes in candidates who \u2018breeze through exams\u2019. Postgraduate success required better \u2018work-study\u2019 balance, self &amp; cross regulation and peer and faculty support.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Conclusion:<\/span><\/b><span lang=\"EN-GB\"> Implementing a composite tool to assess \u2018exam preparedness\u2019, we propose, would help the learners and teachers to skim for non-academic factors (metacognitive self-regulation, self-efficacy, conscientiousness) that influence the chances of success. Understanding &amp; predicting this would help educators to identify the <i>\u2018candidates with difficulty\u2019<\/i> and delegate personalised faculty attention. This could guide the exam candidates to have a \u2018reality check\u2019 to plan and pace their effort with peer learning, consolidated study and goal orientation.<\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Keywords<\/span><\/b><b><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i><span lang=\"EN-GB\">Postgraduate Exam Success, Non-Academic Predictors, Self-Regulation<\/span><\/i><span lang=\"EN-GB\"><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Practice Highlights<\/span><\/strong><\/p>\r\n<ul>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Non-academic attributes impact success in postgraduate examinations.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Postgraduate exam success necessitates work-study &amp; work-life balance. <\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Time on task, self-regulation to task demands is needed when assessments are tougher and high stake.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Exam preparedness: A collective attribute is proposed with a questionnaire to measure predictability of exam success.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Shunning away from \u2018shame of mock vivas\u2019 spirals down to poor chance of passing.<\/span><span lang=\"EN-GB\"><\/span><\/li>\r\n<\/ul>\r\n<div>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">I. <\/span><span lang=\"EN-GB\">INTRODUCTION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Postgraduate summative examinations have an important role in progress as a medical professional. Success in high-stakes assessments have an impact on societal impressions, career shifts and social strata changes (Hamilton &amp; Brown, 2005; Slavin et al., 2014). Examinations ideally measure the students\u2019 competencies, but there are reasons to think that there are factors other than academic predictors.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Learning strategies and monitoring vary across the age groups (Vermunt, 1996). High school education and learning require mastering declarative knowledge, largely through elaboration and rote memory. College students require advanced learning strategies involving skilful metacognitive knowledge monitoring (MKM) and self-regulatory strategies (SRL) (Isaacson &amp; Fujita, 2006). <i>Metacognition<\/i> is the higher order mental process of \u201cthinking about one\u2019s thinking\u201d, wherein, there are two aspects, namely the ability to reflect on the quantity &amp; quality of knowledge acquired (MKM) and the operational strategies in pacing and preparing for the challenge ahead (SRL).\u00a0 Educational programs strive to facilitate this transition to become \u2018adult learners\u2019 (Ormrod, 2009).<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">\u00a0Learning in undergraduate medical education requires \u2018critical reasoning\u2019 to assimilate relevant clinical information and deduce differential diagnoses. Postgraduate learners, particularly in the health professions, need self-regulatory skills to pace their self-directed learning in the absence of regular formative assessments. Zimmerman (2008) asserted that postgraduate learners in higher education possibly achieve superior standards of self-regulation and motivation. However, the adaptations in learning strategies or metacognitive regulatory activities are not well described in the context of postgraduate health professions. Soh (2019) described a six-step approach in the pretext of the \u2018ownership cycle\u2019 for supporting postgraduate learners with difficulty. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">O\u2019Connor and Paunonen (2007) urged researchers to \u2018use multiple predictors beyond intelligence, such as personality, motivation, and study habits when predicting academic achievement\u2019 (Ray &amp; Brown, 2015). We set to explore how we can improve on the understanding of attributes that could be collectively stated as \u2018exam preparedness\u2019 (Appendix 1). We proposed to <b>define <\/b>\u2018exam preparedness\u2019 as:<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">\u201cability of the learner to inculcate <b>educational situation awareness,<\/b> to gauge task difficulty, assess self-efficacy, modify one\u2019s own learning behaviour, manage self and moderate it with resources and personal capabilities, so as to plan and operationalise a scheme\/ construct in exam taking aptitude &amp; skills, resulting in comprehensive exam success\u201d.<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">It is known from literature that testwiseness, \u201c<\/span><span lang=\"EN-GB\">a subject\u2019s capacity to utilise the characteristics and formats of the test and\/or the test taking situation\u201d could impact the outcomes of the examinations (Millman et al., 1965; Sarnacki, 1981; Wahlstrom &amp; Boersma, 1968; Watling &amp; Ginsburg, 2019). Our proposition of understanding \u2018exam preparedness\u2019 is more than coachable test-taking strategy of testwiseness, but on a broader holistic front that looks at emotive, behavioural, self-regulatory perspectives and preparedness for a task in anticipation.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">II. <\/span><span lang=\"EN-GB\">RELEVANCE OF THE STUDY<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">We need ways to measure \u2018exam preparedness\u2019 because, first, it could help the postgraduate learners to identify major deficiencies in being task focussed and hone self-regulatory strategies. Second, it would help teachers to enhance support or \u2018scaffolding\u2019 that suits the needs of individual students.\u00a0 The concept \u2018exam preparedness\u2019 is not well constructed or described in literature. In the context of this research, we identify \u2018exam preparedness\u2019 to be everything but the student\u2019s level of knowledge or competence. The cognitive determinants, like grade point average (GPA), are strong predictors of college success (Conard, 2006; Sladek et al., 2016; Zhou et al., 2014). In the postgraduate medical education context, where the academic capabilities are comparable and are well matched during their selection into residency, there are other non-academic attributes that could predict exam success.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The prediction of exam performance by factors such as achievement goal orientation, self-regulation, (Lucieer et al., 2016) conscientiousness (Brazd\u0103u &amp; Mihai, 2011; Colthart et al., 2008), metacognition and meta-comprehension have been well described (Cook et al., 2011; Dunlosky &amp; Lipko, 2007; Pintrich &amp; De Groot, 1990; Zimmerman, 2000). The inter-relationships among these attributes are complex and not well studied. Our work was designed to help understand postgraduate students\u2019 metacognitive, self-regulation, conscientiousness, and self-efficacy perceptions to aid in their learning.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">III. <\/span><span lang=\"EN-GB\">METHODOLOGY<\/span><\/strong><\/p>\r\n<p><i><span lang=\"EN-GB\">A. Study Design<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The study involved a sequential explanatory mixed methods research design (McKim, 2017). The attribute of \u2018exam preparedness\u2019 was explored using existing predictors of academic success such as metacognition, self-regulation, self-efficacy and conscientiousness quotient.\u00a0 Data obtained by a questionnaire assessing pre-examination attributes were compared with the students\u2019 reflections through focus group discussions, after the formal declaration of results. The mixed methods design consisted of <i>\u2018sequential approach\u2019<\/i> where the questionnaire data collected prior to the high-stake examination provided inputs for quantitative analysis of the predictors of exam outcomes. This was followed by qualitative exploration of themes that emerged through focus group discussions. The themes summarised from the first focus group discussions were used to enhance the richness of second focus group discussion (Hennink, 2013).<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">B. Procedure <\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Anaesthesia postgraduate learners who appeared for the primary anaesthesia examinations were invited for participation in the study. These were high-stake summative examinations and mandatory for all postgraduates, limiting progression to senior years in residency and subsequent accreditation to a specialist. Informed consent was obtained for voluntary participation and confidentiality was ascertained for information on participant profiles and sensitivity of information about personal learning attributes. After approval by the institute review board, a pilot study was conducted to enhance validity of the questionnaire. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">All the study participants who consented (30 out of 42 who appeared for exams) filled the pre-examination questionnaire, one month before the examinations. After completion of examinations and declaration of results, focus group interviews were conducted among students who passed the exam to explore further insights. Candidates who had not passed the examinations were excluded from the second part of study (as per Institutional Review Board (IRB) stipulations). The \u2018passers\u2019 were allocated into two sub-groups: the first-time passers or the <b>\u2018acers\u2019,<\/b> who succeeded in their first attempt and the <b>\u2018non-acers\u2019, <\/b>who were postgraduates with previous unsuccessful attempt(s) and have passed the examinations in this attempt (Figure 1).<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2456-Figure-1-300x185.png\" alt=\"\" class=\"aligncenter wp-image-70984\" width=\"561\" height=\"346\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2456-Figure-1-300x185.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2456-Figure-1-1024x631.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2456-Figure-1-768x473.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2456-Figure-1.png 1297w\" sizes=\"auto, (max-width: 561px) 100vw, 561px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Figure 1. Procedure of the study in chronological order<\/span><\/p>\r\n<div>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">After completion of focus group discussions, the results were summarised and sent back to the participants for authenticity and approval of the content (member checking). Data analysis with mixing of the quantitative and qualitative data was conducted to appraise pre-examination attributes evaluated through the questionnaire with themes that emerged from the post-examination focus group discussions.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">C. Instrument <\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">A 50-point questionnaire was designed to understand the pre-examination attributes of the postgraduate residents when they had to face a high-stake assessment. The chief themes (Table 1) that were explored included the self-regulatory aspects of cognition, motivation\/affect, behaviour and context that were adopted from the Motivated Strategies of Learning Questionnaire (MSLQ) (<\/span><span lang=\"EN-GB\">Cred\u00e9 &amp; Phillips, 2011; Pintrich &amp; De Groot, 1990; Pintrich, 2000).<\/span><\/p>\r\n<table align=\"center\" style=\"width: 100%\">\r\n<tbody>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 11.6751%\">\r\n<p><b><span lang=\"EN-GB\">Themes\/ Attributes<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 41.9869%\">\r\n<p><b><span lang=\"EN-GB\">Definition<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 21.1748%\">\r\n<p><b><span lang=\"EN-GB\">Existing scales\/ comments<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 24.438%\">\r\n<p><b><span lang=\"EN-GB\">Simple meaning <\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 11.6751%\">\r\n<p><span lang=\"EN-GB\">Metacognition &amp; Self-regulation<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 41.9869%\">\r\n<p><i><span lang=\"EN-GB\">\u2018the people\u2019s knowledge of their own learning and cognitive processes, as well as their regulation of those processes to enhance learning and memory\u2019 (Ormrod, 2009)<\/span><\/i><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 21.1748%\">\r\n<p><span lang=\"EN-GB\">MSLQ (Motivated strategies for learning questionnaire, 81 items) (Pintrich &amp; De Groot, 1990)<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p><span lang=\"EN-GB\">MAI (Metacognitive awareness inventory, 52items) (Schraw &amp; Dennison, 1994)\u00a0\u00a0 <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 24.438%\">\r\n<p><span lang=\"EN-GB\">Metacognition= thinking about one\u2019s thinking<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Self-regulation= ability to pace one\u2019s own efforts to task<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 11.6751%\">\r\n<p><span lang=\"EN-GB\">Self-efficacy<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 41.9869%\">\r\n<p><i><span lang=\"EN-GB\">\u2018personal judgments of one\u2019s capabilities to organise and execute courses of action to attain designated goals\u2019 (Colthart et al., 2008)<\/span><\/i><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 21.1748%\">\r\n<p><span lang=\"EN-GB\">SES (Self-efficacy survey, 150 items) (Zimmerman, 2000, 2008)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 24.438%\">\r\n<p><span lang=\"EN-GB\">Self-perception of effectiveness<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 11.6751%\">\r\n<p><span lang=\"EN-GB\">Conscientiousness<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 41.9869%\">\r\n<p><i><span lang=\"EN-GB\">\u2018a broad domain encompassing individual differences in the propensity to follow socially prescribed norms for impulse control; to be goal directed, planful, to be able to delay gratification and to follow norms and rules\u2019 (Roberts, et al., 2009).<\/span><\/i><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 21.1748%\">\r\n<p><span lang=\"EN-GB\">CQI (Conscientiousness quotient inventory,62 items) (Brazd\u0103u &amp; Mihai, 2011)<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 24.438%\">\r\n<p><span lang=\"EN-GB\">Self-disciplined planful and perseverant<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Conscientiousness is one of the big 5 personality traits with well validated proven predictors of academic performance<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 1. Major themes in pre-examination questionnaire<\/span><\/p>\r\n<div>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">Note: <\/span><\/i><span lang=\"EN-GB\">Table showing the basic themes of the questionnaire and the existing published scales used for measurement of each of the attributes from which the questionnaire was developed. <\/span><\/p>\r\n<\/div>\r\n<div>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The sections A-B of the questionnaire addressed time on task, study strategy, goal orientation and task preparedness. These were complemented with questions exploring students\u2019 approach to learning in sections C-D (<\/span><span lang=\"EN-GB\">Pintrich, 2004). Personality traits and themes appraising the proven predictors such as conscientiousness were deduced from the Conscientiousness Quotient Inventory (CQI) (Brazd\u0103u &amp; Mihai, 2011). In Section F, the questionnaire addressed the postgraduates\u2019 reflection on how they handled the situation with \u2018work-study\u2019 and \u2018work-life\u2019 balance, through subsections on procrastination, handling distractions and rejuvenation (taking time off). Metacognition and self-efficacy were appraised in sections E &amp; G with questions adopted from metacognitive awareness inventory (MAI) and self-efficacy scale (SES) (Coutinho &amp; Neuman, 2008; Schraw &amp; Dennison, 1994). These included questions on the residents\u2019 own regulations of their learning such as choice of study resources, environment, effective study group dynamics, self-rated confidence, preparedness and understanding of impact of high stakes of the examination. The questionnaire was constructed with subsections that had reliability value of more than 0.7 in prediction of academic performance. <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">D.\u00a0 Purposive Sampling: Focus Group Discussions<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The focus group discussions were conducted with semi-structured interview guides that were designed from the pre-examination questionnaire results. The questions were designed to be \u2018open-ended\u2019 and to understand \u2018exam preparedness\u2019. The interviewing faculty were carefully chosen to be neither the exam-trainers nor the exam-assessors, to minimise \u2018observer biases\u2019 and to remove confounding from \u2018power\u2019 relationships. The focus group structure included the investigator as the primary interviewer, while the information and discussions were captured through field notes by an assistant present inside the room. Audio or video recording were not permitted by the IRB for this study. To understand the perspectives of \u2018failing\u2019 and \u2018what it takes to bounce back and succeed\u2019, the \u2018non-acers\u2019 focus group was designed. These included students who had the experience of failing in previous examinations and have now succeeded in the present effort. <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">E. Analysis<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">For the questionnaire data, descriptive statistics were computed with SPSS 20 (IBM, Armont, NY, USA). The data analyses were carried out in three stages. First, the pre-exam questionnaire data of the passers were compared with the questionnaire data from the failed candidates to obtain any common patterns or contrasts. Unpaired t tests were performed to obtain the statistical significance of the questionnaire data comparing the two groups. Owing to limited size of the sample (n&lt;60), no formal logistic regression could be performed.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Next, the focus group reflections of the candidates were compared between the sub-group of passers into \u2018acers\u2019 and \u2018non-acers\u2019. Thematic analysis was performed with initial codes applied during preliminary analysis and further confirmed as themes that consistently emerged in the subsequent focus group discussions.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">In the final stage, the focus group discussion data were compared with pre-exam questionnaire attributes of the candidates for understanding the predictors of exam success and to strengthen the construct of \u2018exam preparedness\u2019. <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">F. Ethics<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">National University of Singapore institutional review board approved of the study (IRB:13-276) and focus group discussions were permitted only with candidates who passed the exams. The study was voluntary, and participants were empowered to opt out at any phase of the study.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">III. <\/span><span lang=\"EN-GB\">RESULTS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Forty-two candidates appeared for the primary anaesthesia examinations. Of the 42 primary anaesthesia examination candidates, 30 (n=30) gave consent for the study and filled the pre-examination questionnaire (70% response rate). The overall pass rate was 42.9% (18 out of 42 who appeared for the examinations). 18 out of the 30 candidates who filled the questionnaire passed the exam. One candidate who had appeared for two concurrent primary exams (United Kingdom &amp; Singapore) was excluded from the analyses as she might have received additional exam support. Hence, total number of study participants who passed the examination were 17, of which, 12 had passed the exam in first attempt (acers) and five had succeeded after previous attempts (non-acers). Of those who passed the exam, eight students participated in focus group discussions in two groups (acers and non-acers) of four each. The pass and fail groups were compared based on the various themes of the questionnaire such as study strategy, study time, goal orientation, self-regulation, metacognition and conscientiousness (Table 2).<\/span><\/p>\r\n<table align=\"center\" style=\"width: 100%;height: 1072px\">\r\n<tbody>\r\n<tr style=\"height: 56px\">\r\n<td rowspan=\"2\" valign=\"top\" style=\"width: 15.5311%;height: 136px\">\r\n<p><b><span lang=\"EN-GB\">Attributes<\/span><\/b><\/p>\r\n<\/td>\r\n<td rowspan=\"2\" valign=\"top\" style=\"width: 29.8597%;height: 136px\">\r\n<p><b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Feature assessed<\/span><\/b><\/p>\r\n<\/td>\r\n<td colspan=\"2\" valign=\"top\" style=\"width: 25.2505%;height: 56px\">\r\n<p><b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Passers Subgroups<\/span><\/b><\/p>\r\n<\/td>\r\n<td rowspan=\"2\" valign=\"top\" style=\"width: 14.6293%;height: 136px\">\r\n<p><b><span lang=\"EN-GB\">Passers (17\/29) %(n)<\/span><\/b><\/p>\r\n<\/td>\r\n<td rowspan=\"2\" valign=\"top\" style=\"width: 13.7275%;height: 136px\">\r\n<p><b><span lang=\"EN-GB\">Failed (12\/29) %(n)<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 80px\">\r\n<td valign=\"top\" style=\"width: 11.022%;height: 80px\">\r\n<p><b><span lang=\"EN-GB\">Acers % (n=12)<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 80px\">\r\n<p><b><span lang=\"EN-GB\">Non-Acers\u00a0\u00a0 \u00a0% (n=5)<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 80px\">\r\n<td rowspan=\"2\" valign=\"top\" style=\"width: 15.5311%;height: 160px\">\r\n<p><b><span lang=\"EN-GB\">Study Time<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 80px\">\r\n<p><span lang=\"EN-GB\">Average weekday study time &lt;2 hours \/ day\u00a0 <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 80px\">\r\n<p><span lang=\"EN-GB\">25(3)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 80px\">\r\n<p><span lang=\"EN-GB\">20(1)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 80px\">\r\n<p><span lang=\"EN-GB\">23.5(4)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 80px\">\r\n<p><span lang=\"EN-GB\">83.3(10)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 80px\">\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 80px\">\r\n<p><span lang=\"EN-GB\">Average weekend study time &gt;6 hours in total<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 80px\">\r\n<p><span lang=\"EN-GB\">75(9)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 80px\">\r\n<p><span lang=\"EN-GB\">80(4)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 80px\">\r\n<p><span lang=\"EN-GB\">76.5(13)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 80px\">\r\n<p><span lang=\"EN-GB\">33.3(4)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px\">\r\n<td rowspan=\"3\" valign=\"top\" style=\"width: 15.5311%;height: 168px\">\r\n<p><b><span lang=\"EN-GB\">Study strategy<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 56px\">\r\n<p><span lang=\"EN-GB\">Timetable-based pattern of study <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 56px\">\r\n<p><span lang=\"EN-GB\">41.7(5)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 56px\">\r\n<p><span lang=\"EN-GB\">60(3)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 56px\">\r\n<p><span lang=\"EN-GB\">47.1(8)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 56px\">\r\n<p><span lang=\"EN-GB\">16.7(2)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px\">\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 56px\">\r\n<p><span lang=\"EN-GB\">Weekly Review of timetable <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 56px\">\r\n<p><span lang=\"EN-GB\">50(6)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 56px\">\r\n<p><span lang=\"EN-GB\">60(3)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 56px\">\r\n<p><span lang=\"EN-GB\">52.9(9)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 56px\">\r\n<p><span lang=\"EN-GB\">33.3(4)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px\">\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 56px\">\r\n<p><span lang=\"EN-GB\">Revisions for exam &gt;= 2 times<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 56px\">\r\n<p><span lang=\"EN-GB\">66.7(8)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 56px\">\r\n<p><span lang=\"EN-GB\">80(4)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 56px\">\r\n<p><span lang=\"EN-GB\">70.6(12)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 56px\">\r\n<p><span lang=\"EN-GB\">41.7(5)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 80px\">\r\n<td valign=\"top\" style=\"width: 15.5311%;height: 80px\">\r\n<p><b><span lang=\"EN-GB\">Goal Orientation<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 80px\">\r\n<p><span lang=\"EN-GB\">Mock SAQ exam set rehearsals (Atleast once)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 80px\">\r\n<p><span lang=\"EN-GB\">91.7(11)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 80px\">\r\n<p><span lang=\"EN-GB\">80(4)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 80px\">\r\n<p><span lang=\"EN-GB\">88.2(15)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 80px\">\r\n<p><span lang=\"EN-GB\">50(6)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px\">\r\n<td valign=\"top\" style=\"width: 15.5311%;height: 56px\">\r\n<p><b><span lang=\"EN-GB\">Self-regulation<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 56px\">\r\n<p><span lang=\"EN-GB\">Insufficient material covered &lt;50 % only <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 56px\">\r\n<p><span lang=\"EN-GB\">9.1(1)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 56px\">\r\n<p><span lang=\"EN-GB\">0*<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 56px\">\r\n<p><span lang=\"EN-GB\">5.9(1)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 56px\">\r\n<p><span lang=\"EN-GB\">41.7(5)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 80px\">\r\n<td rowspan=\"3\" valign=\"top\" style=\"width: 15.5311%;height: 192px\">\r\n<p><b><span lang=\"EN-GB\">Conscientiousness<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 80px\">\r\n<p><span lang=\"EN-GB\">Set Targets achieved &lt;50 % only (procrastination)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 80px\">\r\n<p><span lang=\"EN-GB\">16.7(2)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 80px\">\r\n<p><span lang=\"EN-GB\">0*<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 80px\">\r\n<p><span lang=\"EN-GB\">11.8(2)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 80px\">\r\n<p><span lang=\"EN-GB\">41.7(5)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px\">\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 56px\">\r\n<p><span lang=\"EN-GB\">How prepared: feels &lt;50% only<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 56px\">\r\n<p><span lang=\"EN-GB\">33.3(4)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 56px\">\r\n<p><span lang=\"EN-GB\">20(1)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 56px\">\r\n<p><span lang=\"EN-GB\">29.4(5)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 56px\">\r\n<p><span lang=\"EN-GB\">41.7(5)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px\">\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 56px\">\r\n<p><span lang=\"EN-GB\">Rejuvenate &gt;= 2 times\/ week<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 56px\">\r\n<p><span lang=\"EN-GB\">33.3(4)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 56px\">\r\n<p><span lang=\"EN-GB\">60(3)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 56px\">\r\n<p><span lang=\"EN-GB\">41.2 (7)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 56px\">\r\n<p><span lang=\"EN-GB\">50(6)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px\">\r\n<td valign=\"top\" style=\"width: 15.5311%;height: 56px\">\r\n<p><b><span lang=\"EN-GB\">Self-efficacy<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 56px\">\r\n<p><span lang=\"EN-GB\">&gt; 50 % Confidence to face exams <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 56px\">\r\n<p><span lang=\"EN-GB\">41.7(5)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 56px\">\r\n<p><span lang=\"EN-GB\">80(4)*<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 56px\">\r\n<p><span lang=\"EN-GB\">52.9(9)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 56px\">\r\n<p><span lang=\"EN-GB\">41.7(5)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px\">\r\n<td rowspan=\"2\" valign=\"top\" style=\"width: 15.5311%;height: 112px\">\r\n<p><b><span lang=\"EN-GB\">Metacognition<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 56px\">\r\n<p><span lang=\"EN-GB\">Study location: home<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 56px\">\r\n<p><span lang=\"EN-GB\">33.3(4)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 56px\">\r\n<p><span lang=\"EN-GB\">80(4)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 56px\">\r\n<p><span lang=\"EN-GB\">47.1(8)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 56px\">\r\n<p><span lang=\"EN-GB\">75(9)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px\">\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 56px\">\r\n<p><span lang=\"EN-GB\">Study with: solitude <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 56px\">\r\n<p><span lang=\"EN-GB\">58.3(7)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 56px\">\r\n<p><span lang=\"EN-GB\">60(3)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 56px\">\r\n<p><span lang=\"EN-GB\">58.8 (10)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 56px\">\r\n<p><span lang=\"EN-GB\">83.3(10)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px\">\r\n<td rowspan=\"2\" valign=\"top\" style=\"width: 15.5311%;height: 112px\">\r\n<p><b><span lang=\"EN-GB\">Demographics<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 56px\">\r\n<p><span lang=\"EN-GB\">Marital status: single<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 56px\">\r\n<p><span lang=\"EN-GB\">83.3(10)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 56px\">\r\n<p><span lang=\"EN-GB\">20(1)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 56px\">\r\n<p><span lang=\"EN-GB\">64.7(11)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 56px\">\r\n<p><span lang=\"EN-GB\">66.7(8)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px\">\r\n<td valign=\"top\" style=\"width: 29.8597%;height: 56px\">\r\n<p><span lang=\"EN-GB\">Gender: Male<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 11.022%;height: 56px\">\r\n<p><span lang=\"EN-GB\">33.3(4)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.2285%;height: 56px\">\r\n<p><span lang=\"EN-GB\">60(3)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 14.6293%;height: 56px\">\r\n<p><span lang=\"EN-GB\">41.2(7)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 13.7275%;height: 56px\">\r\n<p><span lang=\"EN-GB\">50(6)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 2. Subgroup comparison within passers and with failed candidates<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Note: Table showing questionnaire data demonstrating differences between the two groups of passers and their comparison with the \u2018failed group\u2019 of candidates. Acers=first time passers; Non-acers=candidates who failed before but have succeeded in this attempt. The percentages are calculated in relation to the column header on top of respective rows. (* denotes statistical significance with p value&lt;0.05)<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">A. Time on Task &amp; Self-Regulation<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The passers spent more weekend hours for study (average &gt; 6 hours, 76.5% vs 33.3%) and far more of them planned their study using a timetable (47.1 % vs 16.7 %) (p value 0.036). Where they were timetable-based, passers reviewed their study plans weekly (52.9% vs 33.3%). Passers revised the study materials more often than those who failed (70.6% vs 41.7%). Passers perceived that they covered more study material sufficiently (5.9% lapses to cover in passers vs 41.7% in failure group, p value 0.05). The focus group discussions revealed that<b> <\/b>postgraduates who passed had higher self-regulation, covering larger volumes of sufficient material required. This was more prominent in the \u2018non-acers\u2019 who had failed before. The focus group discussions showed that the candidates rated the attribute of <i>self-regulation as the most important quality<\/i> to succeed in exams. The candidates felt that \u2018<i>diligently apportioning time, effort &amp; resources, knowing to map what examiners want and selectively consolidating preparation\u2019 (effort regulation),<\/i> were predictive of exam success.<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">B. Self-Efficacy<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Passers procrastinated less (perceived self-assessment of set targets achieved) with their study plans (11.8% vs 41.7%, p value 0.057). The focus group discussion showed that <i>group study and external support<\/i> through peers and seniors were vital in providing individualised attention &amp; feedback to stay focused on track. They asserted that \u2018<i>being planful, persevering to achieve more than 50% schedule, pushing one another<\/i> <i>in striving to achieve that goal\u2019<\/i> helped to pass.<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">C. Conscientiousness<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The non-acers scored higher (p value&lt;0.05) on conscientiousness (lesser procrastination) when compared to the failed candidates. Both groups took similar efforts to rejuvenate and recuperate, showing no difference (with p value &gt;0.05), with no specific patterns in how postgraduates prepared for the high-stake assessments.<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">D. Additional Themes<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Social factors like marital commitments (64.7% passers-single) and gender (41.2% passers-male vs 52.9% female) showed little difference (p value 0.335) in overall exam outcomes.\u00a0 Yet, subgroup analysis showed that among the passers, 83.3% of first-time passers were single and only 20% of those who were married passed in first attempt (Table 2). The study environment and study in solitude vs groups were comparable.\u00a0 On further elaboration in focus group discussion, the residents affirmed that not all the study-time with peers involved discussion, but the fact they all studied together helped them to <i>\u2018stick together and push each other to the very end\u2019<\/i> (Table 3). The \u2018non-acers\u2019 study strategies were comparable to the \u2018acers\u2019 and they tend to study longer and plan their study \u2018more timetable-based\u2019 and reviewed it more often.<\/span><\/p>\r\n<table>\r\n<tbody>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Themes<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Acers<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Non-Acers<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Common features <\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">The Primary Exam: general impressions <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Internalised factors:\u00a0 <\/span><\/b><span lang=\"EN-GB\">need deliberate effort, sacrifice, push on to end, set aside time, less social life<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Externalised issues: <\/span><\/b><span lang=\"EN-GB\">exam not structured, mark allocation not clear, no syllabus, no guidance, prep time not enough; requires senior guidance<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Work study balance difficult<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Primary exams a hindrance to progress in career<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Level of task difficulty<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Toughest of exams, difficult content to recall\/ remember<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Need to know relevant knowledge (not a lot), Technique: structure\/ how to answer is vital<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Task difficulty same throughout prep stages<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Difference from past success<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">More deliberate effort; perseverance &amp; discipline; not spoon fed like in UG<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">More applied sciences content involved<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Work study balance needed<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Adaptations when facing exams<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><i><span lang=\"EN-GB\">Not to chance a failure<\/span><\/i><span lang=\"EN-GB\">; adapting study style to exams; perseverance<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><i><span lang=\"EN-GB\">Failure is a possibility; <\/span><\/i><span lang=\"EN-GB\">lots of practice; stay back post call to study;<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Technique: direct answers, open ended, forth coming answers<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Group study: <\/span><\/b><span lang=\"EN-GB\">push each other, enjoy same things, reinforces prep<b><\/b><\/span><\/p>\r\n<p><b><span lang=\"EN-GB\">External \/ senior help: <\/span><\/b><span lang=\"EN-GB\">personalised attention, helps focus and formulate<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">What went well as planned?<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being in groups; <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Study material completion<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Exam goal-oriented selective study; more viva practice<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Study plan: <\/span><\/b><span lang=\"EN-GB\">timetable based; efficient completion; cover 50-75% plan; not giving up<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Perceived reasons for failure<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Not being ready in many ways<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Bad luck; unsupportive hostile examiners<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Gross lack of knowledge<b><\/b><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">What to improve if rewind to 6 months before exam?<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Unpreparedness is an issue to avoid; minimise luck factor; get resources that answers \/ on syllabus on what examiners want\u00a0 <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Do past year questions to know the areas of focus; study leave at least two weeks<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Start earlier; push timetable better; syllabus-oriented prep; learn examiner mapping &amp; prepare \/ practice so<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Exam preparedness: predictable qualities<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Knows weak &amp; strong spots; knows a bare min of everything; consolidates prep to what examiners want<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Not fumble under pressure<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Know well what examiners want; smartly choosing enough material; technique\/ way to answer exam question<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Breezing through exams: qualities<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being in tune with recent exam patterns; not giving up<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Strong memory in foundational sciences- chemistry physics; enough material not lots of it<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Structured diligent exam-oriented prep<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Flexibly tied in plans<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Expressive in viva<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Delivers the wanted<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Advice for future candidates<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Minimise luck factor<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Stick to study plan<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Handling burn outs to avoid study plan disruptions<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Having good social exam taking attributes<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Small textbooks are useful more resources<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\">Not to shy away from shame of mock viva. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Know examiner needs. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Know syllabus well &amp;<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Plan the study and technique<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<i><span lang=\"EN-GB\"><\/span><\/i><\/div>\r\n<div>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 3: Focus group discussions summary<\/span><\/p>\r\n<\/div>\r\n<div><i><span lang=\"EN-GB\">E. Recipe for Exam Success<\/span><\/i><\/div>\r\n<\/div>\r\n<\/div>\r\n<div>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The main themes emerging from the two focus groups are summarised in Table 3. All focus group discussion candidates agreed that failure was chiefly a result of \u2018<i>gross lack in knowledge\u2019<\/i> and \u2018<i>un-preparedness in many ways\u2019<\/i>. The focus group discussions concluded with the passers\u2019 advice for success of future candidates and stated that:<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">\u201cadhering to syllabus &amp; plan of study, technique suited to examiner needs and not shying away from shame of mock exams, minimizing luck factor, possessing good social attributes (viva skills), persevering with study plans and timing of rejuvenation was the key to success\u201d.<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The focus group discussions supported this concept that \u2018<i>the best way of passing the exam was to dare the shame of practice viva<\/i>\u2019 and not to shun away from faculty feedback on performance in mock exams. The \u2018passers\u2019 had spent twice the time and effort in practice exams and revisions when compared to the \u2018fail\u2019 group (self-regulation).\u00a0 <\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Our study showed that the candidates who passed, monitored their learning well by choosing to stay in groups and \u2018stuck together\u2019 by helping one another. The focus group discussions showed that they opted to adopt this mode of studying because the task was difficult and required constant motivation and peer support. This is in accordance with literature that claims the usefulness of peer support and feedback (de la Cruz et al., 2015; Dochy et al., 1999; Lerchenfeldt et al., 2019). What is vital was the ability of the candidates to assess what components of the exam content requires concentrated self-learning, like memorization, and differentiate it from study materials that require learning in groups and further elaboration. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Our study showed that the \u2018passers\u2019 were mindful of how they took time off to study or rejuvenate. The \u2018passers\u2019 tend to procrastinate three times lesser than the ones who failed. More so, a subgroup analysis showed that the \u2018non-acers\u2019 or the previous failed candidates never put away their schedules and stayed pursuing a <i>timetable-based study <\/i>(0% procrastination). The focus group discussions reinforced the fact that the \u2018passers\u2019 felt that there were loads of enormously difficult basic science content to be covered, such as applied physics and pharmacology, and time was limited, requiring further organisation and seamless execution of the study plan.\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Self-efficacy evaluations showed no clear difference when comparing the groups of \u2018passers\u2019 and \u2018failed\u2019 candidates. However, the subgroups analysis showed that the \u2018non-acers\u2019 were twice as confident as the rest. The focus group discussions confirmed that the non-acers, having had the experience of failing before, <i>\u2018had a clear understanding of the difficulty of task and had commenced their study early in a programmed timetable-based manner with specific feedback and personalised attention from faculty supporting them\u2019<\/i>.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Cilliers et al., (2012) modelled the pre-assessment learning effects of high-stakes assessments and postulated \u2018efficacy\u2019 as an adaptation in the learner in anticipation of the task. Our \u2018non-acers\u2019 had been through the actual task difficulty, having failed earlier, had higher self-efficacy and now programmed their study well, expending more time on task. The lower self-efficacy might mean that this is an important lead for the faculty, in how they counselled and supported future candidates that are to be trained for high-stakes examinations (Lucieer et al., 2016).<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">A. \u2018The Exam Ready Candidate\u2019<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Our study showed that passers had higher degree of self-regulation, conscientiousness, and metacognition. The focus group discussions further affirmed the information about the relationship between the various attributes and the students\u2019 perceptions of \u2018exam preparedness\u2019. They felt that the candidates who <b>\u2018<i>breeze through exams<\/i>\u2019,<\/b> in other words, the exam ready, \u2018<i>possessed exam oriented<\/i> (goal oriented) <i>flexibly tied into study plans <\/i>(metacognition), <i>were<\/i> <i>expressive in viva<\/i> (self-efficacy), <i>delivered the necessary content well<\/i> (conscientiousness)\u2019 in addition to \u2018<i>diligently apportioning time, effort &amp; resources<\/i> (effort regulation), <i>knowing to map what examiners want &amp; selectively consolidating preparations<\/i> (study strategy)\u2019.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">B. Understanding the High Failure Rates<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The anaesthesia postgraduate primary examinations had a dismal 42.9% pass rate while undergraduate examinations had more than 90% pass rates. This is intriguing and highlights the complex relationships between the poor predictability of undergraduate academic scores and the influences of other paradigms in postgraduate exam performances (Division of Graduate Medical Studies [DGMS], 2013). The focus group discussions helped us understand this phenomenon better. The residents felt that \u2018<i>unlike undergraduate exams, the postgraduate examinations required lot more application of work-study balance and work-life balance\u2019. <\/i>During the undergraduate years, the students felt that the sole focus was to learn and perform in examinations, with lot more protected time during the day and all the weekends were dedicated to study. Although they require a particular level of academic competence to become a postgraduate, there is more to explore when it comes to exam success such as \u2018work-life\u2019 and \u2018work-study\u2019 balance (Klomegah &amp; Yao, 2007; Rau &amp; Durand, 2000).<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">C. Practical Implications<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Through this study, we identify the presence of attributes such as metacognitive self-regulation, conscientiousness, and self-efficacy. We now know that candidates who score well in these component-attributes tend to pass the examinations. We propose that achieving an element of predictability will be a good lead for:<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">1. The <b>educators<\/b> to identify the <b><i>\u2018candidates with difficulty\u2019<\/i><\/b> and delegate special care and personalised attention to them, while it is feasible and not too late.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">2. The <b>exam candidates<\/b> themselves to have a <b>\u2018reality check\u2019<\/b> on where they stand and what would be the best way ahead: peer learning, consolidated study, goal orientation etc.<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">D. Scoring Exam Preparedness and Planning Scaffolding<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Candidates with \u2018<i>poor conscientiousness score\u2019<\/i> could be scheduled to \u2018receive more structured assistance through study groups, frequent deadlines, shorter assignments, group assignments and clearly defined learning goals\u2019 (Kappe &amp; Van Der Flier, 2012). This was put to light in our focus group discussions when one of the candidates who was unsuccessful earlier, but passed this time (non-acer) stated that:<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">\u201c<i>what made all the difference in this exam was that faculty and peers sat next to me in a quiet room, gave me a short study topic, made me do a SAQ, then a short viva on it, then gave me a critical feedback on how to improve. This was very encouraging, and I felt the intention of the faculty and peers were to help me and not to embarrass me on how unprepared I was. This inspired me to pass this ordeal this time\u2026\u201d<\/i><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Implementing a composite tool to assess \u2018exam preparedness\u2019, we propose, would help the learners and teachers to skim for predictable factors that influence the chances of success. Incorporating a system of \u2018scaffolding\u2019 would help in early guided learning towards exam success. This, we feel, is particularly imperative when educational programs deploy high-stakes single summative exams. Self-efficacy Survey (SES) was described as a measure for identifying disability in adaptive attitudes and disfunctionality (Panc et al., 2012). Using such a measure could identify \u2018trainees with difficulty\u2019 and guide us to channelise our efforts and resources for those who need it the most. Kandaswamy and Anbarasi (2014) suggested early identification of \u2018<i>gifted under achievers<\/i>\u2019 and successfully devised a structured program for psychological support, demonstrating a reduction of dropouts for dental undergraduates.<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">E. Limitations &amp; Reflections<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The chief limitation our study was the aspect that attributes like metacognitive self-regulation, conscientiousness and self-efficacy have considerable overlapping concepts and it was difficult to compartmentalise these themes when interpreting the qualities of a learner. Our study population was limited to anaesthesia postgraduates\u2019 primary examination results from one country. A fair comparison of other specialty postgraduate examinations could not be accomplished in our context owing to variation in exam task difficulty, timings, and patterns of assessments.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Of the 42 who appeared for exams only 30 consented to fill the questionnaire. <i>Only one among the 12 students who chose not to fill the questionnaire passed the exam<\/i>. This could have been another area of rich information. Did the learners know that they were not prepared at all or was the title labelling students \u201cexam smart\u201d made them to excuse themselves off the study? It is possible that respondents gave \u2018socially acceptable answers\u2019 when the questionnaire was given, especially so when our study is titled to explore how \u2018prepared\/ ready\u2019 they were or predicting their chance to pass.\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">There are possibilities that testwiseness could have contributed to exam success and were not explored in the focus group discussions (Millman et al., 1965; Sarnacki, 1981; Wahlstrom &amp; Boersma, 1968; Watling &amp; Ginsburg, 2019). Though the present study involved short answer questions and viva-based examinations that tend to report less of testwiseness, as compared to multiple choice questions, future research could appraise this concept and consider ways to address that in the methodology.<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">1) Validating a questionnaire for \u2018exam preparedness\u2019- A lead for the future:<\/span><\/i><span lang=\"EN-GB\"> Our model of \u2018exam preparedness\u2019 was proposed to address the complex learning and myriad of factors that impact postgraduate academic performance (Appendix 1). A well validated composite score or scale on \u2018exam preparedness\u2019 can be a yardstick for \u2018assessment for exam-readiness\u2019, thereby planning the allocation of resources and faculty time and effort. Future studies could evaluate when it would be an appropriate time for evaluating the score (1 or 3 or 6 months before exams). It should not be too near to the examinations, lest it could be too late for any usefulness of its predictability. <b><\/b><\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">There were similarities in attributes that characterise passing such as <i>time scheduling, plan of study, group and peer support, goal oriented selective mastery learning and effort regulation to task difficulty<\/i>. The two groups of passers also identified that the chief cause of failure to be \u2018gross lack of knowledge\u2019 and \u2018unpreparedness\u2019. Implementing a composite tool to assess \u2018exam preparedness\u2019 we propose, would help the learners and teachers to skim for predictable factors (metacognitive self-regulation, self-efficacy, conscientiousness) that influence the chances of success. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">As teachers, we would agree that the students who are relatively more prepared, tend to seek and receive more faculty support, while those who are trailing, continue to distance themselves with the divide getting more distinct nearer to the examinations. Identifying this discrepancy early, while predicting and preventing failure in high-stakes examinations, we propose, needs in-depth understanding of \u2018exam preparedness\u2019. Using the \u2018exam preparedness\u2019 scale might help to identify the postgraduates with academic difficulty, thereby offering a support system, wherein we don\u2019t lose some <i>\u2018Good Samaritans\u2019 <\/i>who are just not \u2018exam ready\u2019.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Dr Balakrishnan Ashokka is an Anaesthesiologist &amp; Educationalist with special interest in Simulation-based postgraduate education at National University Health System, Singapore. He conceived the idea of the study, performed literature search, conducted the study, and drafted the manuscript of the study. He agrees fully to the final version of manuscript.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Prof Lee Tat Leang has been involved in Undergraduate and Postgraduate teaching and examination processes over 30 years at the National University of Singapore. He provided support during conceptualisation, discussion of results and creation of the manuscript. He fully agrees to the final version of the manuscript.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Dr Dani\u00eblle M.L. Verstegen has a background in Cognitive Science and Instructional Science. She currently leads an e-learning group in the Department of Educational Development and Research, FHML, Maastricht University. She supervised the conduct of the entire study, qualitative analysis and agrees fully to the final version of the manuscript.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The National University of Singapore, Institute Review Board (NUS-IRB) provided the ethics committee approval for the conduct of study on passers of the examination (NUS-IRB approval number NUS 1946, reference code 13-276). No audio or video recording or discussions with failed students was permitted as per the directorate\u2019s policy of research on exam candidates.<b><\/b><\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Data Availability<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The study data with summarised, deidentified data synthesis is provided in tables 1-3 in this manuscript. The NUS-IRB and DGMS had provided approval for the study with a clause for private storage of study data with authors\u2019 password-protected workstation. No permission was granted for open access platforms, as the data contained sensitive information about failed candidates.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Acknowledgement<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The authors acknowledge the anaesthesia postgraduates who participated in this study, offering their valuable time and effort.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">No funding was received for the conduct of the study.<b><\/b><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The authors declare that there are no financial or non- financial competing conflicts of interests.<b><\/b><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Brazd\u0103u, O., &amp; Mihai, C. (2011). The consciousness quotient: A new predictor of the students\u2019 academic performance.\u00a0<i>Procedia-Social and Behavioral Sciences<\/i>,\u00a0<i>11<\/i>, 245-250. <\/span><a href=\"https:\/\/doi.org\/10.1016\/j.sbspro.2011.01.070\" target=\"_blank\" title=\"Persistent link using digital object identifier\" rel=\"noopener\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.1016\/j.sbspro.2011.01.070<\/span><\/a><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Cilliers, F. J., Schuwirth, L. W., &amp; Van der Vleuten, C. P. (2012). 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Medical student mental health 3.0: Improving student wellness through curricular changes.\u00a0<i>Academic Medicine<\/i>,\u00a0<i>89<\/i>(4), 573.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Vermunt, J. D. (1996). Metacognitive, cognitive and affective aspects of learning styles and strategies: A phenomenographic analysis.\u00a0<i>Higher Education<\/i>,\u00a0<i>31<\/i>(1), 25-50.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Wahlstrom, M., &amp; Boersma, F. J. (1968). The influence of test-wiseness upon achievement.\u00a0<i>Educational and Psychological Measurement<\/i>,\u00a0<i>28<\/i>(2), 413-420.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Watling, C. J., &amp; Ginsburg, S. (2019). Assessment, feedback and the alchemy of learning.\u00a0<i>Medical Education<\/i>,\u00a0<i>53<\/i>(1), 76-85.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Zhou, Y. X., Zhao, Z. T., Li, L., Wan, C. S., Peng, C. H., Yang, J., &amp; Ou, C. Q. (2014). Predictors of first-year GPA of medical students: A longitudinal study of 1285 matriculates in China.\u00a0<i>BMC Medical Education<\/i>,\u00a0<i>14<\/i>(1), 1-9.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Zimmerman, B. J. (2000). Self-efficacy: An essential motive to learn.\u00a0<i>Contemporary Educational Psychology<\/i>,\u00a0<i>25<\/i>(1), 82-91.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Zimmerman, B. J. (2008). Investigating self-regulation and motivation: Historical background, methodological developments, and future prospects.\u00a0<i>American Educational Research Journal<\/i>,\u00a0<i>45<\/i>(1), 166-183. <\/span><a href=\"https:\/\/doi.org\/10.3102\/0002831207312909\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.3102\/0002831207312909<\/span><\/a><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><span lang=\"EN-NZ\"><span lang=\"EN-AU\">*<span lang=\"EN-GB\">Dr Balakrishnan Ashokka<\/span><br \/>\r\n<span lang=\"EN-GB\">Department of Anaesthesia,<\/span><br \/>\r\n<span lang=\"EN-GB\">National University Hospital,<\/span><\/span><span lang=\"EN-AU\"><br \/>\r\n<span lang=\"EN-GB\">5 Lower Kent Ridge Road<\/span><br \/>\r\n<span lang=\"EN-GB\">Singapore 119074.<\/span><br \/>\r\n<span lang=\"EN-GB\">Tel: +6597118855<\/span><br \/>\r\n<span lang=\"EN-GB\">Fax: +6567775702 <\/span><br \/>\r\n<span lang=\"EN-GB\">Email: ashokkab@gmail.com<\/span><br \/>\r\n<br \/>\r\n<\/span><\/span><\/p>\r\n<span lang=\"EN-GB\"><\/span><\/div>","protected":false},"featured_media":0,"parent":0,"menu_order":8,"template":"","issues_category":[12],"archive_category":[],"issue_type":[25],"volume_category":[61868],"class_list":["post-70981","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-past-issue","volume_category-volume-6-number-4-october-2021"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u2018Exam preparedness\u2019: Exploring non-academic predictors of postgraduate exam success - The Asia Pacific Scholar<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u2018Exam preparedness\u2019: Exploring non-academic predictors of postgraduate exam success - The Asia Pacific Scholar\" \/>\n<meta property=\"og:description\" content=\"Submitted: 19 October 2020 Accepted: 12 April 2021 Published online: 5 October, TAPS 2021, 6(4), 80-91 https:\/\/doi.org\/10.29060\/TAPS.2021-6-4\/OA2456 Balakrishnan Ashokka1,2, Tat Leang Lee1 &amp; Dani\u00eblle M.L. Verstegen3 1Department of Anaesthesia, National University Health System, National University Hospital, Singapore; 2Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 3Department of [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success\/\" \/>\n<meta property=\"og:site_name\" content=\"The Asia Pacific Scholar\" \/>\n<meta property=\"article:modified_time\" content=\"2022-01-03T23:41:41+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2456-Figure-1-300x185.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"29 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success\/\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success\/\",\"name\":\"\u2018Exam preparedness\u2019: Exploring non-academic predictors of postgraduate exam success - The Asia Pacific Scholar\",\"isPartOf\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2456-Figure-1-300x185.png\",\"datePublished\":\"2021-09-13T06:36:12+00:00\",\"dateModified\":\"2022-01-03T23:41:41+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success\/#primaryimage\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2456-Figure-1.png\",\"contentUrl\":\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2456-Figure-1.png\",\"width\":1297,\"height\":799},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/medicine.nus.edu.sg\/taps\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"\u2018Exam preparedness\u2019: Exploring non-academic predictors of postgraduate exam success\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/#website\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/\",\"name\":\"The Asia Pacific Scholar\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/medicine.nus.edu.sg\/taps\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"\u2018Exam preparedness\u2019: Exploring non-academic predictors of postgraduate exam success - The Asia Pacific Scholar","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/exam-preparedness-exploring-non-academic-predictors-of-postgraduate-exam-success\/","og_locale":"en_US","og_type":"article","og_title":"\u2018Exam preparedness\u2019: Exploring non-academic predictors of postgraduate exam success - The Asia Pacific Scholar","og_description":"Submitted: 19 October 2020 Accepted: 12 April 2021 Published online: 5 October, TAPS 2021, 6(4), 80-91 https:\/\/doi.org\/10.29060\/TAPS.2021-6-4\/OA2456 Balakrishnan Ashokka1,2, Tat Leang Lee1 &amp; Dani\u00eblle M.L. 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