Weak students often continue with little guidance and feedback, and often have ongoing difficulties. Early support may stop students experiencing a cycle of failure. Key to supporting struggling students is to identify reasons for poor performance. We explored the reasons for poor performance in a cohort of fifth year students who failed their final clinical examinations. Qualitative methods (interviews and a focus group) identified several themes. Many of the students had experienced personal problems or issues. They regarded themselves as competent students although they had significantly greater problems with earlier exams than the year mean, and significantly lower scores in formative assessments during the year leading up to these exams than their peers. Factors relating to the exam itself were seen as relevant to failure. More specific support and feedback throughout the MBcHB was seen as desirable. They tended to take little personal responsibility for their performance and were reluctant to seek help. We conclude that while the onus is on Faculty to identify and support failing students, the results indicate that students would benefit from support in developing self-reflection skills in such a way to support life-long learning.

Significant disparities exist between the major ethnic groups in both disease prevalence and management. Future studies examining the management of CKD need to take variation by ethnicity into account.

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Shared undergraduate clinical assessments should not rely on scoring systems and standard setting which fail to take into account other differences between schools. Examiner behaviour and training and other local factors are important contributors to variations in scores between schools. The OSCE scores of students from different medical schools should not be directly compared without taking such systematic variations into consideration.

Objective The present study investigates the impact of quality of care (QoC) and other factors on chronic kidney disease (CKD) stage progression among Type 2 Diabetes Mellitus (T2DM) patients. Methods This study employed a retrospective cohort from a nationwide Diabetes and Hypertension study involving 595 Thai hospitals. T2DM patients who were observed at least 2 times in the 3 years follow-up (between 2011-2013) were included in our study. Ordinal logistic mixed effect regression modeling was used to investigate the association between the QoC and other factors with CKD stage progression. Results After adjusting for covariates, we found that the achievement of the HbA1c clinical targets (7%) was the only QoC indicator protective against the CKD stage progression (adjusted OR = 0.76; 95%CI = 0.59-0.98; p<0.05). In terms of other covariates, age, occupation, type of health insurance, region of residence, HDL-C, triglyceride, hypertension and insulin sen-sitizer were also strongly associated with CKD stage progression.