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Postgraduate medical students may encounter various challenges that contribute to underperformance in exit examinations. Based on the literature, ten primary factors include: Inadequate Exam Preparation: Insufficient study time and ineffective learning strategies can hinder exam readiness. https://www.pjms.org.pk/index.php/pjm... Personal Factors: Family commitments and stress can divert focus from studies, impacting performance. https://pmc.ncbi.nlm.nih.gov/articles... Exam-Related Factors: Perceived harsh or unfriendly examiner attitudes may increase anxiety, affecting candidates' performance. https://pmc.ncbi.nlm.nih.gov/articles... Training-Related Factors: Heavy workloads and inadequate training opportunities can limit preparation time and practical experience. PUBMED CENTRAL Luck: Some students attribute their failure to bad luck, which may reflect a lack of control over the examination process. PUBMED CENTRAL Information Overload: The extensive amount of information to be learned in a limited time can overwhelm students, leading to poor performance. https://pafmj.org/PAFMJ/article/view/868 Poor Time Management: Inadequate time allocation for studies due to extracurricular activities or procrastination can result in insufficient preparation. https://pafmj.org/PAFMJ/article/view/868 Stress and Anxiety: High levels of stress and anxiety can impair concentration and memory, negatively affecting exam performance. https://en.wikipedia.org/wiki/Stress_... Poor Teaching Skills of Educators: Ineffective teaching methods may lead to misunderstandings or gaps in knowledge, hindering students' ability to perform well. Unfair Examination System: Perceptions of an unfair or biased examination process can demotivate students and impact their performance.