title: Participating in university entrance exam despite repeated failure: a qualitative study of participants' experiences.
abstract: OBJECTIVE
  To explore the experiences of general practitioners who continue to sit a highly-competitive residency entrance examination, despite repeated failure.
  
  
  METHODS
  This qualitative, exploratory study employed semi-structured, in-depth interviews with 35 candidates of a residency entrance exam who had failed the examination at least twice and were preparing to sit it again. Interview questions addressed the challenges they faced and how they managed these challenges. Interview data were audiotaped, transcribed, and analysed to identify themes.
  
  
  RESULTS
  The results demonstrated that more than 50% (n=19) of candidates struggled continuously and internally with different aspects of the exam. These include being under a great deal of pressure to succeed, failing to prioritize study materials, inefficient review during the final days  of preparation, and sitting the exam with an afflicted body. Furthermore, during the examination, they frequently used inefficient strategies to answer questions. Afterwards, they experienced feelings of freedom associated with having finished the exam.
  
  
  CONCLUSIONS
  Participation in a highly-competitive examination exerts a considerable amount pressure on low-performing candidates. This climate not only results in burn out of participants, but it also influences their learning styles and identities as future physicians. It is therefore necessary to design a syllabus for both test candidates and policy makers, in order better to manage this environment. Candidates also should be aware of their individual weaknesses in order to improve their studying skills.
authors: Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors: Ruohollah
authors: R
authors: Seddigh
authors: Department of Nephrology, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors: Esmat
authors: E
authors: Abdollahpour
authors: Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors: Somayeh
authors: S
authors: Azarnik
authors: Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors: Behnam
authors: B
authors: Shariati
authors: Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors: Amir-Abbas
authors: AA
authors: Keshavarz-Akhlaghi
mesh_terms: D000328:Adult; D003099:College Admission Test; D003163:Competitive Behavior; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007407:Interviews as Topic; D007492:Iran; D008297:Male; D012649:Self Concept; D058013:Test Taking Skills
keywords: college admission test; competitive behavior; internship and residency; iran; stress; student assessment