Academic achievement in biomedical sciences and its correlates among students of bachelor of nursing science program in Uganda

Abstract

Background: Biomedical science courses such as anatomy, physiology, and biochemistry are critical components of nursing education, providing the foundational knowledge necessary for effective clinical practice. Despite their importance, academic achievement in these courses among nursing students remains low globally, with failure rates ranging from 20% to 50%. However, in Uganda, the extent of this problem and the factors associated with it remain poorly understood. Objectives: This study aimed to examine the level of academic achievement and sociodemographic, student educational and institutional factors influencing it among students in Bachelor of Nursing Science (BNS) program in Uganda. Methods: This mixed-methods study, guided by Critical Realism philosophy and Constructivist learning theory, was conducted at four purposively selected Ugandan public universities between March and July 2024. It employed cross-sectional and descriptive qualitative design for the quantitative and qualitative study aspects respectively. The qualitative study included 12 purposively sampled teaching staff, while the quantitative study used a census approach to enroll 208 students. Data were collected through key informant interviews and a self-administered questionnaire. Quantitative analysis involved Welch’s analysis of variance, Pearson correlation, and a linear mixed-effects model, while qualitative data were analyzed thematically. Results: The study found that academic achievement in biomedical sciences among nursing students had improved over time but remained context-dependent, with an overall failure rate of 8.41%. Physiology had the highest mean GPA (2.86 ± 0.768), while anatomy had the lowest (2.62 ± 0.825), leading to an overall GPA of 2.80 ± 0.788. Most students scored C (37%) and D (33.7%) letter grades. Similarly, one teaching staff stated: “There is a little bit of improvement in performance now”. Older age (e.g., 35+, β = -0.70, 95% CI: -1.25--0.16) and coming from a region outside central Uganda (e.g., Northern region, β = -0.43, 95% CI: -0.74--0.12) were sociodemographic factors associated with lower GPAs. Selecting nursing as a lower-choice career option (e.g., fourth choice, β = 0.62, 95% CI: 0.30-0.93) and using uncollaborative learning methods (e.g., rarely participating in group discussion, β = -0.61, 95% CI: -1.21- -0.12) were student educational factors associated with higher and lower GPAs respectively. Previous secondary education performance did not significantly influence academic achievement in biomedical sciences, despite its role in admission decisions (r = 0.1163). Not receiving feedback (e.g., lecturers not giving feedback on progressive test, β = -0.54, 95% CI: -0.93 --0.14) and using problem-based teaching method (β = 0.48, 95% CI: -0.05 --1.91) were some of the institutional factors associated with GPA. Conclusion: Academic achievement in biomedical sciences among BNS students in Uganda is reported to have improved but remains suboptimal, with overall failure rate of 8.41%. Key factors that influence academic achievement include socio-demographics (age, region of origin), student educational choices and learning approaches (career preference, collaborative learning), and institutional practices (feedback to students, competence-based teaching methods). Notably, prior academic performance at high school did not significantly predict success in biomedical science courses at university, despite its use as a criterion for university admission. Recommendations: To improve academic achievement, universities should provide targeted academic support to older students and those from regions outside central Uganda, strengthen career guidance at secondary level to align students’ interests with nursing education, encourage group discussions and peer-led learning strategies to enhance student engagement and comprehension, ensure regular and timely feedback on assessments to support learning progress, and promote the contextually appropriate use of problem based learning. Universities and government could also consider reviewing the current admission criteria of students into the BNS program.