Faculty perspectives on factors influencing the passing of underperforming health profession students: challenging the ‘success-only’ culture

Introduction: In health professions, assessment plays an essential role in ensuring patient safety, professional competency and academic integrity. Nevertheless, in a variety of educational settings, the phenomenon of "failure to fail," in which underperforming students are allowed to advance, has been documented. There is little data from Pakistan on how faculty members deal with this difficulty, especially in summative clinical and didactic evaluations. The purpose of this study was to investigate faculty perceptions of the variables affecting underperforming undergraduate students' advancement in Pakistani health professions (medical, dental & allied). Methods: A cross-sectional mixed-methods design was employed using a semi-structured, anonymous Google form. The survey was distributed through professional faculty Whatsapp groups. Participation was voluntary and only faculty members actively involved in undergraduate assessments were eligible. Purposive sampling yielded 33 completed responses. Results: The majority of faculty (84.8%) stated that students who performed poorly were nevertheless able to pass. Institutional uncertainty (39.4%), social pressure (27.3%), and pity (12.1%) were among the major factors that contributed. Even though 78.8% had previous experience with failing students, the majority of their decision was based on academic underperformance (72.7%), considering the attitudes of faculty regarding failing students, one-third of participants acknowledged it to be a emotional turmoil, however the majority rejected the fact that failing a student was a reflection of their own teaching. There was little knowledge of institutional support systems (42.4%) and many respondents were either impartial or ignorant of the impact of organisational policies. Discussion: Despite faculty concerns, the majority of participants reported seeing instances where students with subpar or questionable performance advanced to later academic years. Commonly cited factors included uncertainty regarding institutional policies, limited remediation pathways, and emotional and ethical challenges associated with failing students. Qualitative analysis identified themes related to emotional burden, moral dilemmas, perceived institutional pressure, and patient safety concerns.