Factors associated with medical students? scores on the National Licensing Exam in Peru: a systematic review

Purpose: This study aimed to identify factors that have been studied for their associations with National Licensing Examination (ENAM) scores in Peru. Methods: A search was conducted of literature databases and registers, including EMBASE, SciELO, Web of Science, MEDLINE, Pe-ru's National Register of Research Work, and Google Scholar. The following key terms were used: "ENAM" and "associated factors." Studies in English and Spanish were included. The quality of the included studies was evaluated using the Medical Education Research Study Quality Instrument (MERSQI). Results: In total, 38,500 participants were enrolled in 12 studies. Most (11/12) studies were cross-sectional, except for one case -con-trol study. Three studies were published in peer-reviewed journals. The mean MERSQI was 10.33. A better performance on the ENAM was associated with a higher-grade point average (GPA) (n=8), internship setting in EsSalud (n=4), and regular academic status (n=3). Other factors showed associations in various studies, such as medical school, internship setting, age, gender, socioeconomic status, sim-ulations test, study resources, preparation time, learning styles, study techniques, test-anxiety, and self-regulated learning strategies. Conclusion: The ENAM is a multifactorial phenomenon; our model gives students a locus of control on what they can do to improve their score (i.e., implement self-regulated learning strategies) and faculty, health policymakers, and managers a framework to improve the ENAM score (i.e., design remediation programs to improve GPA and integrate anxiety-management courses into the curriculum).