Context: The quality of the educational system is considered to be the most important influential factor in universities. Students have different characteristics that affect their academic achievement and failure. The educational failure of medical students has irreparable effects on various individual, social, and economic aspects. The present study aimed to investigate the influential factors in the academic achievement and failure of medical students in Iran. Methods: This systematic review was conducted through the two-step search of keywords such as “academic achievement” OR “academic failure” AND “medical student” in national and international databases, including SID, Google Scholar, and Scopus, and 32 and 58 articles were extracted from the two database categories, respectively. After reviewing the titles and abstracts, 38 articles were excluded. After the assessment of the remaining full-text articles, 36 other cases were also excluded, and 16 articles were reviewed. Results: The influential factors in academic achievement and failure included the entrance exam quota type, high school diploma grade, gender, parental education level, occupation status, place of residence, interval between the high school diploma and university admission, indigenousness, grades of the specific course of the entrance exam, socioeconomic status, self-esteem, IQ, young age, competitiveness, effort, social interest, the volume of university courses, exam preparation, the quality of the teacher’s education, level of interest in the course, the importance of the course in the comprehensive exam, and the ability of the teachers. In addition, various individual and family factors, socioeconomic status, and educational facilities have been reported to affect the academic achievement or decline of medical students. Conclusions: According to the results, the academic achievement and decline of medical students are affected by several factors, which should be considered in medical education.
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