this topic was just addressed in a newsletter I get from the American College of Physicians. Let me see if I can sum it up...
1) number one reason was inadequate study time/taking a vacation during study period
2) passive study methods. "don't just read, review and reread material over and over again....you not only need to read and review, but you also need to take practice exams, review aloud, quiz one another, and then take more practice exams."
3) isolation from peers. have a buddy/touch base/quiz each other/review. don't engage in negative talk about exam
4) spending too much time on SDN. just kidding! but if I fail, I'm blaming sdn 😉