Background: During COVID-19 all universities have shift their face to face teaching pattern to e-learning.

Objective: This study explores various factors of E-exams and learning associated to academic failure during Covid-19.

Material and Methods: A case-control study was conducted in March, 2021 among 225 dental undergraduate students out of which 75 were cases (failed) and 150 were controls (passed). Online questionnaire consisted of 24 items was filled by BDS students’ from first year till final year.  Hence, odds ratio was calculated by using SPSS version 23.

Results: The results of the study revealed that the rate of failure among the dental students from first year till final year was (60%), (11.1%), (13.9%) and (19.0%) respectively (p= 0.000). Significant E-exam related factors associated to academic failure were effort and time required to attempt exams (p=.000, OR=1.8), online OSPE/OSCE (p= .001, OR=2.7), technical IT skills (p= .009, OR=2.1), Student’s presentation marks (p=0.05, OR=1.7) and cheating (p=0.03, OR=1.8), whereas lower risk factors were MCQ’s (p=0.06), synchronous oral viva (p=0.5), internet connectivity issues (p=0.2), assignments (p=0.3) and online quizzes (p=0.7). Factors associated with highest risk of failing were pre-recorded didactic online lectures (p=0.03), less responsibility of learning online (p=0.04), dissatisfied bedside clinical skills (p=0.02) and poor attendance (p=0.05).

Conclusion: The results of the study conclude that faculty training is immediately required to conduct fair online E-assessments, OSCE/OSPE using appropriate technology and include presentation marks. While designing E-courses, interactive virtual sessions should be conducted to improve student engagement and attendance.