Studies completed with undergraduate populations have shown that attendance positively correlates with academic performance. A marked decline in classroom attendance within medical school has recently been noticed with the availability of video capture of lectures and other online material. This study compares these in the era of online material. It took place during the second-year Gastrointestinal and Renal Systems module. Attendance was mandatory at team-based learning and case-based learning sessions on new material and voluntary at lectures (29 sessions) and case-based learning on material previously covered (9 sessions). Attendance was recorded prospectively. All lectures were recorded, and all related files were available to students online. Performance was based on a 118 multiple-choice question final examination. Students voluntarily completed the Motivated Strategies for Learning Questionnaire (MSLQ). The study group consisted of 78 students (68% of 114 total) of whom 48 completed the MSLQ. Mean attendance was 24%, with 33% of students attending none of the nonmandatory sessions. The median score on the final exam for participants was 86.0 (range: 28.8). High levels of self-efficacy and the ability to self-regulate effort were predictive of low attendance. Attendance was positively predicted by an orientation toward peer learning and help seeking. There was no correlation between the percentage of classes attended and performance on the final exam. We conclude that different facets of self-regulated learning predict attendance, with highly confident students being the least likely to attend, and that attendance at in-class sessions is no longer a good marker for performance.
Historically, attendance has been a marker of academic performance, but the current medical education literature has had mixed results. In addition, attendance is dropping in the preclinical curricula, whereas, at the same time, the focus on United States Medical Licensing Examination Step 1 performance is increasing. This present study is a mixed-method approach correlating student attendance and access to the formal curriculum in a second-year pathophysiology course to performance on Step 1. Additionally, survey and focus group data evaluated the usage and importance of both the formal curriculum and third-party resources. Out of 112 eligible students, 77 participated in the study. There was no correlation between attendance or access to the learning materials and Step 1 performance. There was a strong correlation between the performance on the final examination and that of Step 1 ( r = 0.813; P < 0.001) and a moderate correlation between formative quiz ( r = 0.321; P = 0.005) and individual readiness assessment test performance ( r = 0.351; P = 0.002) and Step 1 performance. Survey and focus group data show that students place high importance on faculty-developed materials that they can use on their own, but not attendance. The third-party resources are highly used as an adjunct to the formal curriculum and to focus on Step 1 study. Attendance and access to the formal curriculum do not predict Step 1 performance, whereas performance on high- and low-stakes internal assessments do. Further study on how the lack of social interaction gained from attendance affects development of other competencies and the learning climate are warranted.
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