Academic performance in medical education is influenced by several personal, institutional, and learning-related factors (1). Overall, attendance is one of the most frequently used measures for student engagement among these. In addition to self-generated reading, medical education also relies on the contributions of lectures, tutorials, practical demonstrations, small group discussions, bedside teaching, and engagement with teachers. Students with good attendance stay in touch with the curriculum, will be able to understand difficult concepts, and will build professional discipline (2, 3).

Absenteeism among medical students is a common concern in many institutions. Students can drop out of class because of their lack of motivation, desire to do self-study, preparation for exams, long courses, health issues, or lack of online learning resources (4). But chronic school truancy can create a disruption in learning and less exposure to key subject matter. The above mentioned earlier studies have shown that Absenteeism is correlated with low academic performance for the undergraduate medical students and better performance in the examinations is generally associated with good attendance (5, 6).

For MBBS education, attendance could be a critical aspect as students are required to acquire theoretical skills and medical knowledge along with practical skills and medical expertise (7). Academic sessions are regular, students can grasp complex medical concepts, having a discussion, observing the clinical methods, and getting feedback timely from teachers. Students who have low attendance rates may receive less of the explanations, clinical examples and the guidance related to assessment that is essential for them to be well prepared for professional examinations (8).

While desired attendance is generally thought to be important, the link between attendance and academic results can differ as a function of pedagogy, student learning style, lecture recording and institutional policy (9). Students can achieve good scores even if they are less often in school, because of their ability to learn by themselves; or they can need frequent discipline attendance in order to grasp the subject matter. Thus, to evaluate the relation between attendance and performance in examinations among the MBBS students of a particular academic setting, local evidence needs to be obtained.

The present study was conducted to determine the relationship between attendance and academic outcomes among MBBS students. The study aimed to compare examination scores, pass/fail status, and academic grades across different attendance categories. The findings may help medical colleges identify students at academic risk and develop early support strategies such as mentoring, counseling, attendance monitoring, and academic guidance.

This study was conducted to assess the relationship between class attendance and academic outcomes among MBBS students. A descriptive cross-sectional study design was used because the objective was to determine the association between attendance percentage and examination performance at a particular point in time. This descriptive cross-sectional study was conducted among 63 MBBS students at HBS Medical and Dental College from March 2025 to September 2025.

The study population consisted of students of MBBS in selected medical college during the study period. Students from various classes were eligible. The total number of students included in the study was 63 MBBS students. Non-probability consecutive sampling was used in the selection of the participants. All students who met inclusion criteria and gave consent were included until sample size of the required number was reached.

MBBS students of either gender who were enrolled in the institution during the study period were included in the study. Available students' attendance and academic records were used to determine eligibility. Students who were absent during data collection, those who failed to give consent and those who had incomplete attendance or examination records were not included in the study. This was to ensure accuracy and completeness of the collected data.

Attendance percentage was the main independent variable of the study, and the academic outcome was the main dependent variable of the study. The percentage of attendance was derived from the official institutional attendance data. The pupils were categorized based on their attendance percentage as low attendance (<75%), moderate attendance (75-84%), good attendance (85-94%) and excellent attendance (95% and above). Academic achievement was measured in terms of examination grades, pass or fail, and academic grade category achieved.

Information were gathered through the use of a structured proforma created for the study. Demographic data like age, gender, year of MBBS and residence status was included in the proforma. Academic data consisted of attendance, mean examination mark, examination pass/fail, academic grade, number of study hours per day and level of class participation. Data were collected from the official departmental or institutional record of a student to minimize recall bias and achieve greater reliability in data collection.

The mean score was recorded and academic grades were also used to categorize the performance of the students in the examination. The students were divided in to four categories based on the marks obtained: poor, average, good and excellent academic performance. Progressive status was noted by the criterion of the institutions for the MBBS examination. The other academic factors like study hours, class participation were also entered to see if these were other factors of academic achievement that were related.

Before data collection, permission was obtained from the concerned department and institutional administration. The study was conducted after receiving approval from the institutional ethical review committee. Participants were informed of the study and consent was obtained for the study. Student anonymity and confidentiality of student information were ensured throughout the study. Only data for research purposes were used, and no student name or roll number was given in the final report.

Data was collected and analyzed with SPSS software. The quantitative variables (age, attendance percentage, examination score) were reported as mean and standard deviation. Gender, type of residence, type of attendance, pass/fail status and academic grade were reported as frequencies and percentages (qualitative variables). The chi-square test was used to test the association between attendance category and pass/fail. One-way ANOVA was used to compare the mean examination scores of the various attendance categories. Pearson correlation was used to evaluate the correlation between attendance percentage and the examination score. A p value < 0.05 was defined as statistically significant. Data was presented in tables and figure. Demographic characteristics were summarised first, followed by distribution of attendance and academic outcome measures. Comparisons of mean scores, pass rates, academic grades and correlation analysis were used to evaluate the relationship between attendance and examination performance. This approach helped in determining whether higher attendance was associated with better academic outcomes among MBBS students.

A total of 63 MBBS students were included in the study. The mean age of the students was 21.3 ± 1.5 years with an age range of 18 - 25 years. Among the participants, 35 (55.6%) were female and 28 (44.4%) were male. The majority of students were from the third and fourth year MBBS courses. As far as the residence is concerned, 34 students (54.0%) were living in the hostel and 29 students (46.0%) were day scholars.

Table 1: Demographic Characteristics of MBBS Students

Students' attendance record revealed that 24 students (38.1%) had excellent attendance (95% and above) and 20 (31.7%) students had good attendance (85-94%). There were 12 (19.0%) students with moderate attendance, and 7 (11.1%) students with attendance less than 75%. This means that the majority of pupils had satisfactory attendance throughout the school year.

Table 2: Distribution of Students According to Attendance Percentage

There was an improvement in academic performance as attendance increased. Pupils who had excellent attendance had the highest mean examination score of 78.6 ± 7.4, followed by those good at attendance, who had a mean examination score of 72.8 ± 8.1. Students who attended moderate attendance had a mean score of 66.5 ± 7.9 and students with low attendance were the lowest with a mean score of 58.4 ± 9.2. There was a statistically significant difference (p<0.001) between the mean examination score of the different attendance groups.

Table 3: Mean Examination Score According to Attendance Category

Pass and fail were also determined by the level of attendance. 23 of the 24 students (95.8%) who had excellent attendance passed, and 1 (4.2%) failed. Among those with low attendance, 42.9% passed and 57.1% failed, compared to 63.6% and 36.4% respectively for those with good attendance. Attendance category was significantly correlated with pass/fail (p = 0.002), in that higher attendance rates were associated with higher passing rates.

Table 4: Association Between Attendance Category and Pass/Fail Status

The students were also categorized based on their academic levels. Students who had excellent attendance had the best academic performance with it and students who had poor attendance had the poor academic performance with it. This trend implies that regular attendance is a factor in better assimilation of course material, better participation in class and better preparation for examinations.

Table 5: Academic Grade According to Attendance Category

Correlation analysis was conducted to check the correlation between the two variables that are attendance percentage and examination score. There was a high positive correlation between attendance and academic score (r = 0.68, P < 0.001). This was because pupils with higher attendance rates tended to achieve higher scores in their academic work.

Table 6: Correlation Between Attendance Percentage and Examination Score

Other educational characteristics were also correlated with examination performance. Students with the highest total study time per day (4 hours or more) earned higher mean scores than those with the lowest total study time per day (less than 2 hours). Likewise, students who participated well in class had higher scores than the students who did not participate well in class. However, of all the academic variables, there was the strongest correlation between examination score and attendance percentage.

Table 7: Academic Factors Associated With Examination Score

Overall, the results showed a clear and statistically significant relationship between attendance and academic outcomes among MBBS students. Students with higher attendance had better mean examination scores, higher pass rates, and better academic grades. The findings suggest that regular class attendance is an important academic factor associated with improved performance in MBBS students.

The graph shows that mean examination scores increased progressively with higher attendance. Students with excellent attendance (≥95%) achieved the highest mean score, while students with low attendance (<75%) had the lowest mean score. The difference across attendance categories was statistically significant (ANOVA p < 0.001).

The present study demonstrated a clear positive relationship between attendance and academic outcomes among MBBS students. Students with excellent attendance had the highest mean examination score, while those with low attendance had the lowest mean score. The difference across attendance categories was statistically significant, indicating that regular attendance may play an important role in improving academic performance. This finding is consistent with Khan et al., who reported that absenteeism among undergraduate medical students was associated with poor academic achievement (10). Similarly, Al Khaja et al. found that attendance in pharmacology and therapeutics resource sessions was positively related to academic performance among pre-clerkship medical students (11). These findings support the idea that regular participation in academic sessions improves exposure to core concepts, teacher explanations, and structured learning.

The findings of the present study showed that students who had an attendance rate of 95% or higher, outperformed students with attendance rates of less than 75% on examination scores. This is in line with the results of Wongtrakul et al. who reported that the absenteeism rate was higher than the examination result of basic science medical courses (12). Mondal et al. also found that improving the way attendance is recorded leads to a better academic performance among medical students (13). In another study, Salzman et al. reported a small positive correlation between attendance and examination performance in one module only and not all modules (14). This indicates that although attendance can have an effect on academic performance, the level of student motivation,

their study habits, the availability of recorded lectures, their prior knowledge and their learning environment may also have an impact.

In the medical education, the relationship between attendance and academic achievement is particularly significant as in MBBS training, students need to be constantly involved with lectures, tutorial, practical session, clinical demonstration, and and professional behavior. Al Shenawi et al. found a high positive correlation between attendance at surgical clerkship and academic performance of medical students during their undergraduate years (15). In a similar way, Hinojosa-Gonzalez et al., concluded that there is a positive correlation between the lesser the frequency of calling students to lecture attendance and the higher their academic performance among medical trainees (16). These studies suggest that attendance is not just linked to theories, but also associates with clinical exposure, communication skills and professional discipline. In this study, students' pass rates were found to be higher and their academic grades were found to be better for students with high attendance levels, further reinforcing the significance of regular academic participation.

The present results are also similar to those in medical education settings in South Asian countries. Cheema et al. found that there is a positive correlation between attendance and written, viva voce and formative assessment scores for preclinical MBBS students in Pakistan (17). In a record-based study, Mitra et al. were able to link absenteeism of undergraduate medical students with their academic performance (18). They pointed out that attendance at lectures in medical schools is still a matter of concern, and that it may be related to the level of engagement, learning style, and academic discipline of students (19). Higher mean scores and an increased percentage of students passing were observed with higher attendance, indicating that a higher rate of attendance may be a method of identifying students at academic risk.

There are several possible reasons why the improvement in attendance leads to improved outcomes in the academic field. Students who attend classes regularly will be able to get organized material, understand complicated concepts, join in discussions, and learn in a continuous manner. The students reported to be absenting on class due to preparing for tests and having busy schedules, or favouring self-study (20) which indicates that absence is multifactorial. The study by Khan et al. also concluded that the attendance–performance association may be different in preclinical compared to clinical years, suggesting that the impact of attendance may vary depending on the teaching approach and academic year (21). There are some limitations in the present study. It was related to relatively small number of students (63) and was carried out using cross sectional design, and thus the causal relationship cannot be confirmed. Attendance and examination performance were evaluated from records available, but other aspects of performance including previous attainment, mental health, learning style, quality of teaching and use of online resources can also have an impact on achievement. A larger sample size and for other confounding variables, multicenter studies are recommended.

The present study concluded that attendance has a significant positive relationship with academic outcomes among MBBS students. Students with higher attendance had better mean examination scores, higher pass rates, and better academic grades. Students with low attendance were more likely to have poor academic performance and examination failure. These findings suggest that regular class attendance is an important academic factor in MBBS education. Medical colleges should strengthen attendance monitoring, student counseling, mentoring systems, and early academic support for students with poor attendance. However, attendance should not be viewed as the only determinant of academic success, as study habits, motivation, teaching quality, and student wellbeing also influence academic performance.

1. Wongtrakul W, Dangprapai Y. Effects of Live Lecture Attendance on the Academic Achievement of Preclinical Medical Students. Medical Science Educator. 2020;30(4):1523-30 DOI: 10.1007/s40670-020-01068-y.
2. Rashid S, Ul Hassan A, Bhat IH, Bhat GM. Analyzing the Attitude of Medical Students Toward Class Absenteeism. National Journal of Clinical Anatomy. 2021;10(4).
3. Lu C, Cutumisu M. Online engagement and performance on formative assessments mediate the relationship between attendance and course performance. International Journal of Educational Technology in Higher Education. 2022;19(1):2 DOI: 10.1186/s41239-021-00307-5.
4. Tadese M, Yeshaneh A, Mulu GB. Determinants of good academic performance among university students in Ethiopia: a cross-sectional study. BMC medical education. 2022;22(1):395 DOI: 10.1186/s12909-022-03461-0.
5. Kim ASN, Shakory S, Azad A, Popovic C, Park L. Understanding the impact of attendance and participation on academic achievement. Scholarship of Teaching and Learning in Psychology. 2020;6(4):272-84 DOI: 10.1037/stl0000151.
6. Mokhtari S, Nikzad S, Mokhtari S, Sabour S, Hosseini S. Investigating the reasons for students' attendance in and absenteeism from lecture classes and educational planning to improve the situation. J Educ Health Promot. 2021;10:221 DOI: 10.4103/jehp.jehp_1112_20.
7. Alghamdi SA, Aljaffer MA, Alahmari FS, Alasiri AB, Alkahtani AH, Alhudayris FS, et al. The impact of low self-esteem on academic achievement and the behaviors related to it among medical students in Saudi Arabia. Saudi medical journal. 2023;44(6):613-20 DOI: 10.15537/smj.2023.44.6.20230055.
8. Hayat AA, Kojuri J, Amini M. Academic procrastination of medical students: The role of Internet addiction. Journal of advances in medical education & professionalism. 2020;8(2):83-9 DOI: 10.30476/jamp.2020.85000.1159.
9. Duke NN. Adolescent Adversity, School Attendance and Academic Achievement: School Connection and the Potential for Mitigating Risk. Journal of School Health. 2020;90(8):618-29 DOI: https://doi.org/10.1111/josh.12910.
10. Latif Khan Y, Khursheed Lodhi S, Bhatti S, Ali W. Does Absenteeism Affect Academic Performance Among Undergraduate Medical Students? Evidence From "Rashid Latif Medical College (RLMC).". Adv Med Educ Pract. 2019;10:999-1008 DOI: 10.2147/amep.S226255.
11. Al Khaja KAJ, Tayem Y, James H, Jaradat A, Sequeira RP. Pharmacology and therapeutics resource session attendance and academic performance of pre-clerkship medical students in problem-based learning curricula. BMC medical education. 2019;19(1):269 DOI: 10.1186/s12909-019-1699-3.
12. Wongtrakul W, Dangprapai Y. Effects of Live Lecture Attendance on the Academic Achievement of Preclinical Medical Students. Med Sci Educ. 2020;30(4):1523-30 DOI: 10.1007/s40670-020-01068-y.
13. Mondal H, Saha K, Mondal S, Saha P, Biri SK. A new method of recording attendance improves the academic performance of medical students. Journal of advances in medical education & professionalism. 2020;8(2):55-60 DOI: 10.30476/jamp.2020.81723.1029.
14. Salzman J, Williamson M, Epsina-Rey A, Kibble J, Kauffman C. Effects of voluntary attendance patterns on first-year medical students' wellness and academic performance during COVID-19. Advances in physiology education. 2021;45(3):634-43 DOI: 10.1152/advan.00071.2021.
15. Al Shenawi H, Yaghan R, Almarabheh A, Al Shenawi N. The relationship between attendance and academic performance of undergraduate medical students during surgical clerkship. BMC medical education. 2021;21(1):396 DOI: 10.1186/s12909-021-02833-2.
16. Hinojosa-Gonzalez DE, Farias JS, Tellez-Giron VC, Aguirre-Villarreal D, Brenes-Castro D, Flores-Villalba E. Lower Frequency of Call Shifts Leads to Higher Attendance, Higher Academic Performance, and Less Burnout Syndrome in Surgical Clerkships. J Surg Educ. 2021;78(2):485-91 DOI: 10.1016/j.jsurg.2020.07.043.
17. Mohsin Ali C, Amra R, Saba K, Syed Muhammad Hammad A, Rida Ajmal K. Role of attendance in academic performance of male and female medical students in pre clinical years: A descriptive study. Journal of University Medical &amp; Dental College. 2022;13(4)DOI: 10.37723/jumdc.v13i4.682.
18. Mitra S, Sarkar P, Bhattacharyya S, Basu R. Absenteeism among undergraduate medical students and its impact on academic performance: A record-based study. J Educ Health Promot. 2022;11:414 DOI: 10.4103/jehp.jehp_638_21.
19. Gardner G, Feldman M, Santen SA, Mui P, Biskobing D. Determinants and Outcomes of In-person Lecture Attendance in Medical School. Med Sci Educ. 2022;32(4):883-90 DOI: 10.1007/s40670-022-01581-2.
20. Mohi Ud D, Noor F, Shazia A, Muqaddas M, Uswa N, Khadija Aziz T. Medical Students' Perspectives Towards Absenteeism in Class. Esculapio. 2023;19(3):365-70 DOI: 10.51273/esc23.251319322.
21. Khan AA, Mahboob UJJoIIMC. MEDICAL EDUCATION: Correlation of Academic Performance with Student Attendance in Pre-Clinical and Clinical Years of Undergraduate Medical Education. 2023;18(4):279-85.