151 Pak J Ophthalmol. 2022, Vol. 38 (2): 151-156 Original Article The Association between Attendance and Academic Performance of MBBS Students of a Private Medical College in the Subject of Ophthalmology Sidrah Riaz 1 , Mariam Sheikh 2 , Muhammad Tariq Khan 3 , Ambreen Mumtaz 4 , Muhammad Saghir 5 1-5 Akhtar Saeed Medical and Dental College, Lahore ABSTRACT Purpose: To study the association between attendance and academic performance of MBBS students belonging to a private medical college in the subject of ophthalmology. Study Design: Cross sectional observational study. Place and Duration of Study: Akhter Saeed Medical and dental college of Lahore, from January 2021 to October 2021. Methods: A total of 152 students were included in study. The attendance record and test records of students in the subject of ophthalmology was retrieved. Both class test and ward tests included Short essay questions and multiple choice questions. Relationship between the attendance and test results was compared by using Pearson Correlation. Results: Among 152 students, 62.5%were females and 37.5% were males. The mean attendance in 3 rd year was 55.73 ± 20.44 and in 4 th year was 77.25 ± 19.03. During 3 rd year MBBS, 80.92% students had attendance below 75% and in 4 th year 32.24% had below 75%. Passed students had mean attendance of 56.82% in 3 rd year and 78.74% in 4 th year. Failed students had mean attendance of 49.27% in 3 rd year and 40% in 4 th year. Regarding ward test, students who passed their batch test in first attempt had mean attendance of 60.92% and 83.54% in 3 rd year and 4 th year respectively. Positive relationship between pass candidates in send up exams and ward tests was demonstrated by Pearson Correlation, showing significant results at 0.01. Conclusion: The academic performance of students is directly related with class attendance. The students with better class performance had better percentage of attendance and vice versa. Key Word: Medical students, attendance, academic performance. How to Cite this Article: Riaz S, Sheikh M, Khan MT, Mumtaz A, Saghir M. The Association between Attendance and Academic Performance of MBBS Students of a Private Medical College in the Subject of Ophthalmology. Pak J Ophthalmol. 2022, 38 (2): 151-156. Doi: 10.36351/pjo.v38i2.1369 Correspondence: Sidrah Riaz Akhtar Saeed Medical and Dental College, Lahore Email: sidrah893@yahoo.com Received: January23, 2022 Accepted: March 16, 2022 INTRODUCTION Professional education especially medical education is demanding and getting admission in institutes of professional education is tough because of competition. 1 It is also associated with economical concerns related to higher education. 2 The admission in medical college and successful completion of MBBS is not an easy job. To ensure producing a professionally competent and a good quality doctor, examining university has to set certain parameters to ensure professional competency standards. Attendance criteria is one of them and for medical students, a minimum of 75% attendance is mandatory to appear in exit exams. Over the decades, it has been observed that students with better grades are more regular in their Sidrah Riaz, et al Pak J Ophthalmol. 2022, Vol. 38 (2): 151-156 152 theory and clinical classes and vice versa. 3 It is also documented that class attendance is a significant determinant of academic performance. 4-6 From technical point of view, a missed day is missed opportunity for a student to learn something new. There are number of factors, which determine students’ attendance. Studies have shown that not only at university level but a primary school level, kids with absenteeism in school is associated with poor academic achievement and deficient general knowledge later in life. 7 In private medical institutions of Pakistan, attendance of the students has always been the issue of great concern. Local data regarding this issue is scarce. This study was designed to see address this issue providing a preliminary data which can help the policy makers in further refining the quality standards. METHODS Total 152 students, who were promoted to 4 th year MBBS class after passing 3 rd professional university exam held in November 2020, were included in study. The students belonged to Akhtar Saeed Medical and Dental College (AMDC), Lahore. The attendance record of the students in 3 rd year in the subject of ophthalmology was also noted from previous records (2020) and 4 th year attendance of lectures and clinical classes was noted over the year (February to October 2021). The attendance of students was either marked by the teacher himself/herself or collected in the form of individually signed paper circulated in class during lecture and counter checked at the end of the class. This was done by getting the signatures of each student in front of his or her mentioned roll number. The attendance record was sent daily to medical education department of the college for computerized records. There were two lectures of ophthalmology of 40 minutes duration per week and a clinical batch class consisting of 20 to 25 students, 5 days a week for 3 hours. The academic performance of the students was noted in the form of class tests and ward test results. There were three (3) class tests held every 3 months which included all chapters at the end of 03 months. The class was divided in 08 clinical batches, which were rotated among different clinical subjects (Ophthalmology, ENT, Community Medicine, Pathology, Gynae Obs, Surgery and Medicine) over the academic year. The Ward test was taken at the end of each clinical ward rotation of Ophthalmology. Both class test and ward test included short essay question and multiple choice question papers and pass marks were 50%. The students who were not able to pass their ward test in first attempt or absent on the day of test were given a second chance to clear their test, as it was mandatory to appear in send up examination. No second chance was provided to students who failed the send up examination or were absent. They were not eligible to appear in the fourth professional examination. Seventy five percent attendance was mandatory criteria set by the university to appear in exams at the end of session. The parents and students were also given three monthly reminders in the form of mobile messages and letters, if their attendance was less than 75%. RESULTS Among the 152 students included in the study, 93 (62.5%) were females and 57 (37.5%) were males. The mean attendance in 3 rd year was 55.73 ± 20.44, 63.05% for females and 43.55% for males. Mean attendance for 4 th year students was 77.25 ± 19.03, 83.11% for females and 67.48% for males (Table 1). During 3 rd year MBBS class 123 (80.92%) students had attendance below 75% and 29 (19.08%) above it (Graph 1). In 4 th year MBBS 49 (32.24%) students had attendance below 75% and 103 (67.76%) had above it (Graph 2). The students who passed their send up examination had mean attendance of 56.82% in 3 rd year and 78.74% in 4 th year. Students who failed in send up examination had mean attendance of 49.27% in 3 rd year and 40% in 4 th year. Regarding ward test, students who passed their batch test in first attempt had mean attendance of 60.92% and 83.54% in 3 rd year and 4 th year respectively. Failed students who re appeared in second attempt had attendance of 48.08% in 3 rd year and 68.83% in 4 th year (Table 2). In the first class-test, students who appeared and declared successful had attendance of 61.59% in 3 rd year and 83.97% in 4 th year. Further details are found in Table 3. The positive relationship between pass candidates in send up exams and ward tests was demonstrated by Pearson Correlation, showing significant test at 0.01 level (2 tailed) shown in table 4. The Association between Attendance and Academic Performance of MBBS Students of a Private Medical College 153 Pak J Ophthalmol. 2022, Vol. 38 (2): 151-156 Table 1: Send up Results and Mean Attendance of Students. Attendance MBBS Class Mean Attendance Female Male Send up Exam Result Pass Fail Absent Mean Attendance 3 rd Year 55.73% 63.05% 43.55% 56.82% 40.00% 16.07% 4 th Year 77.25% 83.11% 67.48% 78.74% 49.27% 39.03% Table 2: Send up & Ward Results and Mean Attendance of Students. Ward Tests Attempt/Absent Send up Results 3 rd year MBBS Mean Attendance 4 th Year MBBS Mean Attendance Female Male Female Male Female Male Ward test passed in first attempt Pass 71 31 66.75% 47.35% 86.64% 76.79% Fail 0 1 0.00% 67.86% 0.00% 73.17% Absent 0 0 0.00% 0.00% 0.00% 0.00% Ward test passed in second attempt Pass 20 19 54.64% 42.67% 76.71% 60.59% Fail 0 1 0.00% 35.71% 0.00% 58.54% Absent 1 0 32.14% 0.00% 78.05% 0.00% Absent in ward test Pass 2 2 33.93% 30.36% 46.34% 53.66% Fail 1 2 57.14% 19.65% 39.02% 37.81% Absent 0 1 0.00% 0.00% 0.00% 0.00% 95 (62.5%) 57 (37.5%) 152 (100%) Table 3: 1 st , 2 nd & 3 rd Class test Results and Mean Attendance of Students. MBBS Academic Year First Class Test Results Second Class Test Results Third Class Test Results Appeared in Test and Pass Appeared in Test and Failed Absent Appeared in Test and Pass Appeared in Test and Failed Absent Appeared in Test and Pass Appeared in Test and Failed Absent Third Year MBBS Attendance (Mean) 61.59% 57.38% 32.59% 66.65% 51.52% 46.04% 58.85% 46.31% 26.19% Forth Year MBBS Attendance (Mean) 83.97% 79.85% 49.29% 86.94% 78.05% 64.00% 82.17% 61.71% 37.40% Table 4: Showing correlation between attendance and academic performance. Pearson’s Correlations 3 rd Year Attendance 4 th Year Attendance Send-up Results Ward-test Results 3 rd -Year Attendance Pearson Correlation 1 .581 ** -.268 ** -.419 ** Sig. (2-tailed) .000 .001 .000 N 152 152 152 152 4 th- YearAttandance Pearson Correlation .581 ** 1 -.354 ** -.566 ** Sig. (2-tailed) .000 .000 .000 N 152 152 152 152 Send Up Exam Pearson Correlation -.268 ** -.354 ** 1 .379 ** Sig. (2-tailed) .001 .000 .000 N 152 152 152 152 Ward Test Pearson Correlation -.419 ** -.566 ** .379 ** 1 Sig. (2-tailed) .000 .000 .000 N 152 152 152 152 **.Correlation is significant at the 0.01 level (2-tailed). Sidrah Riaz, et al Pak J Ophthalmol. 2022, Vol. 38 (2): 151-156 154 Graph 1: Detail of %age attendance of student in 3 rd year MBBS. Graph 2: Detail of % age attendance of student in 4 th year MBBS. DISCUSSION This particular study showed that students are more likely to pass their examinations if they attend school regularly. Existing data has revealed that class attendance is a useful, effective and valuable indicator of successful attainment of any academic degree. 8-11 The Association between Attendance and Academic Performance of MBBS Students of a Private Medical College 155 Pak J Ophthalmol. 2022, Vol. 38 (2): 151-156 The reasons why regulatory bodies are interested in attendance of medical students, are professional development and performance, as attendance is considered as its integral part. 12,13 Another logic is that attendance is the only variable that can be monitored, tracked and regulated to achieve good academic performance. A study from Denmark with data of nearly1000 undergraduate students strongly correlated attendance with academic performance. 8 On the contrary, some studies have provided clue that good academic performance was not related with optimal roll call. 14 Other studies have shown that absenteeism affected students in an adverse way. In addition to falling behind in academics, students who were not in school on a regular basis were more likely to get into trouble with the law and cause problems in their communities. 15 Studies also indicate that chronic absenteeism was also linked with less academic achievement, social withdrawal and isolation among students. 16,17 This particular study showed that female medical students were more regular in attending the classes than their male counterparts. There mean attendance was 63.05% in 3 rd year and 83.11% in 4 th year MBBS class whereas boys had 43.55% and 67.48% in 3 rd and 4 th year respectively. It may be related to more female students in class. There were 93 females in the class of 152. Boys also had more outdoor interests like sports and social activities as compared to girls. 18,19 Overall, girls showed more serious behaviour toward attendance rules and remained abide by the regulations more proficiently. The students showed 55.73% mean attendance in the subject of ophthalmology during 3 rd year MBBS class, that was less than 75%, as compared to 77.25% mean attendance in 4 th year as it was examination subject in 4 th year and not in 3 rd year. Therefore students were less serious about its attendance in third year. In 3 rd year, 9 (5.92%) students had attendance below 10% and 17 (1118%) had below 30%. In 4 th year the students of the same class showed only 2 (1.32%) students below 10% and 5 (3.29%) below 30%. Another study from a private medical college showed similar results. 20 There are different factors, which cause absenteeism among students. 21 When enquired about its reason, poor time management, working against nature’s clock and being awake till late night leading to difficulty in early rising were told by the students in general discussion. As attendance is considered an important predictor of pedagogical success, so a designated cell, under department of Medical Education, collects students’ attendance of lectures and clinical classes, updates students and their parents regularly and maintains a smooth record. Different institutes have adopted different systems to mark attendance of students but our college has approved manual and biometric methods. The timely reminder about students’ attendance, academic results, grades and missed assignments at regular intervals to their parents or guardians has reduced course failures and motivates pupils too to increase class attendance. 22 It is emphasized that lectures should be interesting and ward classes should be more practical to maintain interest of students. Limitations of the study are that only a single subject was considered in this study. It was a private college and public sector data was not included in the study. Basic sciences were also not taken into account. CONCLUSION The academic performance of students when assessed over the year was directly related with class attendance. The students with better class performance had better percentage of attendance and vice versa. Ethical Approval The study was approved by the Institutional review board/Ethical review board (M-21/74/- Ophthalmology). Conflict of Interest Authors declared no conflict of interest. REFERENCES 1. Fatimah N, Hasnain Nadir M, Kamran M, Shakoor A, Mansoor Khosa M, Raza Wagha M, et al. Depression among Students of a Professional degree: Case of Undergraduate Medical and Engineering Students. Int J Ment Health Psychiatry, 2016; 2: 2. doi:10.4172/2471-4372.100012. 2. Stanca L. The effects of attendance on academic performance: Panel data evidence for introductory microeconomics. J Econ Educ. 2006; 37 (3): 251-266. Sidrah Riaz, et al Pak J Ophthalmol. 2022, Vol. 38 (2): 151-156 156 3. Fadelelmoula T. The impact of class attendance on student performance. 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Teachers College, Columbia University, 2017. Retrieved from http://www.columbia. edu/~psb2101/ParentRCT. Authors’ Designation and Contribution Sidrah Riaz; Associate Professor: Design, Literature search, Data acquisition, Data analysis, Statistical analysis, Manuscript preparation, Manuscript editing. Mariam Sheikh; Associate Professor: Data acquisition, Data analysis, Statistical analysis, Manuscript editing, Manuscript review. Muhammad Tariq Khan; Professor: Concepts, Manuscript editing, Manuscript review. Ambreen Mumtaz; Professor: Data acquisition, Manuscript editing, Manuscript review. Muhammad Saghir; Registrar: Data acquisition, Manuscript editing, Manuscript review. .…  …. https://doi.org/10.1111/j.1540-4609.2010.%2000294 https://doi.org/10.1111/j.1540-4609.2010.%2000294 https://doi.org/10.3102/0034654310362998 https://doi.org/10.7916/D89C7650