Association of classroom participation and examination performance in a first-year medical school course
Advances in Physiology Education
advent of internet-based delivery of basic medical science lectures may unintentionally lead to decreased classroom attendance and participation, thereby creating a distance learning paradigm. In this study, we tested the hypothesis that classroom attendance/participation may be positively correlated with performance on a written examination for first-year medical school instruction. The study subjects consisted of 115 first-year medical students. The introductory respiratory structure-function
... instruction was designed to include one noncompulsory pretest, four short postinstruction noncompulsory self-evaluation tests that were unannounced as to date and time, and one compulsory comprehensive examination. The relationship between attendance/participation, measured by the number of noncompulsory tests taken, and performance on the comprehensive examination was determined by Pearson's correlation coefficient, one-way ANOVA, and a 2 -test of significance. The average score on the pretest was 28%; for the same items on the comprehensive examination (posttest), the average score was 73%. For the 80 students who took the pretest, this translated to an overall score increase of 161%. Attendance/participation in four or five of the noncompulsory tests resulted in an 83.3% pass rate on the comprehensive exam compared with a rate of 52.9% for attendance/participation in three, two, one, or none of the five noncompulsory tests; the overall pass rate was 60.9%. There was a significant association between a high rate of classroom attendance/participation and a high score on the comprehensive examination (Pearson's 2 ϭ 8.599, P Ͻ 0.01). These findings suggest that classroom attendance/participation may be a significant determinant of performance of medical students on comprehensive examinations in first-year basic medical science courses. It is concluded that a substantial number of first-year medical students in this study could be at risk for poor performance because they may believe that there is an equivalency between internet-and classroom-based instruction in basic medical science courses. physiology; medical school; technology THE DIFFICULTIES OF LEARNING the fundamentals of physiology in the first year of medical school have been described (1, 7). In the current environment of recording and disseminating classroom lectures by the internet and textbooks supported by various computer-based educational technologies, students are less reliant than ever on classroom teaching (3). We have observed that some medical students have been successful in using these modern educational tools and foregoing regular classroom attendance in favor of independent study. However, many others have not been successful in using this distance learning paradigm. The relationship between attendance and grades in various undergraduate curricula has been studied (2, 6, 10, 11). In the context of a medical school curriculum, it is difficult to perform a controlled experiment to determine whether performance is improved by attendance. A previous study (6) performed in an undergraduate allied health science introductory physiology class has shown a weak positive correlation between attendance and grades. This finding suggests that knowledge among students engaged in distance learning may be almost as good as knowledge among those attending classes. We were interested in documenting the relationship between attendance and grades in a class of medical school students. In contrast to the aforementioned finding of a weak correlation in an undergraduate physiology class, we hypothesized that in an introductory respiratory physiology section of an integrated structure-function medical school course, the correlation between attendance and grades would be a strongly positive one. METHODS One hundred and fifteen first-year medical students enrolled at a historically black university were informed that the respiratory physiology section of their Structure and Function course's cardiorespiratory unit III (S&FIII) would include one noncompulsory pretest, four short postinstruction noncompulsory self-evaluation quizzes that were unannounced as to date and time, and one compulsory comprehensive examination (posttest). Students were advised that the pretest and quiz results would not affect their grade in the course. Because attendance is not required or recorded by the college, the number of unannounced quizzes students took was used as a measure of attendance. Attendance was categorized as "frequent" if students completed four or five of the quizzes and "sporadic" if students completed zero to three quizzes. Posttest scores were compared with pretest scores to determine knowledge gain. Grades on the comprehensive examination were analyzed by the frequency of attendance using one-way ANOVA. Passing rates for the comprehensive examination and final course grade were analyzed by the frequency of attendance using a 2 -test of significance. The correlation between class attendance and course grade was analyzed using Pearson's coefficient. RESULTS Five assessments administered to the first-year medical students (n ϭ 115) were included in the study. The mean number of S&FIII assessments the freshman class completed was 2.29 (SD 1.556). Sixteen students (13.9%) completed no assessment, 28 students (24.3%) completed one assessment, 19 students (16.5%) completed two assessments, 22 students (19.1%) completed three assessments, 20 students (17.4%) completed four assessments, and 10 students (8.7%) completed all five assessments.