European Journal of Cardiovascular Medicine

The educational experience in medicine is distinct and varies greatly from other programs in higher education. Its curriculum is competitive, difficult, stressful, complicated, and lengthy compared to other undergraduate curricula. ^[1-3] Students must acquire a vast quantity of factual knowledge, practical abilities, and competency in a condensed amount of time. ^[3] This is especially stressful for the freshmen at the medical college in terms of emotions, psychology, and occasionally physical stress. ^[2-5]

In schools and universities, offline classroom instruction has been the exclusive approach since the establishment of the system of formal education. Punctuality to courses has been regarded as a crucial predictor of performance, causing governing bodies to adopt requirements for baseline compulsory attendance to guarantee the standard of learning remains high. Being on time and having good attendance are crucial indicators of professional involvement. These newcomers to medical college have challenges with language, interpersonal behaviour, communication, and attitudes, which makes it challenging for them to adjust from school to the medical college setting. Additionally, challenges with conceptual thinking, peer and parental pressure, challenging interactions with teachers, a background in Hindi, etc. hurt their academic achievement. ^[3-6]

Attendance and timeliness in medical school develop essential habits for future practitioners. Universities and regulatory authorities have placed a strong emphasis on attendance policies because of the MBBS's extensive curriculum and high stakes. A lot of universities put the exam eligibility criterion at 75%. Student absences are a problem, underscoring the significance of attendance in laying the groundwork for foundational information, particularly in the first MBBS with a shorter duration. Attendance during the undergraduate program is essential for transferring information to the workplace later on. The majority of learner time is spent in active learning styles, where student engagement is crucial for both individual and group learning. Several studies have demonstrated a favourable relationship between student performance and attendance ^[7-10]; however, some argue that attendance in class may not always be a good indicator of achievement, particularly in theory. ^[11]

Attending college is thought to play a major role in influencing young doctors' personalities and may even have a positive impact on their performance by providing opportunities for contact with peers and teachers. The COVID-19 pandemic had a profound effect on the education sector, leading to the closure of educational institutions and a transition to remote learning. Online learning was very important during the pandemic, saving around two academic years, despite its drawbacks.  As COVID-19 limitations loosened, educational institutions went back to offering offline instruction while upholding proper conduct. The purpose of this study is to investigate how students' academic performance is affected by this mixed teaching style, which combines online and offline approaches, on both a theoretical and practical level.

OBJECTIVES:

1. To identify the factors that influence the academic performance of the phase - I MBBS students in physiology.
2. To recommend measures to improve their academic performance by correcting the factors identified.

Study Design: Institutional-based cross-sectional study.

Study area: The study was conducted in the Department of Physiology, Government Medical College, Kadapa, Andhra Pradesh.

Study Period:  August 2022 – July 2023 (1 year).

Study population: Phase I MBBS students of the 2022-2023 batch joined the GMC, Kadapa.

Sample size: The study consisted of a total of 142 subjects.

Sampling Technique:  Simple Random technique.

Inclusion Criteria: Phase I MBBS students of the 2022-2023 batch joined the GMC, Kadapa, who want to participate and gave consent for the study.

Exclusion Criteria: Students who were absent during the study and who did not want to participate in the study.

Ethical consideration: Institutional Ethical committee permission was taken before the commencement of the study.

Study tools and Data collection procedure:

This is a cross-sectional observational study done on phase I MBBS students of the 2022-2023 Batch. Institutional Ethical Committee Clearance was obtained. At the end of the year, the student data about their academic performance i.e. the final aggregate of internal assessments and the final attendance percentage was collected from the departmental records. Data was collected from the phase I MBBS students of the 2022-2023 batch via Google Forms having the closed questionnaire with student data and the factors that influence the academic performance by sending a link in a WhatsApp group. Factors that helped high achievers to gain marks, and factors affecting the academic performance of poor achievers were validated.

Statistical analysis:

Data were entered in an MS Excel spreadsheet and validated and analyzed using SPSS v20. 0. Incidence was calculated from data. Chi-square was used to analyze variables. All the p-values less than 0.05 were considered statistically significant.

Out of 175 students, 142 (81.1%) students gave their consent and filled up the questionnaire.

Table 1: Gender distribution in the study population

Out of 142, males were 75 (52.8%) and females were 67 (47.2%).

Table 2: Attendance in the study population

Most (85.2%) of the students were having <75% attendance in our study. Only 14.8% of the students were having >75% attendance in our research.

Table 3: Marks (theory) in the study population

Most (93%) of the students were having <50% marks in our study. Only 7% were having >50% marks.

Table 4: Factors associated with the performance of the students

Figure 1: Factors associated with the performance of the students

Table 5: Association between factors and gender

S = Significant; NS = Not significant

There was a statistically significant association between factors 10 and 16 with the gender in our study population.  This means the utilization of the library and study after going home to be updated were the factors associated with gender.

Table 6: Association between factors and attendance

S = Significant; NS = Not significant

There was no statistical significance between factors and attendance in the study population.

Table 7: Association between factors and marks

S = Significant; NS = Not significant

There was a statistically significant association between factors 13, 16 and 17 with the marks in our study population. The language barrier, studying after going home to be updated and using gadgets non-judiciously were the significant associated factors that altered the mark status of our study population.

Out of 175 students, 142 (81.1%) students gave their consent and filled up the questionnaire.

Table 1: Gender distribution in the study population

Out of 142, males were 75 (52.8%) and females were 67 (47.2%).

Table 2: Attendance in the study population

Most (85.2%) of the students were having <75% attendance in our study. Only 14.8% of the students were having >75% attendance in our research.

Table 3: Marks (theory) in the study population

Most (93%) of the students were having <50% marks in our study. Only 7% were having >50% marks.

Table 4: Factors associated with the performance of the students

Figure 1: Factors associated with the performance of the students

Table 5: Association between factors and gender

S = Significant; NS = Not significant

There was a statistically significant association between factors 10 and 16 with the gender in our study population.  This means the utilization of the library and study after going home to be updated were the factors associated with gender.

Table 6: Association between factors and attendance

S = Significant; NS = Not significant

There was no statistical significance between factors and attendance in the study population.

Table 7: Association between factors and marks

S = Significant; NS = Not significant

There was a statistically significant association between factors 13, 16 and 17 with the marks in our study population. The language barrier, studying after going home to be updated and using gadgets non-judiciously were the significant associated factors that altered the mark status of our study population.

Previous research has found a weak but favourable association between academic achievement and attendance rate.¹² Although several complicating variables could influence academic results, students' attendance in class has continuously been shown to be correlated with their cognitive ability and academic success.⁹ There are few studies on the impact of required attendance regulations in medical schools, however, one study found that while attendance rose in Basic Sciences lectures, academic outcomes did not improve in tandem with mandatory attendance laws.¹³

Out of 175 students, 142 (81.1%) students gave their consent and filled up the questionnaire. Out of 142, males were 75 (52.8%) and females were 67 (47.2%). Most (85.2%) of the students were having <75% attendance in our study. Only 14.8% of the students were having >75% attendance in our research. Most (93%) of the students were having <50% marks in our study. Only 7% were having >50% marks. There was a statistically significant association between factors 10 and 16 with the gender in our study population.  This means the utilization of the library and study after going home to be updated were the factors associated with gender. There was no statistical significance between factors and attendance in the study population. There was a statistically significant association between factors 13, 16 and 17 with the marks in our study population. Language barrier, studying after going home to be updated and using of gadgets non-judiciously were the significant associated factors that altered the marks status of our study population.

Richard P. Deane et al.⁷ found a positive correlation between total test results and attendance at OBG clinical and tutorial-based activities. Furthermore, a study conducted in the Department of Anatomy by Sangeeta M. and Varalakshmi K. L.⁸ found a strong positive link between academic success and attendance in class. However, our study was in contrast with these studies as there was no significance seen. Regarding gender, our data did not reveal a significant difference in the average attendance percentage between theory and practicals, in contrast to a study by Sangeeta M. and Varalakshmi K. L⁸. that discovered male students were less likely to attend classes.

According to Hamidi Al Shenawni et al.¹⁴, there was no discernible difference in the academic achievement of male and female students. In our study, females scored slightly better in theory.   Individuals who favoured watching videos on the internet for learning showed superior performance compared to those who did not like this approach.¹⁵ Social expectations were the most commonly stated reason for attending classes, whereas learning effectively in a classroom environment was the least frequently mentioned. The availability of lectures online, a desire for solitary study outside of the classroom, and the hassle of commuting to class were the main excuses given by students for skipping lessons.

The decline in academic performance among Phase I MBBS students in Physiology can be influenced by various factors, ranging from institutional to individual. Here are some potential factors to consider: 1. Teaching Methodology: The teaching methods employed in Physiology classes may not effectively engage students or cater to different learning styles. A lack of interactive sessions, practical demonstrations, or hands-on experiences could lead to disinterest and poor understanding of the subject matter. 2. Curriculum Design: The structure and content of the Physiology curriculum may be overly complex or not aligned with the learning objectives of Phase I MBBS students. If the curriculum is outdated or doesn't integrate well with other subjects, students may struggle to grasp core concepts. 3. Faculty Competence: The competency and teaching skills of Physiology faculty members play a crucial role. If instructors lack effective communication skills, subject expertise, or the ability to adapt teaching methods to student needs, it can hinder learning outcomes. 4. Student Engagement and Motivation: Factors such as lack of motivation, disengagement from coursework, or personal issues can significantly impact academic performance. Students may face stress, burnout, or distractions that affect their ability to focus on their studies. 5. Assessment Methods: Assessment strategies that primarily rely on traditional exams or rote memorization may not accurately measure students' understanding of Physiology concepts. If assessments fail to reflect real-world application or critical thinking skills, it can demotivate students and lead to underperformance. 6. Resources and Infrastructure: Insufficient resources, such as textbooks, laboratory equipment, or study materials, can impede students' ability to fully engage with the subject. Limited access to academic support services or technology infrastructure may also hinder learning opportunities.

7. Learning Environment: The overall learning environment, including classroom dynamics, peer interactions, and campus culture, can influence academic performance. Students feeling isolated, unsupported, or facing interpersonal conflicts can negatively impact their focus and motivation. 8. External Factors: External factors such as socioeconomic background, family responsibilities, health issues, or societal pressures can affect students' ability to dedicate time and energy to their studies. Financial constraints or lack of access to support systems may further exacerbate these challenges. 9. Remedial Support: The availability and effectiveness of remedial support programs or interventions can significantly impact students' ability to overcome academic challenges. Access to tutoring, mentoring, or counselling services can provide valuable assistance to struggling students. 10. Institutional Support and Policies: Institutional support, including academic advising, mentoring programs, and flexible academic policies, plays a crucial role in addressing academic concerns and promoting student success. Clear communication channels and proactive interventions can help identify and mitigate issues affecting academic performance.

Understanding and addressing these factors through collaborative efforts between faculty, administrators, and students can contribute to improving academic performance in Physiology among Phase I MBBS students in a tertiary care teaching hospital. Regular evaluation and adaptation of teaching practices and support systems are essential for fostering a conducive learning environment and promoting student success.

After analyzing the data, we were able to determine that a few factors, such as language barriers, misuse of gadgets, and bad friendships, were significantly associated with students' poor academic performance and needed to be rectified (p-value less than 0.05). We can also suggest that students take certain steps to enhance their academic achievement, such as consistently attending courses, paying attention in class, taking part in brief group discussions, completing slip tests, and other activities for better student results.