REVIEW ARTICLE

Reasons of Absenteeism among Undergraduate Medical Students: A Review

*T Sharmin1, E Azim2, S Choudhury3, S Kamrun3
*1Dr. Tanima Sharmin, Assistant Professor, Department of Community Medicine, Green Life Medical College, Dhaka
2Dr. Ehsamul Azim, Associate Professor, Department of Community Medicine, Green Life Medical College, Dhaka
3Dr. Shamima Choudhury, Lecturer, Department of Community Medicine, Green Life Medical College, Dhaka
4Dr. Sayma Kamrun, Lecturer, Department of Community Medicine, Green Life Medical College, Dhaka

* Corresponding Author

Date of submission: 02. 09. 2016 Date of acceptance: 05. 12. 2016

ABSTRACT
Absenteeism refers to the frequent absence from classes without any good reason. In spite of compulsory
attendance rule, individual students, parents, institute and society suffer when students do not attend
classes in medical college on regular basis. Student absenteeism is a concern in higher education
especially medical education. Student's absenteeism results in inadequate learning and poor academic
performance. Despite the strict rules, absenteeism is an on-going problem in many universities and a
phenomenon that is also on the rise in universities worldwide. There is extensive literature on the link
between absenteeism and lack of subject matter interest, poor teaching strategies, unfavorable learning
environment,excessive socialization among students, part-time jobs, ill health, sleeplessness and poor
relations with lecturers. In addition, accessibility of lecture content in the form of online slides, videos
and audios has their own contribution to absenteeism. Early detection and prevention might prevent
unwanted consequences of absenteeism on medical students' academic performance.Medical colleges
should pay more attention and take immediate measures on those who starting to absent from classes
because they might need support from them.

Key Wards: Absenteeism, medical students

Introduction
One of the most vital considerations among students new problem.3 Number of causative factors has
in higher educational level is academic performance been suggested.4 With the revolution in the
though there are some differences in performance electronic equipment5 there are varieties of
among the students.1 The goal of undergraduate computer based softwares to assist in making the
medical education is to produce a physician with lectures more presentable, interesting and
adequate knowledge of health and diseases, interactive, thus making the traditional teaching
reasonable medical skills and a healthy attitude effective.6 Despite this development low attendance
towards patients and their families.2 Student at lectures is still an issue. Absenteeism at higher
attendance is thought to be an important factor in education level affects the learning process of the
the academic performance of medical students on students as well as the final result at the end of
the basis that clinical contact and teaching are academic session.7,8
necessary to develop competence. Lectures remain
Several studies identify internal and external factors
one of the important modes of teaching in many
associated with academic performance. Class
medical colleges despite adaptation of new
absenteeism is one of the factor that has negative
curriculum. It is easy to deliver knowledge through
effect on the mastery of the academic curriculum.
lecture to a large number of students and logistically
One of the most useful work done by Kelland et al8
saving resources. Low attendance in lectures is not a
reported that a decrease in the examination result
AKMMC J 2017; 8(1) : 60-66
Reasons of Absenteeism Among Undergraduate Medical Students 61

score with increase in the number of absencesin rules, absenteeism is an on-going problem in many
classes during human physiology course. In the universities and a phenomenon that is also on the
study by Fielet al9 it has been demonstrated that rise in universities worldwide.18-20
significant learning occur during the lectures but. In
There is extensive literature on the link between
the study by Riggs et al10 a negative correlation is
absenteeism and lack of subject matter interest, poor
shown between percent absences and examination
teaching strategies, unfavorable learning
scores, suggesting the value of monitoring
environment, excessive socialization among
attendance and identifying students at risk for poor
students, part-time jobs, ill health, sleeplessness,
performance. Sabujet al11 in Bangladesh found that
and poor relations with lecturers.17,18,20-22 In
absenteeism affects academic performance among
addition, accessibility of lecture content in the form
undergraduatepaediatric medicine students.12
of online slides, videos, audios have their own
The lower attendance rate among students who contribution to absenteeism.23-27
previously failed an end-of-year examination
Absenteeism will only allow students not to obtain
suggests that previous poor academic performance
appropriate information and contact with relevant
may be associated with subsequent poor attendance.
material (lectures, practical session, clinical skills,
The medical students were more likely to miss
etc) that is required for effective learning to occur.
classes than health science students (Nursing, Health
In addition, regular attendance in learning activities
Officer, Midwifery, Laboratory Technology,
corresponds to a distributed practice system (i.e. the
Optometry, and Environmental Health) despite the
students allocate learning effort throughout a course
medical curriculum requirement of 100% class
over multiple and short duration of learning
attendance unless the student has legitimate reasons
sessions) that is effective to increase the retention of
for missing class. This could explain why academic
knowledge. Study conducted in Saudi Arabia by
delays and dismissals from the program are
BinSaeedet al28 showed that student absenteeism
commonly observed among medical students,
may contribute to low achievement or vice versa.
particularly during the final years in medical
Under-achievement assumes critical importance for
colleges. If this behavior continues after medical
medical care providers who are involved in decision
education, it will reflect on their work life and
making in life and death situations.
therefore, may affect the quality of health service in
the future.11,13,14 As educators, we want our students to attend
classes. We enjoy teaching and interacting with
In our country medical education are still following
students and work hard to make our classes worthy
the traditional lecture format of teaching. Lectures
of the student's time and energy. We know who our
and classroom discussion represent the primary
best students are because they attend class regularly,
means of teaching for undergraduate medical
but we often have a hard time putting a face to the
students. Students who miss a lot of classes perform
names of the students that fail. On the basis on this
poorly on exams because they were not present
anecdotal evidence, we assume that students who
when the topics were covered, alternatively students
attend class regularly benefit from the lectures,
with high levels of absenteeism less committed to
tutorials and learning activities designed to facilitate
academics in general.15 Lecture and tutorials
their acquisition of knowledge. Conversely, we
provide a platform where students interact with the
assume that excessive absences from class results in
teachers, observe them and distinguish them as role
poor academic performance. These assumptions,
models. Low attendance hence may affect this
however, are not based on empirical evidence.This
process and hinder their professional growth.16 On
review will highlight the reasons of absenteeism
the other hand the role of teachers in improving
among undergraduate medical students.
student's attendance in lectures can not be denied.
Teachers with good teaching skills deliver lectures Factors related to medical students
which are organized and structured; have good
The major reasons for missing lectures were
communication skills which attract students and
preparing for another examination, inconvenient
shows higher attendance rates.17 Despite the strict
class schedule, lack of interest in the subject matter,
62 AKMMC J 2017 : 8(1) T Sharmin, E Azim, S Choudhury et al

dislike of teaching style and the ease of Hafeez et al37 in Pakistan found two top most
understanding the subject matter without guidance.29 reasons why students don't attend lectures were; the
A high number of students remain absent in the pre timings of the lectures were not adjusted according
examination period, which could be explained by to their schedule and that they preferred self/group
their allotting of this time for more intensive study study over lectures. According to Desalegnet al29
before the exams.28,30 Absence in the pre-exams the absence in the morning lectures is higher than
period and at the end of the year is may be due to absence in the afternoon lectures that can be due to
lack of preparedness, so the students prefer to spend delay going to bed. So early-morning classes is
time on study rather than attending lectures.31 Many another cause of absenteeism.There is better
college students have extremely poor time attendance at lectures scheduled in the middle of the
day when students are already likely to be on
management skills. The most obvious sign of poor
campus.38 Transport problem also is a reason for
time management is spending time in extracurricular
absenteeism.39
activities like attending parties, watching TV,
browsing internet, etc instead of studying which Student absenteeism was significantly associated
may cause fatigue making the student unable to with marital status and part-time job. The married
concentrate in classes. Many students think that they students and those who have part time jobs are more
can easily clear their exams so they spend time in susceptible to absence due to non-academic
other activities. This attitude is found hazardous for workloads.31 Social drug use was very strongly
a medical student in an Indian study.30Unlike associated with being absent from lectures. Studies
school teaching, medical education move quickly have shown that substance abuse40 and alcohol
through large portion of study material. Classes that consumption41 are risk factors for prevalent and
are missed entirely often cannot be made up. Some unexcused absence from lectures. Additionally,
students with low motivation are more likely to
students wait till exam dates are announced and
engage in social drug use.42 Society related causes
quickly rush through the books and guides
such as low societal value for educationis also
thereafter. The student then tries to cover many
identified as the reasons for absenteeism in
material in few hours.32
classes.43 Poor family relation sometimes play role
Another common reason for absenteeism is in absenteeism.39 Psychological factor like peer
sickness. Unexpected life situation can occur like pressure may contribute to it.33
illness of student or illness of a family member or a
family problem and then the student is forced to Factors related to teaching stuff
miss classes.33 Class absenteeism due to menstrual Lectures involved teaching a lot of students in a
disorders is common among female medical single large class room and test the ability of a
students.34 Getting to bed late in the night and teacher how efficiently he conveys the knowledge
feeling tired in class are other common reasons for and keeps the students attentive. The qualities of
absenteeism.33 teachers, their practices and the relationship they
Even though medical students opt for the course by have with their students appears to play a role in
choice, they may find the course work more non-attendance to lectures.22 More specifically,
rigorous and demanding than anticipated. disorganized lecturers who do not engage with
Absenteeism can be one convenient way to escape students and are perceived as boring, will see lower
the curriculum.35 Participants lack of interest in the numbers of attendance.44 Teachers should take
subject might be the reason for absenteeism.36 Lack efforts to make subject more interesting useful and
of interest in the subject matter could be attributed relevant. Teachers need to adopt creative teaching
to two reasons: 1) the likelihood that the majority of methodology techniques. There should be a proper
health science students are assigned to the field plan to encourage student's feedback, so that
probably against their choice; 2) even though teaching can become more meaningful. Studentsmay
medical students elect to be on the medical track, feel that teacher is not able to motivate them
they may find the course work more rigorous and sufficiently. Not only student behavior, but also
demanding.29,30 teacher's attitude and teaching methodologies appear
Reasons of Absenteeism Among Undergraduate Medical Students 63

to play a role in student absenteeism from classes. followed online lecture recording instead of
Teachers must make sure that classrooms are classroom lecture. Student must be physically
dynamic.35 Poor teaching skills of lecturers leading present and mentally receptive for learning to
to boring lectures.39,45 Dislike for teaching style and occur.46 Students who choose to skip lecture-based
the ease of understanding the subject without teachings and rely solely on other modes of learning
guidance is also a contributing factor for with the class subject are less likely to retain
absenteeism.29 Lack of clarity about the topic relevant knowledge related to the subject as
among teachers while teaching is a contributing compared to those who attend the class;
reason for absenteeism.30 subsequently those who absent perform poorly on
the examinations.11
Factors related to teaching material/strategy
One study showed that 80% of medical students
The interaction in lecture is part of the professional
chose to attend specific lectures dependent on the
socialization process in which students observe
lecture topic itself, while another found that 69% of
faculty members and recognize them as role
students cite interest in the topic as a key reason for
models.46 The lecture-based teachings are capable to
attendance.53,54 Even though the argument on the
enhance skills related to cognitive, affective and
comparative benefits of different instructional
psychomotor.47 Historically, reports suggested that
designs (e.g., small group discussion, problem
attendance is better at lectures compared to small
based learning, lectures, tutorials, practical
group teaching.48 However, modern publications
demonstrations, and bed side clinical teaching)
have suggested that students prefer self-study or
continues11,skipping class is expected to be
smaller teaching sessions, and quote this as a reason
unbeneficial for learning even the best and most
for non-attendance at larger group sessions.49 In a
sophisticated instructional designs used by
recent publication, 70% of students preferred small
educators. Even lecture-based teaching seems to
group teaching to larger lectures but still recognised
provide substantial benefits for learning to take
that lectures form a fundamental part of education.37
place despite its didactic in nature55, poor feedback,
Omrod et al50 reports that some students seem to
and inability to engage in authentic practice.11
learn better when information is presented through
Lengthy classes are another contributing reason for
words (verbal learners), whereas others seem to
absenteeism.30 Scheduling one lecture in a day has a
learn better when it is presented in the form of
negative effect on attendance. Multiple lectures in
pictures (visual learners). Clearly in a class where
one day result in better attendance.51
only one instructional method is employed, there is
a strong possibility that a number of students will Factors related to medical college
find the learning environment less optimal and this
The comforts of home are desirable from a lonely
could affect their academic performance.Attendance
and discouraged student at medical colleges. A
is poor when lecture slides are available to students
student remain absent because the class environment
prior to lectures, compared to when unavailable.
is not conducive enough for learning.Poorly
This suggests that students believe they can achieve
ventilated lecture hall, overcrowding in the
the same level of knowledge from the resources
classrooms and uncomfortable sitting arrangement
provided regardless of attendance.51 There are
in class are important factors for not attending
numerous positives to accessing online resources.
class.33 Poor infrastructure was also found to be one
Students often struggle to make organised, thorough
of the reasons for absenteeism.30
lecture notes for revision. Having a template in the
form of pre-released slides could potentially rectify Bangladesh situation
this problem and improve revision techniques.52 Educational institutions around the world have been
Accessibility of lecture content in the form of online increasingly confronted with the challenge of
slides, videos and audios have their own making their curricula relevant to the needs of the
contribution to absenteeism.22 Another study time. Medical education in Bangladesh has also
reported that continuous assessment marks were experienced many changes and challenges.56 Last
lower in pharmacology students, where students decade can be considered as the "golden age" of
64 AKMMC J 2017 : 8(1) T Sharmin, E Azim, S Choudhury et al

medical education in Bangladesh. One of the prevention might prevent unwanted consequences of
important developments in recent years in medical absenteeism on medical student's academic
education in Bangladesh is the establishment of a performance. Application of strict attendance policy
large number of medical colleges both in govt. and may influence student attendance and medical
private sector. Currently, there are more than 100 colleges should reinforce the attendance policy as an
medical colleges in Bangladesh.57 effort to improve their student's academic
performance.
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the typical features of colonial education, which is
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