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 Table of Contents  
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 226-231

Analyzing the attitude of medical students toward class absenteeism

1 Lecturer, Department of Anatomy, Government Medical College, Srinagar, India
2 Associate Professor, Department of Anatomy, SKIMS Medical College, Srinagar, India
3 Assistant Professor, Department of Management, Islamic University of Science and Technology Awantipora, Pulwama, India
4 Professor, Department of Anatomy, Government Medical College, Srinagar, Jammu and Kashmir, India

Date of Submission09-Feb-2021
Date of Decision03-Sep-2021
Date of Acceptance07-Oct-2021
Date of Web Publication28-Oct-2021

Correspondence Address:
Ghulam Mohammad Bhat
Department of Anatomy, Government Medical College Srinagar - 190 001, Jammu and Kashmir
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/NJCA.NJCA_52_20

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Background: Class attendance is very important to improve academic performance in medical education. National Medical Commission has made it mandatory to have 75% attendance to appear in the university examination. Classroom teaching is necessary to develop competence in cognitive, affective, and psychomotor domains. The purpose of the present study was to analyze the causes of absenteeism in medical education. Methodology: This descriptive, cross-sectional study was conducted from phase 1 to phase III MBBS students of Government Medical College Srinagar, J and K, India. The response was collected through a structured, pretested, and prevalidated questionnaire. The attitude of medical students towards class absenteeism was obtained using the Likert scale. The response was analyzed using SPSS 22 software. Results: The results showed that major reasons for student absenteeism were poor teaching skills of teachers (mean 3.85), students studying through Self directed learning (SDL) (mean 3.75), unfavorable learning environment (mean 3.43), lack of sleep (mean 3.28), distraction due to concentration problems (mean 3.26) not interested with that subject (mean 3.09), ill-health (mean 2.57), traffic jams (mean 2.53), social media (mean 2.45), climatic conditions (mean 2.37), availability of online resources (mean 2.84), too much self-confidence (mean 2.61), lectures, not enough informative (mean 2.49), family issues (mean 2.01). Conclusion: The causes of student absenteeism are varied. Teachers have to be friendly and cooperative so that students can overcome their inhibitions and weaknesses. Constructive feedback and mentoring programs should be part of the curriculum.

Keywords: Absenteeism, attendance, medical education, questionnaire

How to cite this article:
Rashid S, Ul Hassan A, Bhat IH, Bhat GM. Analyzing the attitude of medical students toward class absenteeism. Natl J Clin Anat 2021;10:226-31

How to cite this URL:
Rashid S, Ul Hassan A, Bhat IH, Bhat GM. Analyzing the attitude of medical students toward class absenteeism. Natl J Clin Anat [serial online] 2021 [cited 2022 May 20];10:226-31. Available from: http://www.njca.info/text.asp?2021/10/4/226/329498

  Introduction Top

Student absenteeism can be defined as recurrent missing classes by students without suitable reasons related to education. It concerns the health profession education worldwide.[1] It is assumed that student absenteeism may negatively affect the general educational process and personal academic achievement of students.[2] It has been observed that student attendance is essential in the academic performance and professional development of medical students. Student attendance is thought to be an important factor in the academic performance of medical students on the basis that clinical contact and teaching are necessary to develop competence. Lectures and small group teaching (SGT) remain the main instruction designs even on the adaptation of the new competency-based medical education (CBME) curriculum. Lectures have been universally used to deliver academic content to a large number of students and helping in saving resources. Absenteeism is an old academic disadvantage having various basic causes.[3] Revolution in information technology along with computer-assisted computer-designed software and designs has helped in delivering the content in a presentable, interesting, and interactive format.[4] Despite the integration of technology into medical education for the delivery of the content to the students, low attendance in medical education is a burning issue. Class absenteeism in medical education hampers the teaching-learning process as well as the academic gain at the end of the session.[5]

The personal and professional experience of teachers is indispensable for the improvement of the cognitive gain of the students, which cannot be acquired through textbooks alone.[6] It has been observed that student-teacher interaction during a lecture or clinical session provides accurate instructions that make learning interesting and accommodative.[2] The goal of undergraduate medical education in our country is to produce Indian Medical Graduate possessing requisite knowledge, skills, attitudes, values, and responsiveness, so that he or she may function appropriately and effectively as a doctor of the first contact of the community while being globally relevant.[7] For the appropriate medical education of the undergraduate students, organized lectures, tutorials, practical and clinical cases are arranged by the different government medical colleges for a specified duration following the undergraduate medical curriculum, which is prepared by the National Medical Commission (NMC) of India under the guidance of the World Health Organization.[8] Hence, attending the classes of undergraduate medical course regularly is mandatory and also very much helpful for the medical student to get a proper and clear idea about the subjects of discussion as per course curriculum, which is essential for satisfactory academic performance in the examinations.[9] The revolution in information technology has led to the incorporation of various computer-based soft wares to make lectures more presentable and interactive and thus helping to provide effective traditional teaching.[4] Even with the use of well-designed computer-based instructions, low attendance in classes is still a major hurdle in teaching. It has been observed that absenteeism in higher education, reduces the learning capability as well as the outcome at the summative assessment.[5] Academic performance is correlated with various internal and external factors, and absenteeism in classes is a major factor for poor performance in academic achievements. It has been observed that there was a decrease in academic outcomes with the increase in the number of absent classes.[10] In developing countries for undergraduate instructions, traditional teaching in the form of lectures, small group discussions, and tutorials represent the basic instruction methods of teaching. Those students who are used to class absenteeism perform poorly in the assessment because they are not able to comprehend the lessons taught in the class.[11] In other words, student absenteeism leads to decreased standards in academic gain and subsequent development of professionalism.[12] Classrooms provide a suitable environment for the students to interact with the teachers and learn the attitude and behavior of their teachers. Thus, class absenteeism may hinder this interaction and culminate in the defective development of the professionalism and ethical values necessary for the medical profession.[13]

What are the causes of student absenteeism in medical education? The reasons vary from country to country, but the majority of these reasons originate from problems within the institution itself. But social and personal factors that cause student absenteeism cannot be overlooked. Major reasons predicted from various studies include poor teaching strategies, poor relations with teachers, unfavorable learning environment, lack of interest in the subject, ill-health and social media addiction.[14] Kashmir is a conflict zone, the causes of student absenteeism in medical education may vary from other regions of the world. Despite the observed nature of the problem, no documented study has assessed and analyzed the magnitude and predictors of absenteeism in Kashmir. Thus, this study was undertaken to analyze the causes of absenteeism among undergraduate medical students in Kashmir.

Objectives of the study

  1. To analyze the causes of class absenteeism among medical students
  2. To suggest various measures to prevent or reduce class absenteeism among medical students.

  Materials and Methods Top

Study design and setting

This descriptive, cross-sectional interventional study was conducted on phase I to phase III MBBS students of Government Medical College Srinagar, J and K, India, using a prevalidated questionnaire. The study was carried out after obtaining ethical approval from the Institutional Ethical Committee and informed consent from the students.


The participants included undergraduate medical students from phase I MBBS to phase III MBBS and only consenting students were included in the study. Informed written consent was obtained from the participants. The purpose of the study was explained to the students and assured confidentiality in the collection of personal data. They were also explained that the study had nothing to do with their grades and was only to know their perspective regarding absenteeism.

Inclusion and exclusion criteria

The study participants comprised full-time undergraduate medical students who were enrolled for at least one semester. Only consenting students were included in the study. The students who had not spent one semester in the college or did not voluntarily consent for participation were excluded from the study.

Questionnaire designing and distribution

The questionnaire for the study was designed in the form of a Google survey form and validated by experts. To measure the students' attitude toward absenteeism, Likert scale was used. To ensure confidentiality, no identifying information was asked. Data were collected regarding gender, age, religion, place of accommodation, monthly income of parents, parent's education level, year of study, and various reasons for missing the classes. The questionnaire was distributed to the students via WhatsApp groups.

Data entry and statistical analysis

The collected data were entered into MS Excel 2016, and SPSS 22 software (IBM Corp., Armonk, NY) was used to analyze and create visual data representations. SPSS 22 software was employed to find the mean, standard deviation using the Students' t-test and one-way ANOVA. The confidence interval and P value were set at 95% and ≤0.05.

  Results Top

This study was descriptive as it tried to explain the causes of absenteeism among medical graduates in Kashmir. Of the total 300 consenting students, only 249 students responded to the online questionnaire, making a response rate of 83%.

As shown in [Table 1], of those students who responded 55.8% were male and 44.2% were female; 68% resided in their own house and 32% were hostellers. Data showed equal participation from both genders to generalize the results better. In terms of age, almost 52% of the respondents were from the age group of 18–20, which again given the fair idea of the sample being the true representative of the population. The majority of respondents were in phase II of their college (41%), followed by phase I (38%). The study also looked at the religious aspects of the respondents and the majority of the students (94%) belonged to the Muslim community and 6% belonged to other religious groups. The study also looked at the fact, whether coming from home or hostel has any impact on absenteeism and the variable type of accommodation was taken into consideration. The majority of the respondents had not used any social drug, as almost 96% of the students reported that they have not used any addicting drug. Moreover, choosing a course by choice is also an important aspect related to absenteeism; almost 86% of respondents believe that they have joined the medical field by choice and the same number (86%) of the respondents have reported that they like the field of study they have chosen.
Table 1: Baseline characteristics of students

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As is depicted in [Table 2], it was observed that major reasons for student absenteeism were poor teaching skill of teachers (mean 3.85), the student can learn through SDL instead of class (mean 3.75), the poor teaching style of teachers (mean 3.56), unfavorable learning environment like an excessive distraction, noise, no proper seating arrangement in the classrooms, overcrowding, poor ventilation (mean 3.43), lack of sleep (mean 3.28), distraction due to concentration problems (mean 3.26) not interested with that subject (mean 3.09), ill-health (mean 2.57), traffic jams (mean 2.53), social media (mean 2.45), climatic conditions (mean 2.37), availability of online resources (mean 2.84), too much self-confidence (mean 2.61), lectures not enough informative (mean 2.49), family issues (mean 2.01), financial issues (mean 1.63), misguidance from seniors (mean 1.90).
Table 2: Statistical analysis of Likert based questions, regarding the attitude of the study participants toward the reasons for absenteeism

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For further analysis, one-sample t-test was run [Table 3] to determine the significance level of the established variables. The results of [Table 3] depict that all the variables verified through this study significantly contribute to the absenteeism of the students. Therefore, a significant focus should be put on these observed variables to improve the presence of students in the classroom.
Table 3: One-sample t-test showing significance level of the established variables

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  Discussion Top

The goal of this study was to analyze the factors which lead to class absenteeism. The observed causes were different for different students. The problem of student absenteeism is the concern of every member of society because the impact of absenteeism occurs not only on the individual but also on the whole society. Absenteeism is usually related to students, home, school, and society.[15] From our study, it was noticed that the reasons for class absenteeism were difficult to elucidate as the issue involved personal and sensitive information. Medical curriculum deals with cognitive (knowledge), psychomotor (skill), and affective (attitude) domains which are to be learned by observation and practice.[16] In our study, the main reasons for absenteeism were stress, climatic conditions, traffic jam on roads, unfavorable learning environment like excessive distraction, noise, no proper seating arrangement in classrooms, over-crowding, poor ventilation, social and family commitments. It was found that poor teacher's skills may predispose to student absenteeism, as was observed by Wadesango and Machingamb.[2] Desalegn et al.[15] reported that student habits and teacher performance play a role in absenteeism, as was observed in our study. Students who remain absent consistently have very poor coordination with teachers and peers, thus resulting in poor academic performance of these students. These students lose on the important assignments of class participation and cannot clear their doubts or raise queries regarding any topic.[16] Therefore, colleges or universities need to use strict disciplinary measures to control absenteeism among students. The universities and colleges should also change the methodology and improve on the quality of delivery of instructions and improve the interpersonal relationship among the students and teachers. Moreover, a reward system can also be brought in to attract the students to attend their classes.

Causes of absenteeism and their solutions

From the above discussion, the main causes of absenteeism of students can be grouped as follows: (a) Factors related to faculty, (b) factors related to students, and (c) factors related to teaching strategy and system.

  1. Factors related to faculty:

    • Lectures involving teaching students in a single large classroom create monotony and loss of interaction. This can be solved by making the large group teaching interactive and engaging by planning the lecture with suitable activities using technology. Furthermore, some of the teaching hours are to be carried out as SGT as recommended in the new curriculum of CBME
    • Disorganized lecturers. When the lectures are not properly planned, there occurs confusion in the delivery of the teaching materials and students fail to understand the instruction. To prevent classes to become disorganized, teachers should revise the teaching strategy to make the subject more interesting and relevant to the topic to be taught. The teacher should be clear about what is to be taught, learning objectives to be clarified and sessions to be properly planned. Teachers need to adopt planned, interactive, and creative teaching methodology so that teaching is student-centric
    • Improper teaching strategy and teaching style of teachers. There should be a proper plan to encourage constructive student feedback regarding the way the teachers are teaching and appropriate steps are taken to improve it. Teachers should adopt interactive teaching methods and lifestyles.

  2. Student related factors

    • Attendance is not given its due importance. NMC has provided guidelines for attendance required for students, but many institutions do not adhere to it and students take it easy. Attendance is usually maintained in our institution by keeping a record of attendance in a register, but ultimately, because of different pressures, the student even with a deficiency in attendance, manages to appear in university examinations. The recording and maintenance of attendance are laborious and a crude form of attendance management and hand manipulation is a possibility. Incorporation of digital attendance can be a possible solution. Incorporating mentoring programs into the curriculum regarding the effects of absenteeism on academic performances may prevent students from skipping classes. There should be strict adherence to mandatory attendance as specified by regulatory bodies like NMC and concerned universities
    • Inconvenient class schedule, like early-morning classes, no break in between classes should be avoided. There should be proper scheduling of the classes so that students do not get exhausted and bored
    • Lack of interest in the subject matter: Teachers should make it interesting by correlating it to clinical aspects and adding a playful way of teaching like gamification
    • Poor time management skills leading to missing classes especially in the preexams period and at the end of the session, should be avoided. Incorporation of time management into the curriculum to avoid fatigue. Time management is the process of planning and exercising conscious control of the time spent on specific activities to work smarter rather than harder. Time management plays a vital role in improving student's academic performance and achievements. Improving time management in classes allows students to enhance their performance and achieve desired goals with less effort. Time management skills reduce the stress level of students as they can cope up with their tasks and achieve their targets[17]
    • Going to sleep late at night and the next day feeling tired in the class. To avoid this, students should be taught proper health styles through counseling. Medical coursework being rigorous and demanding than anticipated by many students. Proper professional counseling at the time of medical admission is needed
    • Poor family relations, substance abuse, and alcohol consumption. Timely proper counseling and de-addiction programs to be adopted for the welfare of the students.

  3. Factors related to teaching strategy and system

    • In a large class, expected professional socialization to enhance skills related to cognitive, affective, and psychomotor domains does not occur due to being only an instructional method of teaching. The class to be delivered has to be interactive, pictorial, and properly planned
    • Availability of study material in the form of online slides, videos, and audio has their contribution toward class absenteeism. The teacher has to provide proper guidance for using these online resources and add them as an addition rather than only teaching method
    • Homesickness: College and hostel environments have to be made friendly for students of different cultures by the proper mentoring programs. In between, college administration should provide a break from classes so that students can visit their homes.


The study has certain limitations that can be taken into consideration in future studies. The study's sample size was limited and results could have been more objective oriented with larger samples by incorporating the study population of other colleges. Convenient purposive sampling method was used, which could give some inherent bias.

  Conclusion Top

Many reasons are responsible for absenteeism among medical students, which leads to a negative impact on their academic performance. The main reasons for student absenteeism are unplanned lectures, lack of professionalism, lack of proper teaching skills, content overloaded curriculum, poor teaching environment, social and family issues, lack of institutional facilities for teaching like no proper internet connectivity, and lack of audio-visual aids. The solution to these problems lies in proper lecture planning, development of professionalism, strict and groomed discipline. Teachers have to be friendly and cooperative so that students can overcome their anxiety and weaknesses without any fear. Constructive feedback from students and mentoring programs should be part of the curriculum. There has to be a balance between institutional administration and students' academic, social and personal life. This will help to mitigate student suffering, raise academic standards and improve medical professionalism.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3]


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