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REVIEW ARTICLE
Year : 2021  |  Volume : 19  |  Issue : 3  |  Page : 171-174

Attendance norms in undergraduate medical education in India: Issue worth considering?


1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission05-Apr-2021
Date of Decision26-Apr-2021
Date of Acceptance03-May-2021
Date of Web Publication05-Jul-2021

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_34_21

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  Abstract 


Medical education has been recognized as a challenging professional course as a lot is expected from the medical students during their training period. An extensive search of all materials related to the topic was carried out in the PubMed search engine and National Medical Council Website, and a total of 15 studies similar to the current study objectives were selected based on the suitability with the current review objectives. In order to ensure that students actively participate in their learning and eventually progress from one professional year to the next one, the regulatory body has formulated eligibility criteria for the students to appear in summative assessments. Although attendance policy tends to have a significant influence on reducing the unnecessary absenteeism in the class, it cannot be conclusively said that the best learning occurs while students are physically attending the class. A student can be asked to mandatory attend those sessions wherein the content cannot be perfected by reading material. To conclude, the clause of meeting attendance norms for being eligible for the summative assessment is a must in many ways to ensure that students remain involved in their learning process. However, there is a definite scope to modify the attendance norms depending on the type of sessions and whether the proposed knowledge or skills can be acquired within the four walls of a class or by the students on their own.

Keywords: Attendance, COVID-19, medical education, undergraduate


How to cite this article:
Shrivastava SR, Shrivastava PS. Attendance norms in undergraduate medical education in India: Issue worth considering?. Curr Med Issues 2021;19:171-4

How to cite this URL:
Shrivastava SR, Shrivastava PS. Attendance norms in undergraduate medical education in India: Issue worth considering?. Curr Med Issues [serial online] 2021 [cited 2021 Dec 4];19:171-4. Available from: https://www.cmijournal.org/text.asp?2021/19/3/171/320649




  Introduction Top


Medical education has been recognized as a challenging professional course as a lot is expected from the medical students during their training period. In order to ensure that students actively participate in their learning and eventually progress from one professional year to the next one, the regulatory body has formulated eligibility criteria for the students to appear in summative assessments.[1] Apart from their performance in internal assessments, a significant weightage has been given toward maintaining the requisite amount of attendance.

As per the recent norms, an undergraduate medical student should have a mandatory attendance of 75% in theory and 80% in practical/clinical in being eligible to appear for the summative assessment in a specific subject.[1] The available review of literature suggests that not many studies or review articles are available that can suggest or infer the relationship between academic performance and the existing attendance norms. Keeping this into mind, the present review article has been written with an aim to understand the existing issues and how we can move forward keeping the interests of students in mind.


  Methods Top


An extensive search of all materials related to the topic was carried out in the PubMed search engine and National Medical Council Website. Relevant research articles focusing on attendance norms in undergraduate medical education published in the period 2013–2021 were included in the review. A total of 18 studies similar to the current study objectives were identified initially, of which 2 were excluded due to the unavailability of the complete version of the articles. Thus, a total of 15 articles were selected based on the suitability with the current review objectives and analyzed. Keywords used in the search include undergraduate medical education, attendance, and coronavirus disease 2019 (COVID-19) in the title alone. The collected information is presented under the following subheadings, namely attendance and academic performance, COVID-19 pandemic and its impact on medical education, COVID-19 and attendance, recommendations on maintaining online attendance, potential recommendations for face-to-face sessions, lessons from the field, plan of action, implications for practice, and implications for research.


  Attendance and Academic Performance Top


It has been envisaged that class attendance is one of the crucial determinants of the academic performance, and the same has been reported across some of the studies, wherein students with better attendance accomplished good academic performance than that of students with less attendance.[2],[3] Although attendance policy tends to have a significant influence on reducing the unnecessary absenteeism in the class, it cannot be conclusively said that best learning occurs while students are physically attending the class, primarily during large-group teaching sessions.[2],[3] As a matter of fact, a lot of research needs to be done to explore the presence or absence of such type of causal association.


  Coronavirus Disease 2019 Pandemic and its Impact on Medical Education Top


The ongoing COVID-19 pandemic has impacted all the sectors, and the same stands true even for medical education.[4] Owing to the presence of large number of students in each professional year and the fact that the disease spreads by close proximity, it was decided by the government authorities to stop the physical classes till the cases are under control.[5] However, we soon realized that the process of teaching and training must go on and that leads to the emergence, exploration, and application of a wide range of online teaching–learning methods and online methods for carrying out the assessment of all the learning domains.[6]

As it is a very well-known fact that in any field, students tend to have a limited attention span, unless the teaching session is interspersed with some or the other kind of interactions to ensure that students remain engaged throughout the learning period.[5],[6],[7] In face-to-face classes, it was quite easy to monitor the students as they are right in front of our eyes and even involve them in some interactions (via questioning, buzz group, and brainstorming). However, in online learning session, the process of interaction becomes difficult with more than 100 participants being present at the same time.[8],[9]

From the students' perspective, we totally accept that it is little difficult for them to continue to attend online classes throughout the day (increased screen time). This calls for the need to have stress busters in between and also conducting the theory sessions for a limited period of time in the day.[10],[11] The best approach will be to carry out practical sessions or clinical sessions as well during online teaching–learning and supplement the same with periodic assessment and constructive feedback about the performance of the students.[8],[9],[10],[11] In short, although the process has been quite challenging, with lack of awareness among faculty members about the use of online tools, administration support, infrastructure concerns, nevertheless we can still be very proud that we rose to the occasion and continued with our primary role of teaching and training and being helpful to the students.[5],[6],[7],[12]


  Coronavirus Disease 2019 and Attendance Top


The domain of attendance during online sessions has emerged out as a tricky topic for all the medical educators. In our experience, we observed that there were some sections of students who just enrolled for the session but were not attending the class or doing some other kinds of work. Further, it was even reported that some of the students just joined the session at the start and were there till attendance was recorded and subsequently exited from the session. In fact, many other kinds of irregularities were also reported and eventually maintaining attendance during online sessions became a big headache for all the educators.[13] This brings us to an important concern that we explore or deeply look into the issues of mandatory and nonmandatory attendance.[2] The need of the hour is that we decide what type of learning experiences requires physical presence and what not, as it will be useful for the students owing to their involvement in self-directed learning.[3],[14]


  Recommendations on Maintaining Online Attendance Top


The ideal approach for maintaining proper online attendance for any medical institution will be to adopt and implement a learning management system (LMS) in their settings.[15] The presence of a LMS in the institution envisages the implementation of both synchronous and asynchronous forms of learning. We must accept and acknowledge that the medical students are adult learners, and it will not be a right approach to make it mandatory for them to learn during the online sessions alone. These students should be given the freedom to learn at their own pace and thus the presence of a LMS in the institution makes life easier for the students. The medical students can access the presentations, resource materials, and assessments any time during the day and ensure that the learning continues.[15]

Another approach will be to use those kinds of online learning platforms that precisely monitor the duration for which each and every student was actually present in the online session (viz. Zoom platform).[4],[5],[6] In fact, an institutional policy can be formulated and all students who have attended the class above the cutoff time limit can be marked present for the session.[11] It will also be a good practice to emphasize regularly that the attendance is mandatory and students should make an attempt to attend all the sessions, not only for the attendance's sake but also to improve their learning and staying abreast with the topics that are important.[11],[12],[13] The teachers can directly (viz. by asking all the students to switch on their webcam) or indirectly (viz. asking questions to random students during the session) monitor the physical and mental presence of the students during the online session.


  Potential Recommendations for Face-to-Face Sessions Top


A student can be asked to mandatory attend those sessions wherein the content cannot be perfected by reading material (such as clinical postings where students learn from patients or small-group teaching sessions such as tutorials, seminars, workshops, and practical, where students learn by active engagement in a self-directed manner or skill-based sessions).[4],[5],[14] Moreover, it is always encouraging to make the students physically attend the sessions that derive roots from experiential learning. However,in alternative teaching–learning methods, the clause for mandatory attendance can sometimes be relaxed.[14]


  Lessons from the Field Top


At Shri Sathya Sai Medical College and Research Institute, a constituent college of Sri Balaji Vidyapeeth, Deemed-to-be University, Puducherry, different strategies have been adopted to monitor the attendance of undergraduate students during online sessions. These include adoption of LMS for medical students from all professional years, employment of Zoom platform for all professional years (that allows precise monitoring of session-wise students' attendance), use of breakout rooms (to advocate small-group discussion and active participation of all students), making it a mandatory practice to switch on the webcam, and recording the attendance of the students at any random time and not specifically during the start or the end of the session.


  Plan of Action Top


It is easier said than done, as there are multiple bottlenecks and conventional policies that will eventually determine the formulation of norms pertaining to attendance.[2],[3],[14] The best approach will be to consider the local dynamics and take a collective decision involving administrative staff, members of the curriculum committee, and heads of the departments.[16] However, from a nation's perspective, wherein the delivery of medical education is governed by a regulatory body, the members of the body should be first convinced and accordingly modifications can be brought in the existing norms.[1],[16]


  Implications for Practice Top


On the similar lines of discussion and the facts presented so far, there is a significant need to define what kind of sessions should be compulsorily attended and which one can turn out to be optional. The regulatory body can create a panel comprising experts from different medical institutions, representing both government and private colleges, as the issues faced by them are many times different. These experts can discuss in depth and come out with potential recommendations, which can be introduced as amendment in the existing attendance norms. However, it will be vital to obtain the views of medical students as well and it will not be right to ignore them completely.


  Implications for Research Top


The basic fear among the minds of the medical educators is that the majority of them feel that if students attend the class, they will perform better in assessments. The same feelings are even shared by the parents, as they are also the part of the same society and everyone wants their ward to attend all the classes, regardless of their utility or not. Acknowledging the presence of these strong thoughts in the mind of teachers and parents, it will be quite worthy to carry out research work with an aim to explore the presence or absence of such type of causal association (viz. attendance in class determines the performance in examinations and eventually the results). These studies have to be carried out in multiple settings across different parts of the nations, so that eventually generalization can be accomplished.


  Conclusion Top


The clause of meeting attendance norms for being eligible for the summative assessment is a must in many ways to ensure that students remain involved in their learning process. However, there is a definite scope to modify the attendance norms depending on the type of sessions and whether the proposed knowledge or skills can be acquired within the four walls of a class or by the students on their own.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Medical Council of India: Competency-Based Undergraduate Curriculum; 2019. Available from: https://www.mciindia.org/CMS/information-desk/for-colleges/ug-curriculum. [Last accessed on 2021 Apr 05].  Back to cited text no. 1
    
2.
Subramaniam B, Hande S, Komattil R. Attendance and achievement in medicine: Investigating the impact of attendance policies on academic performance of medical students. Ann Med Health Sci Res 2013;3:202-5.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Daud A, Bagria A, Shah K, Puryer J. Should undergraduate lectures be compulsory? The views of dental and medical students from a UK University. Dent J (Basel) 2017;5:E15.  Back to cited text no. 3
    
4.
Ferrel MN, Ryan JJ. The impact of COVID-19 on medical education. Cureus 2020;12:e7492.  Back to cited text no. 4
    
5.
Alkhowailed MS, Rasheed Z, Shariq A, Elzainy A, El Sadik A, Alkhamiss A, et al. Digitalization plan in medical education during COVID-19 lockdown. Inform Med Unlocked. 2020;20:100432. doi:10.1016/j.imu.2020.100432.  Back to cited text no. 5
    
6.
Li L, Xv Q, Yan J. COVID-19: The need for continuous medical education and training. Lancet Respir Med 2020;8:e23.  Back to cited text no. 6
    
7.
Tokuç B, Varol G. Medical education in Turkey in time of COVID-19. Balkan Med J 2020;37:180-1.  Back to cited text no. 7
    
8.
Rajab MH, Gazal AM, Alkattan K. Challenges to online medical education during the COVID-19 pandemic. Cureus 2020;12:e8966.  Back to cited text no. 8
    
9.
Ahmed H, Allaf M, Elghazaly H. COVID-19 and medical education. Lancet Infect Dis 2020;20:777-8.  Back to cited text no. 9
    
10.
Sahi PK, Mishra D, Singh T. Medical education amid the COVID-19 pandemic. Indian Pediatr 2020;57:652-7.  Back to cited text no. 10
    
11.
Gordon M, Patricio M, Horne L, Muston A, Alston SR, Pammi M, et al. Developments in medical education in response to the COVID-19 pandemic: A rapid BEME systematic review: BEME Guide No. 63. Med Teach 2020;42:1202-15.  Back to cited text no. 11
    
12.
Torda A. How COVID-19 has pushed us into a medical education revolution. Intern Med J 2020;50:1150-3.  Back to cited text no. 12
    
13.
Hammond D, Louca C, Leeves L, Rampes S. Undergraduate medical education and Covid-19: engaged but abstract. Med Educ Online. 2020;25:1781379. doi:10.1080/10872981.2020.1781379.  Back to cited text no. 13
    
14.
Kumar S, Zayapragassarazan Z, Dharanipragada K. Twin principles for need-based attendance policy in undergraduate medical education. Korean J Med Educ 2018;30:369-72.  Back to cited text no. 14
    
15.
Kabassi K, Dragonas I, Ntouzevits A, Pomonis T, Papastathopoulos G, Vozaitis Y. Evaluating a learning management system for blended learning in Greek higher education. Springerplus 2016;5:101.  Back to cited text no. 15
    
16.
Campbell AM, Ikonne US, Whelihan KE, Lewis JH. Faculty perspectives on student attendance in undergraduate medical education. Adv Med Educ Pract 2019;10:759-68.  Back to cited text no. 16
    




 

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