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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 137-143

A study of factors influencing academic performance of undergraduate medical students


1 Department of Community Medicine, ESIC Medical College, Faridabad, Haryana, India
2 Department of Community Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India

Date of Submission16-Sep-2019
Date of Decision20-Dec-2019
Date of Acceptance02-Apr-2020
Date of Web Publication24-Dec-2020

Correspondence Address:
Dr. Priyanka
Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCFM.IJCFM_74_19

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  Abstract 

Introduction: An important indicator of quality of medical education is students' academic performance and the study of factors which influence the academic performance of medical students is important as it can provide information to improve educational programs.
Material and Methods: This was a cross-sectional study involving medical students who passed their final professional examinations and were about to start their internship training. They were asked to complete an anonymously administered feedback form which contained questions regarding the academic performance of students in all the professional examinations of MBBS along with background characteristics of students. Data entry and statistical analysis was carried out using statistical software SPSS version 12. The primary outcome was the proportion of students in different levels of academic achievement. The secondary outcome was the factors associated with different levels of academic achievement. Descriptive statistics were used to describe the distribution of all variables. For finding out the association, an analysis using Chi-square test was done for qualitative data.
Results: The mean age of participants was 22.7 ± 0.67 years (range 21–25). About 43.6% of the students had scored <60% marks, while 56.4% had scored more than that. High-performing students were found to spend more time on hobbies as well as on physical activities and less time on social networking sites as compared to the average-performing students. Study and sleep habits of high performers were significantly different from average performers.
Conclusion: Many factors were found to have a significant association with academic performance of students such as residence, having a doctor parent, spending time on personal hobbies and social networking sites, time spent on study, and duration of sleep a day before examination.

Keywords: Academic performance, examination, factors, medical students


How to cite this article:
Priyanka, Goel MK, Rasania SK. A study of factors influencing academic performance of undergraduate medical students. Indian J Community Fam Med 2020;6:137-43

How to cite this URL:
Priyanka, Goel MK, Rasania SK. A study of factors influencing academic performance of undergraduate medical students. Indian J Community Fam Med [serial online] 2020 [cited 2021 Mar 5];6:137-43. Available from: https://www.ijcfm.org/text.asp?2020/6/2/137/304800


  Introduction Top


The primary aim of undergraduate medical education is to generate doctors who are competent enough to carry out their duties and responsibilities. In the past few years, there has been an increased focus on the shortage of doctors in our country and the need for increasing the number of medical seats. As a result, the number of undergraduate medical seats has increased considerably, but the quality of medical education is facing challenges. As medical teachers, our focus should be to identify these challenges and rectify them wherever possible.

An important indicator of the quality of medical education is students' academic performance which is a known predictor of professional competence in long-term careers. Research has shown that students with poor academic performance are at increased risk of subsequent professional misconduct.[1] The study of factors which influence the academic performance of medical students becomes more important under these circumstances as it can provide information to improve educational programs.

Objectives

  • To study the pattern of academic performance of undergraduate medical students
  • To study the association between different factors and academic performance of study subjects.



  Materials and Methods Top


A cross-sectional study was conducted by the department of community medicine of a premier medical institute of Delhi in the last week of December 2017. The study participants included all the medical students who passed their final professional examinations held in November–December 2017 and were about to start their internship training from January 01, 2018. They were informed about the purpose of the study and explained that their participation is purely voluntary and they can opt out of the study if they feel so. They were asked to complete a feedback form which was self-administered and filled anonymously. This feedback form contained questions regarding the academic performance of students in all the professional examinations of MBBS along with background characteristics of students like the place of residence, schooling, education, and occupation of parents. Academic performance was measured by average marks obtained in all the university professional examinations. The students were categorized into two groups based on the average marks obtained by them. Those who obtained more than 60% marks were categorized as high performers and the students having 50%–60% marks were included in the average performer category. In addition, information regarding time spent by students on extracurricular activities such as hobbies, physical activities, television, social media, and study was also recorded. They were inquired about their habits and pattern of study and sleep, on routine days as well as a day before examinations.

Data entry and statistical analysis was carried out using statistical software SPSS version 12. The primary outcome was the proportion of students in different levels of academic achievement. The secondary outcome was the factors associated with different levels of academic achievement. Independent variables which were assessed include background characteristics of students such as age, place of residence, education of parents, their schooling, coaching taken for clearing entrance examination, and other factors like time spent on hobbies, physical activities, social networking sites, and on study. The dependant variable includes academic performance. Descriptive statistics were used to describe the distribution of all variables. For finding out the association, an analysis using Chi-square test was done for qualitative data.

Ethical consideration

The feedback forms were collected anonymously without any identifying information of the respondents. The students filled the forms voluntarily and their confidentiality was maintained. As the information collected was totally anonymous, permission for data analysis and presentation along with waiver of written consent was obtained from the Institutional Ethics Committee.


  Results Top


The proforma was completely filled by 110 interns who were included in the final data analysis. The mean age of participants was 22.7 ± 0.67 years (range 21–25). The students were divided into high performer and average performer groups based on the average marks obtained during all the MBBS professional examinations taking 60% as cutoff point. About 43.6% of the students had scored <60% marks, while 56.4% had scored more than that.

All of the students had undergone some coaching for clearing the pre-medical entrance test. The majority of the students (92.7%) belonged to urban areas. A considerably large proportion of students did their schooling from private schools. Nearly 78.2% had studied in private schools till middle school level and 80.9% had studied from private schools after senior secondary school level. Almost 90% of the students' fathers were educated up to a minimum of graduate level, while mothers of 70% of the students had studied up to graduation or higher level. About 13.6% of the students had at least one parent who was doctor. On relating students' performance with the occupation of both father and mother, it was found that the proportion of students with doctor parents was significantly higher in high-performing students as compared to average-performing ones. Almost two-fifth of the participants were day scholars and the rest were staying in the college hostel. We did not find any significant association between the place of living and academic performance [Table 1].
Table 1: Demographic profile of average- and high-performing students

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We found that medical students do not devote much time to their hobbies. The frequency of time the students spent on hobbies was quite less in both the groups, but the high-performing students were found to spend time on hobbies significantly more frequently as compared to the average-performing students (P < 0.05) [Table 2].
Table 2: Time spent on extracurricular activities among average- and high-performing students

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The time spent on physical activities by the students is also very less with a slightly less than one-fourth of the students never doing any physical activity. High-performing students were found to spend more time on physical activities as compared to average-performing students, although it is not statistically significant [Table 2]. Similarly, watching TV is not very popular among medical students, and it was not found to have any significant relationship with academic performance (P > 0.05).

However, using social networking sites was found to be quite popular among the students. The high-performing students used to spend significantly lesser amount of time on social networking sites than the average-performing students (P < 0.01). More than half of high performers spent <2 h in a day, while almost one-third of average performers spent more than 4 h/day on social networking sites. This shows that spending too much time on social networking sites negatively impacts academic performance [Table 2].

Almost all of the high-performing students used to study daily on routine nonexamination days with a very large proportion studying for more than 2 h daily, whereas in the average performing group, approximately one-fourth of the students did not study daily on nonexamination days and only one-third used to study for more than 2 h daily. This difference was found to be statistically highly significant (P < 0.001). When asked about the time spent on studying a day before examination, the maximum number of high-performing students (88.7%) reported studying for 10–15 h, while in case of average-performing students, they studied either < 10 h (39.6%) or more than 15 h (35.4%) with only one-fourth of the students studying for 10–15 h. The two groups differed significantly in this aspect also (P < 0.001) [Table 3].
Table 3: Pattern of study habits among average- and high-performing students

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As far as the preferred time for study is concerned, almost two-third of the students preferred to study late night. The proportion of students who preferred to study early morning was slightly higher (35.5%) in the high-performing group as compared to the average-performing group (27.1%). A majority of students (64.5%) preferred to study alone rather than group study. We did not find any significant association of academic performance of students with preferred time or preferred method of study (P > 0.05) [Table 3].

This study shows that a majority of students in both average- and high-performing categories slept for more than 6 h on routine days. Almost two-third of the students (67.7%) from high-performing group and half (50%) from average-performing group reported sleeping for 6–8 h on nonexamination days. Students from both the groups used to sleep for lesser time on the day before examination as compared to routine days. However, a majority of high-performing students slept for 4–6 h, while the majority of average performers slept for less than 4 h. This difference between the two groups was found to be statistically highly significant (P < 0.01) [Table 4].
Table 4: Pattern of sleep habits among average- and high-performing students

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  Discussion Top


The present study focused on the factors that affect the academic performance of medical students. More than half (56.4%) of the students had scored more than 60% average marks in MBBS. A majority of students did their schooling from private schools. The proportion of students studying from private schools is larger after senior secondary level as compared to the middle level. This shows that more students prefer to study in private schools after middle school level. The reason for this may be that private schools are supposed to provide academically better environment which will, in turn, help in clearing medical entrance examination. Kumwenda et al. have reported that students from independent private schools performed better than students from state-funded schools.[2]

The parents of majority of students had studied at least up to graduation level. We did not find any association of educational status of father or mother with the academic performance of the students. However, out of the high performers, fathers of one-fourth of the students and mothers of one-fifth of the students were doctors, while this proportion was significantly less in average-performing group. The reason may be that doctor parents can give better guidance and support to their children studying medicine as compared to parents from other professions. Our findings are in accordance with the results of another study involving medical students conducted in the Netherlands which shows that most students had parents with a higher level of education, and approximately 13% of the students had at least one parent with a medical background.[3]

A slightly more than half of the students from high-performing group lived in hostels as compared to two-third of average performers, but there was no significant relationship between the place of living and academic performance. Similar results have been reported by other researchers as well.[4],[5],[6]

We assessed the time spent by the students on their hobbies. Interestingly, a larger number of high-performing students (17.7%) spent time on their hobbies daily as compared to average performers (6.3%). Almost two-third of the high performers spent time on hobbies at least once a week or more, while almost half of the average performers did so. This difference was found to be statistically significant. This shows that spending time on hobbies has a positive association with academic performance. Hence, medical students should be encouraged to spend some time on their hobbies and recreational activities which would be expected to improve their academics, although others authors have reported no significant association between time spent on personal hobbies and academic performance of medical students.[4]

As far as time spent on physical activities is concerned, high-performing students spent more time on physical activities as compared to average-performing students, although it is not statistically significant. Overall, this shows that medical students lead a very sedentary life which may not be a healthy practice. Results of another study by Stroebele et al. show that less physical activity by students is related to lower academic performance.[7]

Almost half of the participants did not watch TV and a slightly lower proportion watched it for <2 h in a day. We did not find any association of spending time watching TV and academic performance. Similar results have been reported from other studies,[4] but one study shows the association of hours of TV watching with academic performance.[7] We found that watching TV is not very popular among our study participants and only a minority of students watched TV for more than 2 h in a day.

However, in our study, students reported that they spent a considerable amount of time on social networking sites. All the students were active on these sites. The high-performing students used to spend a lesser amount of time on social networking sites than the average-performing students. We found this association highly significant (P < 0.001). It can possibly act as a distraction from academics and would lead to a wastage of time which could better be utilized for academic purposes by the students. This aspect needs further exploration, and there is a need to conduct extensive research in this area to identify not only the extent of the problem but also the reasons and remedies for it. Al Shawwa et al. have also found similar results stating that the amount of time spent on social networking had a significant effect on students' performance.[4] Another study by Rithika and Selvaraj shows that students use social media extensively, and there is a significant relationship between social media usage and student's academic performance.[8]

A maximum proportion of high-performing students reported studying more than 2 h a day on routine nonexamination days, while almost one-third of the students in the average-performing group did so. The proportion of average-performing students who studied <2 h daily and who do not study daily is quite large as compared to high-performing students. This difference was found to be statistically highly significant. This clearly reflects that spending more than 2 h a day on the study on a regular basis is a positive predictor of better academic performance and irregular study habits deteriorate students' performance in examination.

We also found a statistically significant difference in the time devoted to studying on the day before examination in both the groups. While a majority of high performers typically spent 10–15 h on study, a large proportion of average performers spent either <10 h or >15 h on study on the day before examination. These findings are in contrary to another research which shows no effect of duration of study prior to examination and number of hours of studying on the day before examination on academic achievement.[4] Our results might reflect that not studying on regular basis and spending excessive time on study (more than 15 h) on the day before examination has a negative effect on academic performance of students which is also there when students devote <10 h to studying before examination. Our results are consistent with findings of Alos et al. who have concluded that it is important to study over a period of days rather than waiting and leaving everything till the last minute.[9]

A major proportion of students preferred to study late night than early morning, but no significant difference was found in the two groups with regard to the preferred time of study and preferred method of study which included studying alone, studied with a friend, or studying in groups, although a larger proportion of students in both the groups preferred to study alone rather than with friends. These findings are in accordance with the results of a similar research conducted in Iran.[10] Other studies have reported a significant difference in the method of study where high-performing students preferred to study alone, and students with lower performance preferred group study.[4],[11]

This study shows that a lack of sleep a day before examination adversely affects the academic performance and sleeping for a duration of >6 h before examination also results in decline in academic performance. This may be because of the vast medical curriculum which requires a long time for revision, for which the students have to compromise their sleep, but sleep duration of <4 h may result in mental exhaustion, thereby adversely affecting the recall capacity during the examination, which will ultimately deteriorate students' performance. Similarly, Shareef et al. have reported that to comply with large academic load, many of medical students do not devote much time to rest or sleep, especially when it is close to their examinations.[12] Veldi et al. have reported that complaints about sleep problems are common in young medical students and sleep quality is significantly associated with academic progress.[13]

A study conducted by Al Shawwa et al. in Saudi Arabia also shows that a significantly higher proportion of medical students with low grade point average tend to sleep for longer duration a day before the examination as compared to students with high grade point average.[4]

In contrast to our findings, Reddy et al., from Uttrakhand, have found no correlation between the duration of sleep before the examination and academic performance.[14] Another study conducted among school students shows that sleeping for >9 h/night is associated with better grades. This difference could be due to the difference in course standards.[7]


  Conclusion and Suggestions Top


The study participants had an overall good academic performance, with 56% scoring more than 60% marks. Many factors were found to have a significant association with academic performance of students like residence, having a doctor parent, spending time on personal hobbies, spending time on social networking sites, time spent on study, and duration of sleep a day before examination. We found that not studying on a regular basis and spending excessive time on study and sleeping <4 h a day before examination has a negative effect on academic performance. We did not find any association of schooling, parents' education, place of living, time spent on physical activities, and watching TV and preferred time and method of study on academic achievement of medical students. We suggest that to improve academic performance, medical students should be encouraged to spend some time regularly on extracurricular activities like hobbies. They should also devote a minimum of 2 h daily to studying on a regular basis and sleep for 4–6 h on the night before examination. Excessive use of social networking sites should be discouraged, as it may interfere with academics.

Limitations of the study

  • The academic performance of students was measured by the information self-reported by the students themselves and could not be cross-verified
  • We studied only some of the factors affecting academic performance. To make better inferences, we need a more comprehensive evaluation by including more variables
  • We have done a univariate analysis in this study. Multivariate analysis could have been done.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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