Declining medical student attendance: a single institution thematic analysis of reasons students don't attend a preclinical public health course

Declining medical student attendance has been noted for decades, becoming particularly challenging in the years surrounding the COVID-19 pandemic. The reasons why medical students have not attended class in the years since the pandemic and the transition of USMLE Step 1 scores to Pass/Fail are not well established. This study evaluated why medical students did not attend a preclinical public health course. A secondary aim is to compare trends in self-reported attendance. Student course evaluations include self-reported attendance and free-text responses to 'Why did you choose not to attend live sessions more often?' Using inductive thematic analysis, faculty reviewers identified themes affecting attendance. The median self-reported attendance each year for first-year (MS1) and second-year (MS2) students was calculated and analyzed between 2018 and 2023. The overall evaluation response rate was 75.3% for MS1 and 59.3% for MS2. Five non-attendance themes emerged: academic schedule, learning style/delivery, content not valued, convenience/efficiency, and personal conflicts. MS2 attendance was significantly lower than MS1 attendance (<i>p</i> = 0.0227). Attendance varied significantly over time for both MS1 and MS2. MS1 had the highest percentage in 2018, which subsequently declined, with a nadir in 2021 (57.1%), before increasing again in 2022 (72.3%) and 2023 (75.9%) (<i>p</i> < 0.001). A similar pattern was observed for MS2 (<i>p</i> = 0.019), though with less rebound. Medical educators can adjust schedules and vary content delivery to impact some identified themes. Other themes, including convenience/efficiency and personal obligations, are more complex for educators to impact. Non-attendance is a multifaceted problem that escalated during the pandemic. MS2 visits rebounded less after the pandemic than for MS1. Step 1 grading changed during that time and may have played a role in attendance. This study adds to the sparse literature describing why MS1 and MS2 do not attend class. The identified themes provide a framework for further study. The effect of changing Step 1 scoring warrants further study.