Association of Attendance Format with Learning Gain and National Examination Performance in a HyFlex Preparatory Course for Pharmacy Students

Attendance format may be associated with the learning-support effects of preparatory courses for the National Examination for Pharmacists (NEP). This retrospective observational study examined associations of self-selected attendance format with course-period learning gain and subsequent NEP performance in a four-month HyFlex course for sixth-year pharmacy students. Students received the same course content and examinations and were classified into face-to-face (F2F), live online (LO), or mixed (MIX) attendance groups. Course-period learning gain was defined as the difference in examination score percentage between the post-course and pre-course examinations. The F2F group showed greater learning gain than the LO and MIX groups. Although the NEP pass rate was higher in the F2F group, the difference among groups did not reach statistical significance in the primary analysis (p = 0.086). Similar findings were observed in a sensitivity analysis. In conclusion, F2F attendance was associated with greater course-period learning gain than LO or MIX attendance. However, this advantage was not clearly reflected in NEP outcomes, indicating that course-period learning gain alone may not fully explain final examination performance and continued post-course support may be needed. Because the attendance format was self-selected, these findings should not be interpreted as evidence of a causal effect.