Clinical Skills Laboratory Research Articles

Implementation of Innovative “Integrated Learning Modules” in a Spiral Curriculum: Successes and Challenges

Study ObjectiveIntegration of basic and clinical sciences have become important for relevant learning. Issues regarding satisfaction and acceptance of the amount and extent of integration early in the curriculum has always been a subject of debate among curriculum developers. Also, organization and implementation is a major challenge for curriculum coordinators and facilitators. At SQU, one of the hallmarks of the spiral curriculum adopted in the MD degree plan are the integrated modules which emphasize integration of basic and clinical sciences through horizontal and vertical integration in the phase 2/M2 of the curriculum. Various teaching learning activities included in this module are case based presentations, clinical skills, and lectures on medical professionalism and ethics. The purpose of the study is to evaluate the integrated modules from the students and tutors' viewpoint and analyze the strengths and weakness of the integrated program.MethodsModule design included‐ Module planning, module development and module implementation. Case presentations were so designed to understand the pathophysiology of signs and symptoms, rationale for ordering investigations, interpretation of results and principles of management in a case based student directed learning environment along with anatomical skills pertaining to the case presentations. Students and facilitators were given a structured questionnaire which dealt with appropriateness of content and objectives, teaching learning methods, content coherence and evaluation methods.ResultsOver 70% of students felt the learning objectives and content were appropriate as it reinforced deep learning and relevance of learning. 96% of students felt the clinical skills lab enhanced their basic science reflections on clinical application of practice. 84% felt the assessments using team‐based assessments improved group learning and professional socialization. However, more than 70% students felt that most facilitators were discipline centered. The facilitators felt that there is need for commitment of faculty and departments for efficient conduction of sessions. However, facilitating the sessions of this module helped them to realize the deficiencies in the curriculum and the emphasis that needs to be laid in their core disciplines. It also promoted co‐operation between staff members from different disciplines and enhanced integration within disciplines.ConclusionIntegration between basic and clinical sciences stimulates profound and self ‐ directed learning among students. Faculty workshops on integrated teaching as part of professional development is likely to strengthen integrated teaching in the curriculum by reducing discipline bias and focusing on case centered learning. Also, forming integrated subcommittees will make the implementation of this module more robust.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Predicting NAPLEX scores using student performance in the clinical skills laboratory setting

IntroductionMany predictors of success on the North American Pharmacist Licensure Exam (NAPLEX) have been studied, but little information is available regarding the effect of assessments in the clinical skills setting on student success. One way to determine if these assessments affect NAPLEX success is to review student performance in clinical skills laboratory courses (termed patient care lab [“PCL”] at our institution), which incorporate such assessments. MethodsStudents (n = 88) enrolled in a four quarter PCL sequence completed several individual assessments (both knowledge and skills-based), including drug information (DI) quizzes/final exams, patient case presentations and associated critical thinking questions, and formal DI responses. Linear regression assessed the relationship between PCL assessments and NAPLEX scores. Statistical tests were performed using IBM SPSS version 22 with a p-value <0.05 considered significant. ResultsWhile drug information responses were not predictive of total NAPLEX scores (p = 0.192), the patient case presentation and associated critical thinking questions predicted 31.1% of variability (p < 0.05). ConclusionPerformance of one cohort of students on certain pharmacy clinical skills lab assessments was predictive of total scores on the NAPLEX. Students who struggle with assessments in the clinical skills lab setting may be targets for early intervention to help improve the likelihood of success. More research is needed to fully elucidate the relationship between assessments in the clinical skills lab setting and NAPLEX performance.

Mechanical factors in the prediction of integrity of the gastrojejunal anastomosis in ex-vivo RYGB models

BackgroundSurgical staplers represent one of the important instruments in modern surgery. Laparoscopic Roux-en-Y gastric bypass is one of the most commonly performed bariatric procedures. Various techniques have been described for performing gastrojejunal (GJ) anastomosis, including linear stapled anastomosis (LSA), circular stapled anastomosis (CSA) and hand-sewn anastomosis (HSA). ObjectivesAn ex-vivo porcine-based experiment was designed to compare the mechanical integrity of the GJ anastomosis among the 3 different techniques by measuring burst pressure (BP). SettingLaboratory-based study conducted at the clinical skills laboratory at Birmingham Heartlands Hospitals, Birmingham, United Kingdom. MethodsPorcine stomachs and small bowels were used to create a GJ model. Four GJ anastomosis models each were created using circular stapler (CSA group) and hand-sewn techniques (HSA group). Stomach and small bowel thickness were recorded. BP was measured by sequential injections of methylene-blue diluted saline until a leak was detected. Total volume until leak is recorded. Compliance (C) was calculated using the formula C = ΔP/ΔV. ResultsResults from our previous experiment for the LSA group are included. One model was excluded from the CSA and the HSA groups due to technical errors. Results were presented as mean ± standard deviation. Total volume in LSA, CSA, and HSA groups was 60 ± 4.08 mL, 73.67 ± 3.22 mL, and 51.67 ± 20.21 mL, respectively. BP in LSA, CSA, and HSA groups was 18 ± 4.69 mm Hg, 20.33 ± 5.77 mm Hg, and 9.67 ± 3.79 mm Hg, respectively. There was a statistically significant difference in BP among the 3 groups (P = .033; Kruskal-Wallis test). C in LSA, CSA, and HSA were 3.50 ± .88 mm Hg/mL, 3.78 ± .85 mm Hg/mL, and 5.39 ± 1.34 mm Hg/mL, respectively (P = .064). ConclusionBP was higher in CSA and LSA groups compared with the HSA group, suggesting a mechanically stronger anastomosis. Despite the lack of statistical significance, higher BP recorded in the CSA group than in the LSA group suggests better anastomotic integrity.

Acute medical unit clinical skills lab

City Hospital opened the first dedicated clinical skills lab within an acute medical unit (AMU) in November 2016. We believe this is the first in the UK with the aim of prompt accessibility in a high-acuity, fast-turnover area. The principle is to ‘learn in chunks of 15 minutes’ and bring back the concept of learning on the job. We were keen to create a culture of learning and education for nurses, doctors, students, allied health professionals (AHPs) and our patients which has led to an improvement in quality of care and job satisfaction as well as a decrease in expenditure. …

Improvement of the Quality of Basic Clinical Skills Training and Evaluation of the Efficacy of Objective Structured Clinical Examination (OSCE): An Action Research with a Mixed Method

Background One of the main goals of action research is to improve the quality of education at both individual and organizational levels. Management enables organizations to improve their performance in areas, which have the greatest impact on students’ learning and empowerment, without compromising the quality of education. Objectives In this study, we aimed to improve the quality of basic clinical skills training for nursing students in an action research, using the available resources. Methods In this action research, a sequential mixed method was applied. The participants in the qualitative phase included experts in the field of education, students, and stakeholders responsible for training at the nursing skills, midwifery, and medical-surgical nursing units of Razi Faculty of Nursing and Midwifery in Kerman, Iran. Assessment of facilities and resources in the quantitative phase was also carried out using a data collection form, a student survey form, and a checklist of basic clinical skills. The stages of action research included action planning for problem-solving, implementation, evaluation, and reflection. The students’ problems with the basic clinical skills and their possible causes were also identified. The most effective and practical solutions for quality improvement included improvement of the educational environment of skill laboratories, followed by the enhancement of skills assessment process using an objective structured clinical examination (OSCE). Results The conventional method failed in the assessment of students’ competence and lacked adequate objectivity and reliability. A significant difference was observed in the mean scores of basic clinical skills (e.g., injection, measurement of vital signs, and dressing) between the conventional method and OSCE (P < 0.05). From the viewpoint of students, OSCE is more reliable and accurate than the conventional method and uses more suitable educational materials and facilities. Conclusions Based on the findings, by improving the educational environment of clinical skills laboratories and implementation of OSCE, nursing students can translate their knowledge of basic clinical skills into practice. We can also improve the quality of health services and clinical care for patients and reduce the incidence of practical errors made by nursing students.

Best practices to impart clinical skills during preclinical years of medical curriculum.

Globally, health is regarded as a booming industry with greater stress being laid on high quality, accountability, and transparency. Traditional medical curricula rely primarily on clerkships during the clinical period of study to train clinical skills, while the preclinical period is mainly used to teach the basic sciences. In recent years, the early introduction of clinical skills training has received increased attention. This review aims to identify and summarize teaching approaches of clinical skills for medical students during preclinical years, namely, (1) framing objectives (2) learning activities, and (3) evaluation strategies. Although the clinical tutor's role is to ensure that students receive effective preclinical skills through different modes of learning (lectures, presentations, and problem-based learning), the role of advanced technologies, namely, simulation-based learning platforms and gamification are found to be very successful. To improve the communication skills, there is strong evidence in support of role plays, and similarly, for enhancing observation skills, an introduction of fine arts in clinical skills training was found to be very useful. Medical schools worldwide should give high priority to conduct faculty development programs on various aspects of training and teaching modalities, evaluation strategies, and improving the evaluation of various clinical skills. Students should be provided with sufficient learning opportunities including a well-equipped clinical skills laboratory and individual attention, and constructive feedback should be given to students for building their confidence level during their learning process.

DEVELOPING LOW-COST MANNEQUIN FOR UNDERGRADUATE IV LINE PHLEBOTOMY

Background: Skills laboratory training had been providing students the opportunity to practice medical skills in a longitudinal education curriculum with various methods. The integration of skills lab learning methods and the use of mannequins could provide the students to practice invasive medical procedures on patients like the real condition in the clinical setting, but still remains a safe simulation. However, simulations in the skills lab require commercial mannequins that have been imported with limited design options and very expensive prices. The effect of this expensive training will hamper institutions to facilitate students’ learning. Therefore, Clinical Skills Laboratory, Faculty of Medicine, Universetas Gadjah Mada had initiated to produce low-cost and innovative mannequins. This study is aimed to develop low-cost mannequin in order to facilitate learning.Methods: This study is a comparison study to 3 types of simple infusions mannequin which will be attached to simulated patients. These 3 types of mannequin are based from the materials: silicone, silicone plus oil, and latex. There were three groups of respondents: 30 students, 15 teachers, and 15 simulated patients and were randomly invited to review those mannequins using a questionnaire and structured interviews. The data were analyzed using Mann-Whitney test and an “inductive content analysis”.Results: The low-cost mannequins were highly accepted by the respondents and the best mannequin was made from silicone (p&lt;0.05). However, the mannequins need improvement on the skin design and the prevention of fluid leakage from the pumps and tubes. These mannequins were designed to stimulate undergraduate students not only to practice inserting needle to veins, but also learning how to communicate with patients at the same time.Conclusion: These low-cost mannequins can be used to practice integrated clinical skills in skills laboratory education. However, the mannequins should be evaluated and improved regularly.

COMPARISON OF TRUWINIST INTERDIGITAL METHOD AND CONVENTIONAL IN LEARNING APPROPRIATE DRUG SELECTION AND PRESCRIBING FOR TYPE 2 DIABETES MELLITUS

Background: Medical education in Indonesia has been using Problem Based Learning curriculum. Meanwhile, the patient management ability evaluation showed the lowest result among all evaluation in Ujian Kompentensi Mahasiswa Program Pendidikan Dokter (UKMPPD). Truwinis Interdigital Method (TIM) has been developed to improve student ability in choosing the appropriate drug and prescribing for Diabetes Mellitus type 2. The purpose of this research is to compare the effectiveness of TIM toward Conventional Method (CM).Methods: This research used cross-sectional design. The subject is 82 student who attend Clinical Skill Laboratory of Endocrine and Metabolism System of Faculty Medicine of Universitas Padjadjaran. The subject is divided into two groups, Group I: CM (control), Group II: TIM (Intervention). TIM consist of e-learning and audiovisual material. Parameters in this research were ability of choosing appropriate drugs test and Objective Skill Clinical Examination (OSCE). The data is analyzed statistically. Results: The data showed homogenousity in both groups (p&gt;0,05). The average test score for CM group was 25,11 ± 10,84 and for TIM group was 80,06 ± 14,19. This was statistically significant (p &lt; 0,0001). The average test score of OSCE for CM group was 39,63 11,73 and for TIM group was 62,74 ±14 ,07. This was also statistically significant (p&lt;0,0001).Conclusion: Truwinist Interdigital Method is more effective than the Conventional Method in learning appropriate drugs selection and prescribing for type 2 Diabetes Mellitus.

Snaps+: Peer-to-peer and academic support in developing clinical skills excellence in under-graduate nursing students: An exploratory study

Peer to peer learning is not a new concept. It has proven to be a valuable approach to enhance deeper learning, improve critical thinking and problem solving. It has been used in the clinical environment, the classroom and the clinical skills laboratory. The aim of this study was to evaluate the effectiveness of student nurse assisted in practice sessions (SNAPS+) with the addition of an experienced nursing academic. Using an eight item Likert scale questionnaire together with three open ended questions, this study found that having a nursing academic present in supporting the peer teachers helped improve confidence in practicing clinical skills and was an effective teaching approach to support student learning and by also providing a critical eye over the skills being practiced. Content analysis revealed to central themes – ‘being and feeling supported’ and ‘feeling more able and competent at undertaking essential nursing skills. The results suggest that overall the nursing students found the SNAPS+ supportive in allowing the time and space to practice skills in an informal manner. The implications for practice could include an evaluation as to whether there is any effect on student success in the clinical placement environment after attending SNAPS+ sessions.

The Medical Education Partnership Initiative: Strengthening Human Resources to End AIDS and Improve Health in Africa

Faced with a critical shortage of physicians in Africa, which hampered the efforts of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Medical Education Partnership Initiative (MEPI) was established in 2010 to increase the number of medical graduates, the quality of their education, and their retention in Africa. To summarize the accomplishments of the initiative, lessons learned, and remaining challenges, the authors conducted a narrative review of MEPI—from the perspectives of the U.S. government funding agencies and implementing agencies—by reviewing reports from grantee institutions and conducting a search of scientific publications about MEPI. African institutions received 11 programmatic grants, totaling $100 million in PEPFAR funds, to implement MEPI from 2010 to 2015. The National Institutes of Health (NIH) provided an additional 8 linked and pilot grants, totaling $30 million, to strengthen medical research capacity. The 13 grant recipients (in 12 countries) partnered with dozens of additional government and academic institutions, including many in the United States, forming a robust community of practice in medical education and research. Interventions included increasing the number of medical school enrollees, revising curricula, recruiting new faculty, enhancing faculty development, expanding the use of clinical skills laboratories and community and rural training sites, strengthening computer and telecommunications capacity, and increasing e-learning. Research capacity and productivity increased through training and support. Additional support from NIH for faculty development, and from PEPFAR for health professions education and research, is sustaining and extending MEPI’s transformative effect on medical education in select African sites.

Design of hospital errors and omissions activities that include patient-specific medication related problems

Background and purposeMedication-related problems persist in hospital settings. New types of errors have emerged with changing technology. There is a need for updated, realistic, and patient-specific activities to train student pharmacists to identify medication-related problems. Educational activity and settingWe describe efforts to redesign hospital errors and omissions activities in a clinical skills lab course. A hospital errors and omissions template is described with multiple-choice answer options redesigned to reinforce that each instance of dispensing in a hospital is an opportunity for patient-centered care. FindingsIn the redesigned hospital errors and omissions activities, students identified the correct errors and omissions 77% of the time with an average point biserial of 0.491. Qualitative evaluation of student course evaluations and student self-selected learning goals suggest that students perceived the revised activity to be valuable. SummaryIt is possible to create and deliver hospital errors and omissions activities that include patient-specific medication related problems.

Establishing Clinical Skills Center in a Developing Country- LMDC Experience

Clinical skills centers have become an integral part of the curricular requirements in most modern medical schools and postgraduate centers; worldwide. There has also been a growing interest in the development of clinical skills laboratories in the developing countries in the past decade. Lahore Medical and Dental College, Lahore, Pakistan took the initiative of developing a low cost clinical skills lab in July 2010.The development of skills lab required a multi-step approach. A six steps approach of Syme-Drant (2005) was modified and used to develop clinical skills lab teaching and learning protocols. The objective of this study is to describe the stages involved in the development of a low cost, clinical skills training center in a medical college in a developing country.

Sensor and actuator simulation training system for en-route intravenous procedure

A system has been developed to simulate transport in a medical emergency vehicle with the intent of assisting paramedics improve their skills in en-route cannulation. En-route cannulation makes pre-hospital venous access possible, which in turns helps to minimize the risk of lengthening transfer times. The system is designed to attain full monitoring of transport conditions, not just in the spatial but also in the temporal sense, and to physically recreate these parameters on a fabricated six degree of freedom simulator system. Tests conducted revealed the viability of applying an inertial measurement unit board sensor to collect data from a vehicle during transport and to subsequently reproduce the exact motions encountered on the simulator. It was found that a smartphone could be used to collect transport data that are dominated by perturbations in the O(101) Hertz scale. With a training arm for venipuncture placed on the simulator, a preliminary study conducted with six participants showed more pronounced performance deterioration amongst those who were untrained in cannulation when the simulator was switched on. The demonstrated system has features that make it amenable for incorporation into a clinical skills laboratory setting.

The development of a clinical skills laboratory at Ross University School of Medicine.

Dedicated clinical skills laboratories (CSLs) that make use of models, mannequins and simulators, are being increasingly established in medical and veterinary schools. These have been commonplace in medical schools for more than two decades, but their incorporation within the teaching of veterinary curricula has occurred much more recently. In 2007, a decision was taken to establish a CSL at Ross University School of Veterinary Medicine. We considered the range of skills that we wished to teach, the physical space and equipment needed, the storage and air conditioning requirements, the facilities needed to deliver PowerPoint lectures and case study presentations, and other essentials necessary to handle cadaver specimens. We converted an appropriate campus building to our needs, hired teaching staff, and started to source models and mannequins for the teaching of veterinary clinical skills. In 2010, 177 senior students completed a survey evaluating their experiences within our CSL. Student satisfaction was generally high, with 95% of respondents feeling that the CSL had improved their psychomotor skills. However, 15% of them felt that the models were insufficiently realistic. Our clinical skills programme has since developed considerably, and it currently offers instruction in a diverse array of surgical, medical and other clinical skills. We hope that this description of our experiences may assist others embarking on similar projects elsewhere.

Perceptions of Medical Students About Bedside Teaching in a Medical School

Bedside teaching is an important and established learning tool in medical education. However there is a decline in bedside teachings over the years throughout the world including Nepal, due to advancement in medical technology, clinical skills labs and simulation techniques. This study aimed to find out the perception of Nepalese medical students towards different domains of bedside teaching. This was a descriptive cross-sectional study. A questionnaire consisting of Likert scale, open ended and closed ended questions was developed on different aspect of bedside teaching and the filled questionnaires were included for analysis. Three hundred and six questionnaires were included. Almost all of medical students responded that bedside teaching is a useful learning modality in clinical teaching 304 (99.3%) and provides active learning in real context 291 (95%). The majority of medical students 233 (76%) were satisfied with the steps of history taking, examination followed by management discussion employed at bedside teaching. The students 223 (73%) were satisfied, how to elicit signs following demonstration of clinical exam by teachers at bedside. However majority 196 (64%) felt lack of individual opportunity at bedside. According to students, focussing more on practically oriented clinical skills with proper supervision would improve learning while hindering factors were large number of students and patient's uncooperativeness. Good communication was considered the best method of alleviating patient discomfort at bedside teaching in this study. The study concluded that medical students have positive response and learning attitudes towards different aspects of bedside teaching.

Physician Assistant Student Perceptions of "Muddiest Point" Classroom Assessment Technique Implementation.

To assess student perceptions of the use of the "Muddiest Point" as a type of formative classroom assessment technique (CAT) in a clinical skills laboratory course. Physician assistant (PA) students enrolled in a private university were invited to complete a perception survey regarding the use of the Muddiest Point at the conclusion of the course. Survey results showed positive overall student perceptions of the Muddiest Point and desire for broader use of this CAT in other courses. The Muddiest Point is a CAT that is simple for the instructor to implement and showed overall perceived benefit to the PA student. The Muddiest Point is an effective method to gauge student learning and allows students to be active participants in their education.

Promoting Clinical Skills Acquisition and Proficiency Using Video Modelling Among Medical Students in Preclerkship

This study was designed to make bare the importance of a proficiency driven curriculum, the need to foster self -directed and self- motivated learners hence the study investigated the factors influencing the acquisition of clinical skills and skills proficiency in preclerkship clinical education using video modelling among medical students in MacArthur Clinical Skills Laboratory (MCSL). It adopted the ex-post facto design. The population of the study was three hundred and eight(308) 4 th and 5 th year medical students who took the course Introduction to Clinical Medicine (ICM). Four research questions and four hypotheses guided the study. The instrument titled clinical skills acquisition through video modelling questionnaire (CSATVMQ) was developed and used to collect data. The reliability of the instruments was established using the Cronbach Alpha method of internal consistency. The reliability coefficients of the sub scales of CSATVMQ were 0.57, 0.84, 0.86, 0.95, respectively for self- directed learning, clinical skills acquisition, frequency of visitation and proficiency. Simple percentage was employed for analyzing the research questions while the hypotheses were tested using the chi-square. The findings established that the utilization of video modelling technique for the promotion of clinical skills acquisition and proficiency was not dependent on gender, academic level and age of medical students, also further test with lambda ( λ) indicated no relationship with a λ value of 0.0 between the dependent and independent variables studied. The researcher therefore recommend that College of Health Sciences, University of Port Harcourt should allocate more time in their Faculty lecture timetable to provide students with adequate practice hours and feedback sessions while enforcing it as a compulsory teaching and learning technique to enhance proficiency and self –evaluation of learnt skills during preclerkship clinical training.

Nursing and midwifery students' perception of learning enablers and gains in the first semester of their BSc programmes: A cross sectional study

BackgroundThe student experience in the first year of university is fundamental to successful adaption to the higher education environment and shapes student engagement with their chosen degree. Students' feedback on this experience is essential when designing or reviewing curricula. ObjectivesThe aim of this study was to explore students' perceptions of their learning gains to identify factors that support student learning and identify elements that need improvement if specific learning needs are to be met. DesignA cross sectional descriptive study. SettingA large urban university in Ireland that provides undergraduate nursing and midwifery degree programmes. Participants and MethodsThe study was conducted using the Student Assessment of Learning Gains (SALG) questionnaire. This instrument consists of a series of closed questions which explore perceived student gains in skills, cognitions and attitudes. The questionnaire was adapted for a semester rather than a module evaluation. The tool also includes a series of open questions inviting students to comment in each section. ResultsStudents (n = 206) positively evaluated teaching and learning approaches used. The greatest enablers of learning were clinical skills laboratory small group teaching and support followed by online learning materials and multiple choice formative assessment questions. They reported gains in knowledge, generic skills development and an increase in confidence and enthusiasm for their chosen career. ConclusionThe feedback gained in this study provides valuable knowledge about the elements that support nursing and midwifery students learning and highlights areas that require attention. This is particularly useful for faculty who are involved in curriculum review and enhancement and in student engagement and retention.

Simple, but not easy – Opportunities and challenges from teachers’ and students’ perspectives in the 21st century of veterinary parasitology teaching

One of the main goals in academia is, and has been, high quality education of students to provide theoretical and practical knowledge essential for professional life. Achieving this goal is highly dependent on teaching procedures and, consequently, on a constant adaptation of teaching styles to align to technical advances and cutting-edge topics. Technical advances can strongly influence teaching and learning in the complex subject area of veterinary parasitology. Today’s students are provided with extensive, digital lecture notes, and e-learning offers including virtual microscope technology to independently obtain intensified theoretical knowledge and understanding. As veterinary parasitology is also highly reliant on proficient practical skills, lectures with integrated diagnostic exercises are mandatory. Nowadays, such practical skills, such as carrying out faecal examination procedures, can be strengthened by having access to clinical skills labs. Advances such as digital lecture notes, e-learning and virtual microscopes do not only provide new, innovative opportunities, but can also comprise challenges. In this context, provision of sufficient relevant studying material may discourage students to take on responsibilities for autonomous gathering of information. Besides technical advances, ‘Zeitgeist’ changes are shaping teaching contents, which are progressively expanding as zoonoses are increasingly being focused on. With the aim of adopting the one-health concept, students today are expected not only to bear responsibilities for animals, but also for their owners and public health. This article will cast light on some key challenges and opportunities in modern veterinary parasitology teaching from the teachers´ and the students´ perspectives.

An Observational Study of the Impact of Attendance on Pre-Clinical Undergraduate Medical Education Performance

1. Abstract <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.1. <span style=font-size:10.0pt;font-family: times= new= roman,serif=>Background: <span style=font-size:10.0pt; font-family: times= new= roman,serif=> With the availability of online lecture recordings and other online information, pre-clinical medical students now have access to many course materials without being physically present in the classroom. <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.2. <span style=font-size:10.0pt;font-family: times= new= roman,serif=>Objectives: <span style=font-size:10.0pt; font-family: times= new= roman,serif=> To conduct an in-depth assessment of whether or not high versus moderate physical attendance affects performance in the context of pre-clinical medical education at an allopathic medical school in the Pacific Northwest. <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.3. <span style=font-size:10.0pt;font-family: times= new= roman,serif=>Methods: <span style=font-size:10.0pt; font-family: times= new= roman,serif=> In this observational retrospective cohort study,a self-administered survey was used to assess high versus moderate self-reported attendance ( > 80% vs. <80%). This information was linked to student examination scores, stratified by subject-matter block (Fundamentals of Medicine; Blood & Host Defense; Skin, Bone & Musculature; Cardiopulmonary & Renal; Hormones & Digestion; Nervous System & Function; and Developing Human) and learning session type(large group sessions, clinical skills lab, science skills lab, and anatomy sessions).Multiple linear regressionmodels were performed to test the association between attendance andcomponent scores, controlling for statistically significant demographic and educational factors. <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.4. <span style=font-size:10.0pt;font-family: times= new= roman,serif=>Results: <span style=font-size:10.0pt; font-family: times= new= roman,serif=> Of 139 eligible participants, 106, provided information for analyses (76%). Of 130 session types and assessment score combinations tested, 123 instances (94.6%) were not associated with any significant relationships between attendance and performance at > 80%. In six instances, greater attendance was associated with an improved component score. In oneinstance, less attendance was associated with an improved component score. <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.5. <span style=font-size:10.0pt;font-family: times= new= roman,serif=>Conclusion: <span style=font-size:10.0pt; font-family: times= new= roman,serif=>Attendance at > 80% was not consistently associated with improved assessment scores. It is reasonable to conclude that complete attendance alone is not beneficial to performance for a vast majority of educational sessions. 2. Keywords: <span style=font-size:10.0pt; font-family: times= new= roman,serif;mso-bidi-font-weight:bold=> Assessments; Attendance; Online lecture recordings; Performance; Undergraduate medical education