Research Paper
E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 11 | NOV 2017
ABSENTEEISM AMONG STUDENTS OF MEDICAL STUDIES: ASSESSMENT AND ANALYSIS OF THE CAUSES ELMEKKAOUI AMINE 1 | BENBRAHIM ZINEB 2 | ZAHI ISMAILI 1 1 2
FACULTY OF MEDICINE AND PHARMACY OF OUJDA, MOHAMMED THE FIRST UNIVERSITY. FACULTY OF MEDICINE AND PHARMACY OF FEZ. MOHAMMED BEN ABDELLAH UNIVERSITY.
ABSTRACT Background: The aim of this study is to evaluate the prevalence and causes of absenteeism among graduate medical students of Oujda university. And the correlation between non-attendance and results of the final exam. Methods: We conducted a cross-sectional study using a self-administered questionnaire. A comparison between two essential groups was achieved, a group of students "always present" to lectures {group(P)} and a group bringing together students "never" or "sometimes" present to lectures {group(A)}. Results: The study sample consisted of 105 students of the second cycle of medical study (3rd, 4th and 5th years). Groups (P) and (A) were represented by 16.2% and 50.5% of students respectively. The comparison between the two groups find that 23,5% of students within group(P) are male while they are majority in group(A) (p=0,02). There were no differences between the two groups concerning age, students from rural areas, food intake in the university restaurant. But there were significant differences concerning accommodation and the high level of the mother’s education. The main reasons reported for missing lectures were lecturer’s teaching style, social conditions and a busy schedule. A comparison between the success rates in the first session, found a rate of 82.4% among students from group(P) vs. 49.1 % group A (p=0.01). Conclusion: This study highlighted the importance of absenteeism our Faculty. The study also concluded that social conditions and the quality of the lectures were the most important factors associated with absenteeism. Paying attention to these causes could help institutions improve the learning of the medical discipline. Keywords: Absenteeism, Nonattendance, Lectures, Medical Education, Medical Students.
Background Student’s absenteeism at lectures is a major and old concern for medical education worldwide Recent studies especially those conducted in African Universities have shown that absenteeism is becoming more common. Moreover, these studies concluded to an association between absenteeism and the quality of competencies building. Our young faculty of medicine in Oujda does not seem to escape this problem but no study has approached it before. For this reason, we conducted this study to evaluate absenteeism as well as its possible causes among the students of medicine of the faculty of medicine and pharmacy of Oujda (FMPO). The primary objective of the study was to assess the phenomenon of absenteeism in our faculty and to identify the main causes of absenteeism.
Materials and methods Study design and eligibility criteria We conducted a cross-sectional study on lectures attendance of students in the 3rd, 4th and 5th year at the FMPO. Education of students in these levels consists of clinical training at the Mohammed VI University Hospital in the mornings and school courses in the afternoons. Students in each level are divided into 8 groups rotating in the different departments of medicine and surgery of the
hospitals. We randomly selected 2 groups in each level to respond to our self-reported questionnaire.
Measurement of class absenteeism and data collection The dependent variable was self-reported class attendance during the preceding semester.Independent variables included gender, age, origin, type of high school completed (public, private or French school), year of study, alimentation and place of accommodation while at the university, father’ education level, mother’s education level, toxic habits and reasons for missing classes. Data collection was doneone week after displaying results of the first semester. To ensure anonymity,no identifying information was included in the questionnaire. The data was then transferred to an "Excel" table to be analyzed.
Statistical analysis We dichotomized class absenteeism in two groups, a group of students who were "always present" (called group (P)} and a group bringing together students "never" and "Sometimes" present at lectures (called group (A)}. The group who often attends the lectures was considered as a “buffer group”.Data were compared between the two groups using the χ2 (Chi-2) test for qualitative variables and Student test for quantitative variables. All the statistical tests were two tailed and considered statistically
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E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 11 | NOV 2017
significant for p-value < 0.05. Statistical analysis was carried out using the Epi Info software. 7.
the hospital. Distribution of these reasons in each group is displayed in tables 4 and 5.
Results
Finally, 58.8% of students reported that Learning Clinical Reasoning was the most important method of medical training. Half students confirmed that clinical training in the hospital was their preferential method whereas less than a quarter of students have chosen plenary and small group lectures lectures taught in the faculty of medicine as the best methods of medical training (21,6% and 13,7% of students respectively).
One hundred and five students responded to the questionnaires. Table 1 describes absenteeism frequency in the entire sample and each medical school level. Sixteen point two percent of students were always present at the lectures (= Group (P)) whereas 50.5% of the students were never present or present only occasionally (= Group (A)). The mean age was identical between the two groups: 21.2 +/- 1.2 years in Group A versus 21.1 +/- 1.4 years in Group P (p = 0.7). Male students were predominant in Group A (54.7%) comparatively to Group P (23.5%) (p = 0.02). In the group P, none were of rural origin compared with 9.43% in the group A (p = 0.18). Five point eighty eight percent of the group P had their bachelor's degree in a private secondary school compared with 11.3% in the groupA (p = 0.51). No differences were noted between the two groups regarding food intake in the university setting 5.7% (Group P) Vs 5.9% (Group A). On the other hand, the place of residence was different between the two groups; 23.5% of Group P students versus 3.7% of Group A students were housed in a university residence (p = 0.03). 64.7% of students’ mothers in group P versus 35.8% of those in group A had high education level (p = 0.03). whereas, no difference was found between the two groups regarding fathers’ education levels (p = 0.79). Socio-economic characteristics of each group is displayed in tables 2 and 5. For toxic habits, none was recorded among students in Group P while 9.43% of cases were recorded in Group A (p = 0.14) (tables 3, 5). Absenteeism was a concern in the three medical school levels with no significant difference between the two groups (p = 0.7). Eleven point eight percent in the group (P) versus 37.7% in a group (A) affirmed that lectures rarely or never meet their training expectancies (p = 0.04). The group (P) students had also declared that they did medicine by personal choice (17/17) but also that they all like medicine (17/17); While 11.3% of (A) group say that the choice to do medicine was not theirs (p = 0.14) and 11.3% also declared that they did not like medicine (P = 0.14). Eighty two point four percent of students in group P succeeded all exams in the first session compared to 49.1% in group A (p = 0.01) The main causes of absenteeism according to the students werethe heterogeneity of courses quality (48.8%), social conditions (48.8%), lack of time (38.1%), length of the courses (26.2%), and preparation of the exams (22.6%). Other causes reported by students were their preferences of learning through internet (17.9%) or medical books (10.7%). Besides, 9.5% of students reported they do not attend courses because of exhaustion by clinical training in
Discussion: This study shows that our faculty does not escape the problem of absenteeism since only 16.2% of the students in our samplereported they always attend lectures. This phenomenon is ubiquitous since it concerns medical studentsin African as well as in Western universities (1-3). Absenteeism is also a concern in the faculties where attendance to lectures is mandatory (1).Moreover, this problem concerns also lectures of other non-medical sectors (4-7). Several studies conducted in other universities to assess the extent of absenteeism concluded that this phenomenonis more important in more advanced levels of training. This finding was not consistent in our study which may be true or may be related to the small number of students in 3d level. Comparison between the two groups,underlined the association between absenteeism and other sociodemographic characteristics such male gender, housing outside the university residency, lower rate of mothers’ higher education, toxic habits and rural origin. Other factors tended to be associated with absenteeism like lack of interest in medical studies or disliking teaching style which do not meet their training expectancies. These findings were consistent with data of an Ethiopian study concerning students of the medical branch (1). Indeed, this study found in univariate analysis that male gender, rural origin, lower level of education in the mother (and not the father), private secondary school, negative judgment on the quality of the courses, food intake outside the university setting, higher students income andtoxic habits were all related to absenteeism. It is clear from the data of this study that absenteeism solutions lie in a global and multidisciplinary approach of the students including their socio-economic conditions like improving conditions of transport, accommodation and food intake in the faculty setting. Quality of lectures should also be taken into consideration. Many types of intervention can be proposed in this context: Increasing the courses attractiveness by making them more interactive and value more the practical content, improving teaching methods such as clinical reasoning and clinical training especially in the hospital and finally giving more trainings to trainers in order to improve the teaching methodologies.
Conclusion
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This study has highlighted the importance of absenteeism among graduate students at the Faculty of Medicine and Pharmacy of Oujda. We also reported that causes of absenteeism in our faculty were dominated by the social conditions and the quality of the lectures. Paying attention to these reasons could help institutions improve the learning of the medical discipline.
level
Primary
2 (11,8)
5 (14,3)
Secondary
1 (5,9)
6
(16,7) 8 (19,5)
3 (25)
Graduate
11 (64,7)
17
14 (34,1)
5
(48,6)
Table 1: Comparison between Groups A and P regarding the level of medical school SCHOOL YEAR
Number
Percentage
Group P: n (%)
Group A: n (%)
3rd
43
40,95%
7 (16,3%)
22 (51,2)
4th
32
30,48%
4 (12,5%)
17 (53,1)
5th
30
28,57%
6 (20%)
14 (46,7)
Overall
105
100%
17 (16,2 %)
53 (50,5 %)
Studentâ&#x20AC;&#x2122;s father Education level
No educated Primary
Secondary Graduate
Number
Often attend
attend
attend
Never attend
41 (39,1)
12
(%)
(33,3)
(11,4)
Age
21,1 +/-
21,2
21,4 +/-
20,7
(years +/-
1,4
+/-
1,2
+/- 1,2
23 (56,1)
6 (50)
18 (43,9)
6 (50)
SD)
(8,6) 3 (17,6)
Overall students
University
2 (4,9)
1 (8,3)
2 (11,8)
7 (20)
5 (12,2)
1 (8,3)
10 (58,8)
20
25 (61)
8
1 (5,9)
1
16 (94,1)
Current residence
University
1 (2,4)
2
40 (97,6)
5
10 (83,3)
2 (4,9)
0
17 (41,5)
8
(14,3) 6 (35,3)
15
House With Family
(42,9) 7 (41,2)
15
(66,7) 22 (53,7)
4(33,3)
(42,9)
21,2 +/-1,3
18 (17, 1) 47 (44,8) 16 (15,2) 11 (10,5) 15 (14,3) 63 (60)
5 (4,8)
(16,7)
34
4 (23,5)
17 (16,2)
(66,7)
(2,9)
Rental 105 (100)
2 (16,7)
5
Group A Sometimes
35
9 (22)
(97,1)
Always
17 (16,2)
3
(57,1)
Others Group P
2 (11,8)
(41,7)
(14,3)
Place of food intake
Table 2: Socio-economic characteristics of the students according to their groups
2
(17,1)
Tables
Sex
8 (19,5)
100 (95,2) 11 (10,5) 46 (43,8) 48 (45,7)
1,4 Male
4 (23,5)
10
43 (41)
Table 3: Toxic habits of the students included according to their groups
(28,6) Female
13 (76,5)
25
Grou pP
62 (59)
(71,4) Where
Rural area
0
they grew up
High
3
5 (12,2)
Alwa
8 (7,6)
(8,6) Urban area Public
17 (100)
32
ys 36 (87,8)
(91,4) 16 (94,1)
school
31
1 (5,8)
4
37 (90,2)
No educated
10 (83,3)
4 (9,7)
(11,4) French school
12 (100)
(88,6) Private
Studentâ&#x20AC;&#x2122;s mother education
0
2 (16,7)
0
0
0
0
3 (17,6)
7 (20)
11 (26,9)
2 (16,7)
23 (21,9)
es attend
Neve r atten d
4
5 (12,2)
0
Sometim
Overal l studen ts
d Tobacco/Alcohol/d
- Yes
0
rugs consumption
(11,4
5 (12,2)
4)
11 (10,5) 0
Often atten d
atten
97 (92,3) 94 (89,5)
Group A
Tobac co Alcoho l
0
1
4 (9,8)
0
4 (9,8)
3 (7,3)
0
3 (7,3)
(2,9) 0
0
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Other drugs
3
1 (2,4)
0
1 (2,4)
(8,6)
Difficulties related to language comprehensio n
0
2 (5.7)
1 (2,4)
0
3 (2,9)
Table 4: Absenteeism causes reported by the students according to their groups Group
Group A
Overal
P
Often
Alway
attend
Sometime
Neve
s
s
s attend
r
Group A (50,5%)
Statistical analysis (p)
Age (years old)
21,1
21,2
NS
Male
23,5 %
Rural area
0
9,4 %
0.1
Private high school
(1) 5,8 %
(6) 11,3%
0,5
atten d
Students
17
35
attendance
(16,2)
(33,3)
41 (39,1)
12
105
(11,4
(100)
) School year
Group P (16,2%)
l
attend
3rd
Table 5: Comparison between groups A and P regarding socio-economic characteristics and causes of absenteeism
7
14
(41,2)
(40)
14 (34,2)
54,7
%
0.02
8
43
(66,7
(40,9)
Meal at university
5,9%
5,7%
NS
1
32
Accommodation at university campus
23,5%
3,7%
0.03
(8,3)
(30,5)
3
30
High level of mother’s education
64,7%
35,8%
0.03
(25%
(28,6) High level of father’s education
58,8%
62,2%
NS
Toxic consumption
0
(5) 9,4
0.1
School year
-
-
0.7
Lectures never or rarely fulfill trainee needs
(2) 11,8%
(20) 37,7%
0.04
Lack of interest to medical studies
0%
11,3%
0.1
) 4th
5th
4
11
(23,5)
(31,4)
6
10
(35,3)
(28,6)
16 (39)
11 (26,9)
) Does lectures
Mainly
fulfill the
2
12
(11,8)
(34,3)
training
Sometime
13
18
needs?
s
(76,5)
(51,4)
5 (12,2)
22 (53,7)
1
20
(8,3)
(19,1)
5
58
(41,7
(55,2)
) Rarely
2
5
(11,8)
(14,3)
11 (26,8)
5
23
(41,7
(21,9)
) Never
0
0
3 (7,3)
1
4 (3,8)
(8,3) Teaching modality associated to best learning
Plenary Lectures
5 (29,4)
12 (34,3)
5 (12,2)
0
22 (20,9)
Small group lectures
0
7 (20)
6 (14,6)
1 (8,3)
14 (13,3)
Clinical training
11 (64,7)
18 (51,4)
17 (41,5)
5 (41,7 )
51 (48,6)
Learning clinical reasoning
9 (52,9)
18 (51,4)
25 (61)
8 (66,7 )
60 (57,1)
REFERENCES 1. Desalegn AA, Berhan A, BerhanY(2014). Absenteeism among medical and health science undergraduate students at Hawassa University, Ethiopia. BMC Med Educ.;14(1):81. 2. Pr. François Besançon et Dr. Henri Joly. etudier l’etudiant, enquete. Available from: http://www.parlersante.fr/etudier_etudiant.htm
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3. Hassan Hosseini. Enquête sur l’absentéisme des étudiants aux cours de la Faculté de Médecine de Paris XII [Internet] [mémoire de DIU de pédagogie médicale]. Available from: http://www.edu.upmc.fr/medecine/pedagogie/memoi re/Hosseini_2003.pdf 4. Coulon A, Paivandi S. (2008). État des savoirs sur les relations entre les étudiants, les enseignants et les IATOSS dans les établissements d’enseignement supérieur. Rapp Pour L’OVE;2(09):2011. Availablefrom : http://www.ovenational.education.fr/medias/files/pu blications/Rapport_OVE_-_Coulon-Paivandi.pdf 5. Massingham P, Herrington T. (2006). Does Attendance Matter? An Examination of Student Attitudes, Participation, Performance and Attendance. J Univ Teach Learn Pract.;3(2). Available form :http://ro.uow.edu.au/jutlp/vol3/iss2/3 6. Moore S, Armstrong C, Pearson J. (2008) Lecture absenteeism among students in higher education: a valuable route to understanding student motivation. J High Educ Policy Manag.;30(1):15‑24. 7. Paisey * C, Paisey NJ. (2004). Student attendance in an accounting module – reasons for non-attendance and the effect on academic performance at a Scottish University. Account Educ. ;13(sup1):39‑53.
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