Factors affecting medical students' attendance on clinical attachments: a qualitative focus group study

Recent literature has reported declining attendance among certain medical student cohorts. The limited existing studies primarily explore attendance at lectures but not attendance on clinical attachments, which are mandatory for satisfactory student progression. This study aimed to investigate the factors influencing medical students' decision to attend learning activities on clinical attachments, to optimise attendance and to formulate recommedations with respect to educational outcomes and the student experience.

Nine focus groups with clinical year medical students were conducted at a UK medical school, based at three different hospital sites (n = 39). Thematic analysis of transcripts was performed (NVivo Software V14.23.2).

Key factors which influenced medical students' decision to attend clinical attachments were grouped into 6 main themes: (1) student factors, (2) learning activity factors, (3) assessment pressure, (4) organisational factors, (5) tutor factors, and (6) attendance monitoring. Fourteen sub-themes were then identified under these key themes. Specific factors that encouraged attendance included clustered learning activities that maximised student time efficiency and high tutor interactivity with an awareness of student-specific learning outcomes. Factors that discouraged attendance included a prioritisation of students for self-directed learning largely driven by exam pressure and a belief amongst some students that attendance on clinical attachments may not correlate with exam performance. Attendance may be optimised through clustering timetabled learning activities, transparently balancing self-study and timetabled activities, increased faculty development initiatives and further optimising university assessments to emphasise the skills acquired through patient exposure.

This study highlights the heterogenous decision-making relating to attendance among medical students on clinical attachments. The data presented may help to explain the declining attendance trends on clinical attachments observed in certain cohorts. Future research could quantitatively investigate the effect of specific recommendations to optimise both attendance and the student experience.