Classroom behavioral indicators predict academic performance in large-class clinical instruction: a cohort study
Shiying Sun1, Shenglin Xu2, Xue Wang2
1Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, P. R. China. sunsy71@hotmail.com.
BMC Medical Education
|April 30, 2026
Summary
Student engagement and quiz completion are key predictors of academic success in medical education. Fostering active student engagement and optimizing assessment formats can improve learning outcomes.
Area of Science:
- Medical Education
- Educational Technology
- Academic Performance Analysis
Background:
- Understanding in-class behaviors is crucial for enhancing instructional effectiveness in medical education.
- This study investigated behavioral indicators from a digital teaching platform to predict academic success.
- The focus was on an undergraduate obstetrics and gynecology course.
Purpose of the Study:
- To identify meaningful predictors of academic success in medical students.
- To examine the relationship between behavioral indicators and academic performance.
- To assess the impact of assessment format on learning outcomes.
Main Methods:
- Utilized data from 1,048 fourth-year medical students (2020-2021 cohorts).
- Tracked four behavioral indicators: attendance rate, quiz completion rate, answer accuracy, and student engagement.
- Employed univariate and multivariate linear regression analyses, including assessment format as a variable.
Main Results:
- Student engagement score, quiz completion rate, and assessment format were significantly associated with answer accuracy.
- Student engagement score demonstrated the strongest association with answer accuracy.
- Multivariate analysis confirmed independent associations for all three variables.
Conclusions:
- Real-time behavioral analytics offer actionable insights into learning dynamics.
- Fostering active student engagement is instructionally important.
- Engagement-focused strategies and assessment designs can improve learning outcomes in clinical education.
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