Table 4. Correlation Results Table

IV. DISCUSSION

Clinical Rotations are an important aspect of undergraduate medical education, giving students an opportunity to apply their theoretical knowledge, develop core clinical principals and prepare for professional responsibilities of the future. Attendance during these rotations correlates with academic performance, patient safety and readiness for medical practice (Bamuhair et al., 2016). This cross-sectional study involving 270 students, highlights an alarming pattern of absenteeism with attendance rates of only 29%, 40% and 36% among third-year, fourth year and final year students, respectively. A trend like this, if unaddressed can have a negative impact on the competencies of medical graduates.

One of the most frequently cited reasons for absenteeism in this study was discontentment with faculty behaviour and teaching methods. Students frequently referred to inadequate communication, absence of constructive feedback, lack of interest in teaching, and instances of unprofessional conduct as major drivers of their disengagement. These findings are in line with those of Bahadori et al. (2021), who outlined that unprofessional conduct and poor interaction between student and faculty served as key reasons for absenteeism during clinical rotations. Similarly, Desalegn et al. (2014), reported that faculty performance and student discipline were significant determinants of attendance habits.

A lack of faculty engagement not only discourages student participation but also contributes to a disconnection between theoretical instruction and its clinical application, thereby reinforcing surface learning strategies such as rote memorisation. This perception is reinforced by Nevins et al. (2016) who observed substantial improvement in attendance when sessions were made more clinically relevant in a medical school based in the United Kingdom (UK). Hence, these findings highlight the pivotal role of faculty in moulding students’ motivation and engagement with clinical training.

An inflexible and poorly structured curriculum appears to be a significant deterrent to clinical attendance. The participants of this study lay emphasis on the burden of excessive academic workload, especially during non-exam-specific rotations, which were often perceived as less valuable. These concerns align with findings by Hafeez et al. (2014) and Massingham and Herrington (2006), who reported that students are likely to prioritise independent study over attendance when clinical rotations are not directly assessed. Similarly, a Nigerian study by Olorunfemi et al. (2021) found that the absence of structured feedback and ineffective curriculum delivery led to a drop in engagement with clinical training.

Interestingly, Simcock et al. (2017) found that while students increasingly used recorded lectures for exam preparations, those who attended live, interactive sessions showed better academic performance. These findings underscore the importance of in-person, interactive learning experiences despite the growing availability of digital alternatives.

A range of personal factors emerged as contributors to absenteeism. These included mental health concerns, such as anxiety and stress, physical illness and family responsibilities. The findings of this study are consistent with Massingham and Herrington (2006), who noted that student well-being has a significant impact on attendance. Although the cross-sectional nature of the current study captures these concerns at a particular point in time, longitudinal research may offer deeper insights into health-related absenteeism. The concept of “sickness presenteeism” is of particular relevance here, whereby students continue to attend lectures despite illness due to fears of academic disadvantage. This phenomenon, discussed by Desalegn et al. (2014), highlights the importance of ensuring adequate access to healthcare and mental health support within educational institutions.

Family responsibilities, especially among students from joint families or low socio-economic backgrounds, were also found to negatively affect attendance. Furthermore, peer influence was recognised as a notable social factor; numerous students admitted to missing non-examination-based sessions due to collective absenteeism within their peer group. This observation aligns with the findings of Khatoon et al. (2024) who observed that peer pressure played a major role in determining attendance trajectories. Notably, although Stenberg and Carlson, (2015) in a Swedish cohort, found that peer learning enhanced confidence and clinical competence, they also noted the presence of competitive stress. These findings suggest that peer dynamics can contribute as both motivating or inhibiting factor in clinical attendance, depending on the nature of the interactions.

Students displayed markedly higher attendance during exam-specific rotations, primarily driven by examination pressure and mandatory completion requirements. While this behaviour is understandable, it undermines the broader educational aims of clinical training, which extend beyond exam preparation. The perception that certain rotations are less valuable unless directly linked to assessments reflects a strategic learning approach, whereby students prioritise immediate academic performance over long-term skill development. This trend, which was also observed by Hafeez et al. (2014), appears to be a response to cope with the extensive academic workload faced by medical students.

Such findings suggest that the current structure of clinical education may inadvertently reinforce surface learning behaviours. The tendency to devalue non-exam-specific rotations indicates a misalignment between students’ learning priorities and the intended outcomes of clinical education. It is crucial to address this disconnect by devising curricular strategies that foster intrinsic motivation and emphasise the enduring clinical relevance of all rotations.

From a global perspective, patterns of absenteeism appear to be context-dependent, shaped by institutional culture and pedagogical frameworks. For example, Simcock et al. (2017), in a study conducted across Australia and New Zealand, highlighted the limitations of recorded lectures, noting that their substitution for live teaching sessions negatively impacted student engagement. In contrast, Stenberg and Carlson, (2015) demonstrated that peer-led teaching models positively influenced student participation in clinical settings.

On the contrary, Marburger (2006) presented evidence that traditional, structured, lecture-based teaching methods were associated with improved academic performance in certain settings. This divergence underscores the importance of accounting for local educational cultures, student learning preferences, and institutional dynamics when developing interventions aimed at improving attendance.

Although the present study did not identify significant differences in attendance rates between male and female students, certain gender-based academic disparities were observed. Hakami (2021) reported that increased absenteeism was more strongly associated with academic decline among male students compared to their female counterparts. This disparity may reflect variations in learning styles, coping strategies, or resilience across genders, suggesting that male and female students may respond differently to academic pressures and absenteeism. These findings point to the potential value of adopting a more nuanced, gender-informed perspective when analysing academic outcomes in relation to attendance behaviour.

Despite numerous studies addressing absenteeism in medical education, there remains a notable lack of focus on attendance during clinical rotations, particularly within South Asian institutions (Bahadori et al. 2021; Hafeez et al. 2014). Much of the existing research is centred on preclinical or lecture-based settings, which do not fully capture the distinct challenges faced by students in clinical environments. By focusing on clinical rotations within this regional context, the present study helps to fill this gap and offers insights that are underrepresented in current literature. However, given the complexity of factors influencing attendance and their evolution over time, further longitudinal and multi-institutional research is warranted to better understand these dynamics and inform targeted interventions.

However, this study is not without limitations. As it is a cross-sectional study, it only captures student behaviour at single point in time, thereby limiting its ability to shed light on evolving patterns or long term trends in clinical attendance. The use of self-reported data introduces the possibility of response bias. Moreover, the study was conducted within a single institution, which may restrict the generalisability of the findings to other medical colleges with differing academic cultures, policies, or student demographics. The absence of qualitative interviews or focus groups also constrained a deeper exploration of underlying motivations and interpersonal dynamics influencing absenteeism. Future research could benefit from adopting a longitudinal, multi-centre design incorporating both quantitative and qualitative methodologies for better understanding.

V. CONCLUSION

This study highlights a multifaceted set of factors contributing to absenteeism among medical students during clinical rotations, including dissatisfaction with faculty engagement, inflexible curricular structures, mental health challenges, peer influence, and the strategic devaluation of non-exam-specific sessions. These findings point towards systemic and cultural gaps in clinical education that may compromise the quality of learning and long-term professional development.

In light of these findings, several policy-level interventions are recommended. Medical institutions should ensure that all clinical rotations—regardless of examination linkage—are regarded as essential and are integrated into structured assessment frameworks. Attendance policies should be applied uniformly and accompanied by transparent accountability mechanisms. Faculty development programmes must be prioritised, with particular emphasis on improving communication skills, delivering constructive feedback, and maintaining professional conduct. These efforts could help restore trust and motivation among students while strengthening the link between theoretical knowledge and clinical practice.
In addition, educational institutions should provide accessible mental health services to support students coping with stress, anxiety, and illness, thereby reducing both absenteeism and the phenomenon of sickness presenteeism. Awareness sessions on peer influence and group dynamics could transform peer pressure from a deterrent into a positive, motivating force. Lastly, curricular reforms that balance academic workload and reinforce the clinical relevance of all rotations are essential to promote consistent student engagement and long-term competence.

Notes on Contributors

Maheen Zulfiqar led the conceptualisation of the study and was responsible for drafting the original manuscript. She also played a key role in reviewing and editing the final version.

Muhammad Khalilur Rahman contributed to both the conceptual development and project administration, ensuring coordination across the team. He was also actively involved in reviewing and refining the manuscript.

Behram Khayyam handled the methodological design, formal analysis, and validation of results. He also participated in the review and editing process, enhancing the technical rigour of the study.

Ayesha Mazhar Khan supported the methodological and validation efforts, contributing to data analysis and manuscript revisions.

Naeem Sarwar oversaw project administration and contributed to the manuscript’s review and editing, ensuring smooth project execution.

Ashbil Malik was responsible for data curation and participated in the review process, offering insights based on her data expertise.

Hassan Saleem co-managed data curation with Ashbil Malik and assisted in reviewing and editing the manuscript for data-related accuracy.

Ethical Approval

This cross-sectional study was conducted after taking approval from the Institutional Review Board (RLMC/IRB/2024/153). IRB approval letter has been provided in the attached documents.

Data Availability

Our dataset is publicly accessible through the referenced repository and is available under the CC BY 4.0 license, ensuring open usage and attribution (https://doi.org/10.6084/m9.figshare.28602041.v1).

Funding

The authors declare that no financial support or funding was received from any organisation or institution for the research, authorship, or publication of this article.

Declaration of Interest

No potential conflict of interest relevant to this article was reported.

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*Ayesha Mazhar Khan
Department of Surgery,
Arif Memorial Teaching Hospital/Rashid Latif Medical College,
Lahore, Pakistan
+92 3009494461
Email: ayeshamazharkhan.amk@gmail.com