Effects of voluntary attendance patterns on first-year medical students' wellness and academic performance during COVID-19.

There is increasing evidence that attendance is not a reliable predictor of academic performance, which invites the question of whether attendance may have alternative positive effects such as increased student wellness. While conducting an observational cohort study on the relationship of attendance to performance and wellness, the COVID-19 pandemic lockdown changed the ability of students to attend class. Matriculating medical students were recruited to participate at the beginning of their first year in August 2019. In-person attendance was collected prospectively until the lockdown began in March 2020. This was then correlated with performance on course final examinations and responses to two separate incidences of a survey on stress, burnout, social isolation, and loneliness. The first survey was deployed January through February 2020 (pre-COVID) and the second June 2020 (during COVID lockdown). Attendance declined across the year (76.0%-25.0%). There was a small positive correlation of attendance to performance in module 1 (r = 0.235, P = 0.035) with none in the remaining two modules (P = 0.870, P = 0.410). The high attenders at the time of the lockdown had no decline in their performance when attendance was no longer possible. Attendance negatively correlated with stress and loneliness but not with the remainder of the wellness metrics. There was no significant change in any of the wellness metrics between the pre-COVID and during COVID time points. While the data support the conclusion that attendance is not required to maintain performance in this population, these data suggest a small protective effect against stress and loneliness.