Home⇛Health Sciences Journal⇛vol. 15 no. 1 (2026)

Demographic and Academic Characteristics of First-Year Medical Students with Low Academic Performance Across Face-to-Face, Online, and HyFlex Learning: A Seven-Year Single-Center Study

Maria Milagros U. Magat | Jennifer M. Nailes | Vinna Marie Quinones

Discipline: medicine by specialism

 

Abstract:

Introduction Medical student attrition and poor academic performance have implications for both medical schools and the future healthcare workforce. This study aimed to determine the demographic and academic characteristics of first-year medical students with low academic performance across different instructional modalities—traditional face-to-face, online, and HyFlex learning. Methods This non-concurrent cohort study included first-year medical students enrolled from School Years (SY) 2018–2019 to 2024–2025. Student characteristics analyzed included sex, pre-medicine degree, pre-medicine general weighted average (GWA), National Medical Admission Test (NMAT) score, and academic performance in annual first-year subjects. Low academic performance was defined as failure in at least one annual subject. Students were grouped according to instructional modality: faceto-face (SY 2018–2020), online (SY 2020–2022), and HyFlex (SY 2022–2025). Demographic and academic characteristics were compared between students with and without low academic performance. Results A total of 2,936 first-year medical students were included. The proportion of students with low academic performance was 19% during the face-to-face period, 17% during the online period, and 27% during the HyFlex period. Across all instructional modalities, students with low academic performance had significantly poorer pre-medicine GWA than students who passed all annual subjects (p<0.05). During the online and HyFlex periods, students with low academic performance also had significantly lower NMAT scores than students who passed all annual subjects (p<0.05), whereas no significant difference in NMAT scores was observed during the face-to-face period. Conclusion Pre-medicine GWA was consistently associated with academic performance across face-toface, online, and HyFlex instructional modalities. Lower NMAT scores were associated with low academic performance during online and HyFlex learning. Early identification of students with poorer pre-medicine academic performance and lower NMAT scores may facilitate timely academic support.



References:

  1. Stoehr F, Müller L, Brady A, et al. How COVID-19 kick-started online learning in medical education: the DigiMed study. PLoS One 2021;16. doi:10.1371/journal.pone.0257394.
  2. Milone AS, Cortese AM, Balestrieri RL, Pittenger AL. The impact of proctored online exams on the educational experience. Curr Pharm Teach Learn 2017;9(1):108-14. doi:10.1016/j.cptl.2016.08.037.
  3. Comas-Forgas R, Lancaster T, Calvo-Sastre A, Sureda- Negre J. Exam cheating and academic integrity breaches during the COVID-19 pandemic: an analysis of internet search activity in Spain. Heliyon 2021;7(10). doi:10.1016/j.heliyon.2021.e08233.
  4. Al-Maskari A, Al-Riyami T, Kunjumuhammed SK. Students’ academic and social concerns during COVID-19 pandemic. Educ Inf Technol (Dordr) 2022;27(1):1-21. doi:10.1007/s10639-021-10592-2.
  5. Khan AM, Patra S, Gupta P, Sharma AK, Jain AK. Rapid transition to online teaching program during COVID-19 lockdown: experience from a medical college of India. J Educ Health Promot 2021;10:99. doi:10.4103/jehp.jehp_606_20.
  6. Akram H, Yingxiu Y, Al-Adwan AS, Alkhalifah A. Technology integration in higher education during COVID-19: an assessment of online teaching competencies through the technological pedagogical content knowledge model. Front Psychol 2021;12:736522. doi:10.3389/fpsyg.2021.736522.
  7. Albalushi H, Al Mushaiqri M, Sirasanagandla SR, Das S. Students’ performance in face-to-face, online, and hybrid methods of teaching and assessment in anatomy. Int J Environ Res Public Health 2022;19(20):13318. doi:10.3390/ijerph192013318.
  8. Memon I, Feroz Z, Alkushi A, Qamar N, Ismail F. Switching from face-to-face to an online teaching strategy: how anatomy and physiology teaching transformed post- COVID-19 for a university preprofessional program. Adv Physiol Educ 2021;45(3):481-5. doi:10.1152/advan.00233.2020.
  9. Liu X, Lu C, Zhu H, Wang X, Jia S, Zhang Y, et al. Assessment of the effectiveness of a BOPPPS-based hybrid teaching model in physiology education. BMC Med Educ 2022;22:217. doi:10.1186/s12909-022-03259-0.
  10. Guo J, Li L, Bu H, Feng M, Yang Y, Zhang Y, et al. Effect of hybrid teaching incorporating problem-based learning on student performance in pathophysiology. J I n t M e d Re s 2 0 2 0 ; 4 8 ( 9 ) : 3 0 0 0 6 0 5 2 0 9 4 9 4 0 2 . doi:10.1177/0300060520949402.
  11. David CC, Ducanes G, Bacigalupo JLV, Tengco SM, Yee KM. Eliminating the deficit in medical doctors: strategies and costs [Internet]. Quezon City (PH): University of the Philippines Center for Integrative and Development Studies, Program on Higher Education Research and Policy Reform; 2019 [cited 2025 Jun 17]. (UP CIDS Discussion Paper Series No. 2019-02). Available from: https://cids.up.edu.ph/download/up-cids-discussion-paper-series-2019-02-eliminating-the-deficit-in-medical-doctors-strategies-and-costs/
  12. Holder KAN, Pallath V, Vadivelu J, et al. Using document phenomenology to investigate academic failure among Year 1 undergraduate Malaysian medical students. BMC Med Educ 2023;23:310. doi:10.1186/s12909-023-04285-2.
  13. Wilkinson D, Zhang J, Byrne GJ, Luke H, Ozolins IZ, Parker MH, et al. Medical school selection criteria and the prediction of academic performance. Med J Aust 2008;188(6):349-54. doi:10.5694/j.1326-5377.2008.tb01653.x.
  14. Rashid A, Yasmeen R, Ahmed R, Jawed K. Factors leading to the academic failure of undergraduate medical students: predict early to prevent. Pak J Med Sci 2022;38(8):2071-5. doi:10.12669/pjms.38.8.5951.
  15. Aston-Mourney K, McLeod J, Rivera LR, et al. Prior degree and academic performance in medical school: evidence for prioritising health students and moving away from a biomedical science-focused entry stream. BMC Med Educ 2022;22:700. doi:10.1186/s12909-022-03768-y.
  16. Pinyopornpanish M, Sribanditmongkok P, Boonyanaruthee V, Chan-ob T, Maneetorn N, Uuphanthsath R. Factors affecting low academic achievement of medical students in the Faculty of Medicine, Chiang Mai University. Chiang Mai Med Bull 2004;43:15-23.
  17. Merchant AAH, Afzal N, Rahim KA, Shah SA, Jamal WZ, Rahim A, et al. Application to achievement: association between pre-admission factors, admission scores, and medical students’ performance. BMC Med Educ 2025;25(1):223. doi:10.1186/s12909-025-06800-z.
  18. Dabaliz AA, Kaadan S, Dabbagh MM, Barakat A, Shareef MA, Al-Tannir M, et al. Predictive validity of pre- admission assessments on medical student performance. Int J Med Educ 2017;8:408-13.
  19. Puddey IB, Mercer A. Predicting academic outcomes in an Australian graduate entry medical programme. BMC Med Educ 2014;14:31. doi:10.1186/1472-6920-14-31.
  20. Simpson PL, Scicluna HA, Jones PD, Cole AMD, O’Sullivan AJ, Harris PG, Velan GM, McNeil HP. Predictive validity of a new integrated selection process for medical school admission. BMC Med Educ 2014;14:86. doi:10.1186/1472-6920-14-86.
  21. Mercer A, Puddey IB. Admission selection criteria as predictors of outcomes in an undergraduate medical course: a prospective study. Med Teach 2011;33(12):997-1004. doi:10.3109/0142159X.2011.577123.
  22. Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Washington (DC): National Academies Press; 2000.
  23. Topping KJ. The effectiveness of peer tutoring in further and higher education: a typology and review of the literature. High Educ 1996;32:321-45.
  24. Avonts M, Bombeke K, Michels NR, et al. How can peer teaching influence the development of medical students? A descriptive, longitudinal interview study. BMC Med Educ 2023;23:861. doi:10.1186/s12909-023-04801-4.
  25. Tanveer MA, Mildestvedt T, Skjærseth IG, Arntzen HH, Kenne E, Bonnevier A, et al. Peer teaching in undergraduate medical education: what are the learning outputs for the student-teachers? A systematic review. Adv Med Educ Pract 2023;14:723-39.
  26. McNally G, Haque E, Sharp S, Thampy H. Teaching empathy to medical students. Clin Teach 2023;20(1). doi:10.1111/tct.13557.

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