IMPORTANCE Student attendance is thought to be an important factor in the academic performance of medical students, in addition to having important regulatory, policy, and financial implications for medical educators. However, this relationship has not been well evaluated within clinical learning environments.OBJECTIVE To evaluate the relationship between student attendance and academic performance in a medical student obstetrics/gynecology clinical rotation. DESIGN, SETTING, AND PARTICIPANTSA prospective cohort study of student attendance at clinical and tutorial-based activities during a full academic year (September 2011 to June 2012) within a publicly funded university teaching hospital in Dublin, Ireland. Students were expected to attend 64 activities (26 clinical activities and 38 tutorial-based activities) but attendance was not mandatory. All 147 fourth-year medical students who completed an 8-week obstetrics/gynecology rotation were included.EXPOSURES Student attendance at clinical and tutorial-based activities, recorded using a paper-based logbook. MAIN OUTCOMES AND MEASURESThe overall examination score (out of a possible 200 points) was obtained using an 11-station objective structured clinical examination (40 points), an end-of-year written examination comprising 50 multiple-choice questions (40 points) and 6 short-answer questions (40 points), and an end-of-year long-case clinical/oral examination (80 points). Students were required to have an overall score of 100 points (50%) and a minimum of 40 points in the long-case clinical/oral examination (50%) to pass. RESULTSThe mean attendance rate was 89% (range, 39%-100% [SD, 11%], n = 57/64 activities). Male students (84% attendance, P = .001) and students who failed an end-of-year examination previously (84% attendance, P = .04) had significantly lower rates. There was a positive correlation between attendance and overall examination score (r = 0.59 [95% CI, 0.44-0.70]; P < .001). Both clinical attendance (r = 0.50 [95% CI, 0.32-0.64]; P < .001) and tutorial-based attendance (r = 0.57 [95% CI, 0.40-0.70]; P < .001) were positively correlated with overall examination score. The associations persisted after controlling for confounding factors of student sex, age, country of origin, previous failure in an end-of-year examination, and the timing of the rotation during the academic year. Distinction grades (overall score of Ն60%) were present only among students with attendance rates of 80% or higher. The odds of a distinction grade increased with each 10% increase in attendance (adjusted odds ratio, 5.52; 95% CI, 2.17-14.00). The majority of failure grades (6/10 students; 60%) occurred in students with attendance rates lower than 80%. The adjusted odds ratio for failure with attendance rates of 80% or higher was 0.11 (95% CI, 0.02-0.72).CONCLUSIONS AND RELEVANCE Among fourth-year medical students completing an 8-week obstetrics/gynecology clinical rotation, attendance at clinical and tutorial-based activities was positively correlated with overall examinati...

There has been limited research addressing whether behavioural change in relation to smoking is maintained throughout pregnancy and the effect on perinatal outcomes. A cohort study addressed lifestyle behaviours of 907 women who booked for antenatal care and delivered in a large urban teaching hospital in 2010–2011. Adverse perinatal outcomes were compared for “non-smokers”, “ex-smokers” and “current smokers”. Of the 907 women, 270 (30%) reported smoking in the six months prior to pregnancy, and of those 160 (59%) had stopped smoking and 110 (41%) continued to smoke at the time of the first antenatal visit. There was virtually no change in smoking behaviour between the first antenatal visit and the third trimester of pregnancy. Factors associated with continuing to smoke included unplanned pregnancy (OR 1.9; 95% CI 1.3, 2.9), alcohol use (OR 3.4; 95% CI 2.1, 6.0) and previous illicit drug use (OR 3.6; 95% CI 2.1, 6.0). Ex-smokers had similar perinatal outcomes to non-smokers. Current smoking was associated with an average reduction in birth weight of 191g (95% CI −294, −88) and an increased incidence of intrauterine growth restriction (24% versus 13%, adjusted OR 1.39 (95% CI 1.06, 1.84). Public Health campaigns emphasise the health benefits of quitting smoking in pregnancy. The greatest success appears to be pre-pregnancy and during the first trimester where women are largely self-motivated to quit.

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