Optometric Education

The Journal of the Association of Schools and Colleges of Optometry

Optometric Education: Volume 41 Number 1 (Fall 2015)


Should We Require Class Attendance?

Aurora Denial, OD, FAAO

Aurora Denial, OD, FAAO

Aurora Denial, OD, FAAO

A few weeks ago, I walked by a large lecture hall and observed approximately 15-20 students in the room. I thought it must have been an elective course that just happened to be scheduled in a lecture hall, but it was actually a core course for second-year students. (Total enrollment in the second-year class is 125 students.) The lecture format represents an efficient way to deliver information, knowledge, concepts and ideas and remains one of the most frequently used methods of delivering optometric education. But discussions with colleagues revealed that absenteeism from lecture is a major concern for educators and administrators. A review of the literature demonstrates that this concern traverses educators in many different healthcare professions. Our concerns may be based on the assumption that poor class attendance will negatively impact academic achievement. However, the evidence linking attendance to academic achievement is inconclusive. McCarey et al. demonstrated that attendance was a significant predictor of performance in nursing students, with absenteeism being associated with poorer grades.1 However, several studies indicate no relationship between attendance and academic performance.2-4

Do Formats Other than Live Lecture Leave Something to be Desired?

Alternative teaching methods, such as video-recorded lectures, webcasts, blogs, etc., have provided students with different ways to obtain lecture content. But, is watching a video recording of a lecture the same learning experience as being present and engaged in class? Are students missing an important component of learning by not attending lectures? When students attend a lecture in person, they have the opportunity to ask questions and clarify concepts to help them apply information to relevant clinical scenarios. There is the potential for an exchange of information between classmates, exposure to new perspectives and learning from each another. This of course is based on the assumption that the classroom time is spent on more than just dispensing facts and information. A good lecture should foster an atmosphere that is conducive to student participation and engagement.

Faculty, too, can benefit from the live lecture format because immediate feedback from students can allow them to assess the effectiveness and understandability of their lectures. Several colleagues have indicated that looking at a student’s confused expression gives them the opportunity to immediately clarify a concept, give an example or change teaching strategies. Consider also that a classroom of students, who are all together in one room learning their chosen profession, may be a very different learning experience than sitting alone at home watching a video. Does a sense of belonging to a profession and collegiality occur when students attend and participate in class? Are we changing the learning environment? Studies have associated student absenteeism with a negative impact in the classroom community by creating a sluggish environment.5-7

I hypothesize that most students would not favor a policy that requires attendance at all classes. They may argue that adult learners should be responsible for deciding how and when to acquire the needed information, that not all classes have equally important content, or that a specific class isn’t given at a time that is conducive to their schedule. Additionally, students may argue that if a class is perceived as valuable, they will attend. This of course is based on the assumption that students are in a position to accurately assess the worth of a course in relationship to their future profession. If my hypothesis is correct, could an attendance requirement negatively impact the admissions process, student retention or participation in future alumni activities?

The Harvard Medical School Approach

It is obvious that being physically present in a classroom does not ever guarantee learning. Therefore, should our expectations for learning include not only being physically present but also cognitively engaged? Engagement refers to the “positive energy invested in one’s own learning, evidenced by meaningful processing, attention to what is happening in the moment and involvement in learning activities.”8 Harvard Medical School requires attendance and active engagement in all components of the curriculum, as stated in the student handbook:9

“Students pursuing the MD degree at Harvard Medical School (HMS) are physicians in training who must meet standards of professional conduct and responsibility to develop into effective physicians. As a professional school, HMS requires attendance and active participation in all components of the curriculum, as defined by course and clerkship directors. Active participation in the School’s course and clerkship activities indicates the student’s understanding and mastery of professional responsibilities. The granting of the MD degree attests to the fact that the student has demonstrated a commitment to his/her professional responsibilities through participation in all aspects of the curriculum as defined by the faculty. … The Pathways MD curriculum is designed to promote active engagement of each student in all components of the curriculum with the following goals for students: to develop a sense of professionalism, to promote collegiality, to engage students in teaching one another, and to give students experience working in teams where different backgrounds and expertise are represented. Meeting these goals requires each student to be present and actively engaged; consequently, attendance is required at all sessions of each course. … Attendance at and participation in learning activities in all four years of the curriculum, whether classroom or clinical, is considered critical for the professional development of the physician. … The integrated curriculum of the Pathways MD program in the foundational preclerkship phase and in the integrated advanced science/clinical courses post-clerkships is designed to promote an engaging, collegial interchange of ideas among students and faculty in all sessions, including large group formats such as lectures. Students are required to attend all sessions and to participate.”

What Message are We Sending Our Students?

With its approach, Harvard is setting a high expectation for its future doctors. It is conveying a message that when students arrive at HMS, they are considered doctors in training who are professionals. As such, they must act in a professional manner, which includes actively engaging in all classes including lecture classes. Additionally, students have a responsibility to their future colleagues and to the faculty to actively participate in all activities including discussions. This message transcends a more superficial learning of content and reflects a deeper understanding of the material along with the development of other elements such as professionalism, collegiality, etc.

What message are we sending our students? I welcome optometric faculty and administrators to share their opinions on this important topic. Should attendance be required?



1. McCarey M, Barr T, Rattray J. Predictors of academic performance in a cohort of pre-registration nursing students. Nurse Educ Today. 2007;27(4):357-64.

2. Hunter S, Tetley J. Lectures. Why don’t students attend? Why do students attend? In proceedings of HERDSA Annual International Conference held in Melbourne, Australia, July 12-15, 1999. Available from http://www.herdsa.org.au/wp-content/uploads/conference/1999/pdf/Hunter.PDF.

3. Rodgers JR. Encouraging tutorial attendance at university did not improve performance. Australian Economic Papers. 2002;41(3):255-266.

4. Grabe M. Voluntary use of online lecture notes: correlates of note use and note use as an alternative to class attendance. Computers and Education. 2005;44(4):409-421.

5. Brauer J. Correspondence : should class attendance be mandatory? Journal of Economic Perspectives. Summer 1994;8(3):205-207.

6. White FC. Enhancing class attendance. NACTA Journal. December 1992;36(4):13-15.

7. Longhurst RJ. Why aren’t they here? Student absenteeism in a further education college. Journal of Further and Higher Education. 1999;23(1):61-80.

8. Schreiner LA, Louis MC. The engaged learning index: implications for faculty development. Journal on Excellence in College Teaching. 2011;22(1):9.

9. Harvard Medical School. Student Handbook. Boston, Mass. 2015. [cited October 15, 2015]. Available from: http://hms.harvard.edu/departments/office-registrar/student-handbook/2-academic-information-and-policies/202attendance.

Dr. Denial, Editor of Optometric Education, is a Professor and Chair of the Department of Primary Care at the New England College of Optometry and a Clinical Instructor at a community health center in Boston.