Policy and preference: the intersection of attendance hurdles and student perceptions of practical classes

Practical classes and skills labs, where students learn, practice, and demonstrate key professional and technical skills, are essential in health professional education. As such, attendance at practical classes has historically been mandated and, in some cases, an "attendance hurdle" (i.e., mandatory minimum attendance requirement that students must meet to pass the course) is applied to subjects where practical classes are a core part of the curriculum. We aimed to explore students' attitudes, beliefs and experiences of attendance hurdles for practical classes. We surveyed students from entry-to-practice programs in Medicine, Dentistry, Oral Health, Optometry, Physiotherapy, Social Work, Nursing, and Speech Pathology who were currently or previously enrolled in a subject/s with attendance hurdles for practical classes. In a single online survey, students answered multiple-choice, ranking, and Likert questions about their attitudes, beliefs, and experiences of attendance hurdles for practical classes. Data were analysed descriptively and with Pearson chi-squared test of association. Sixty-three percent (n=362) of 575 students who completed the survey wanted to maintain attendance hurdles. In contrast, almost 80% of students stated they would attend 80% or more of classes without attendance hurdles. Many students believed that attendance hurdles could adversely affect some individuals (e.g., due to personal circumstances and sociodemographics), and half believed as adult learners, they should decide whether to attend practical classes. Students valued the in-class tutor feedback and application to clinical practice that practical classes offered. Students suggested that greater flexibility in the timing of practical classes would be more likely than hurdles to improve attendance. The advantages of participating in practical classes to develop essential clinical skills are evident to students, and likely motivate them to attend most scheduled classes. Numerous factors can lead to student absences, and mandating attendance may disadvantage some students. Alternatives to attendance policies could include offering scheduling flexibility and student sign-up, accommodating students' personal and health needs, and aligning classes to student values.