Chronotypic characteristics, academic achievement, and absenteeism attitudes among preclinical medical students: a cross-sectional study

This study examined associations among chronotype, academic performance, and attendance-related attitudes among third-year medical students in the preclinical period. In this cross-sectional study, all 376 third-year medical students at Erciyes University Faculty of Medicine were invited to participate. Of these, 341 completed the face-to-face questionnaire (90.7% participation), and 319 were included in the final analyses. The questionnaire included self-reported academic performance and attendance-related information, the Morningness–Eveningness Questionnaire (MEQ), and the Absenteeism Attitude Scale. Chronotype was analyzed in three categories (evening, intermediate, and morning), and the MEQ total score was also examined as a continuous variable. Group comparisons, correlation analyses, and path analysis within a structural equation modeling framework were performed. Intermediate chronotype was most common (72.1%), followed by evening (17.9%) and morning (10.0%) types. Grade point average (GPA) did not differ across chronotype groups (Kruskal–Wallis H(2) = 1.750, p = .417, ε² < 0.001), and neither did final committee examination scores (H(2) = 0.078, p = .962, ε² < 0.001). The MEQ total score was not significantly associated with GPA (ρ = 0.103, p = .066) but showed a weak positive association with the Absenteeism Attitude Scale score (ρ = 0.152, p = .006). Absenteeism Attitude Scale scores differed across chronotype groups (F(2,316) = 6.997, p = .001, η² = 0.042), with higher scores among intermediate-type than evening-type students. The scale score was weakly but positively associated with GPA (ρ = 0.194, p < .001). In the path model, chronotype showed no statistically significant direct association with GPA (β = 0.062, p = .256). A small total indirect association was statistically supported (β = 0.048), although only the serial specific indirect pathway through absenteeism tendency and absenteeism attitude was supported (β = 0.007). No statistically significant differences in GPA or final committee examination scores were observed across chronotype groups. Attendance-related attitudes showed more consistent associations with GPA. Given the cross-sectional design, the indirect associations identified in the path model should not be interpreted as evidence of causal mediation.