Purpose
Student attendance in our school has declined following the transition to a pass/fail curriculum and Step 1 changes. Course evaluations indicate that students find mandatory classes burdensome when similar content is accessible through outside resources. In response, we implemented strategies to promote engagement, making small group active learning (AL) sessions mandatory while keeping lectures and large group discussions with an AL component optional. To incentivize attendance at AL, students received 1 point for attending at least 60% of these sessions. This study aimed to examine the relationship between attendance and student performance.

Methods
Attendance at AL in 6 units was tracked via sign-in sheets. At the course's conclusion, student performance was assessed through an NBME exam and an open-ended Diagnostic Reasoning (DxR) Exam. Pearson correlations and linear regression analyses were used to evaluate the strength and nature of these associations. Additionally, an anonymous voluntary survey explored students' reasons for attending and their perceptions of how attendance impacted performance.

Results
Only 66 students responded to the survey. The most common reasons why students chose to attend a session were the quality of the session and the topic (high yield material). The most cited reasons for not attending were the high workload, the pace of the session and the ability to review the recording later. Despite 62% of students stating that attending sessions did not affect performance in the course, we observed that attending AL had a positive correlation with various NBME, DxR and final grades (n=121, Pearson range, 0.18-0.69; p <0.05) for courses with more than 5 AL sessions.

Conclusion
Overall, students who attended more sessions were more likely to achieve a higher score and performed better in the course.