Purpose
Medical students are often given the option to disengage from passive learning sessions such as attending a lecture or watching pre-recorded educational content. This decision is based on the lower retention rate of material delivered by passive educational methods. The goal of this study was to track engagement of high and low-performing students during the pre-clinical curriculum and determine if student engagement was associated with performance in either group.

Methods
Participation in an optional, weekly formative TopHat quiz was used as a proxy to measure the behavioral dimension of student engagement.

Results
Both high and low-performing students disengaged over time, although low-performing students disengaged at a higher rate. Engagement was often associated with higher academic performance, although this effect was largely driven by disengagement of low-performing students. High-performing students received some benefit from engagement.

Conclusions
These data suggest that strategies to increase engagement may not positively impact the student population with the most need.