This study shows the significant absence of students from lectures and the numerous shortcomings they perceive in these lectures. The significant decrease in attendance observed throughout the semester highlights a concerning trend in medical education. Our data indicate that absenteeism is perceived as a significant issue by most faculty members. Faculty perspectives on medical student absenteeism have been primarily explored in a few key studies, not as much as students’ perceptions. Professors generally perceive student absenteeism as a significant problem and a challenge in curriculum delivery within education globally.

Our data extracted from the teacher survey results align significantly with the prevailing discourse in existing literature regarding teacher perceptions of student absenteeism. This convergence underscores the consistency and general patterns observed within medical education.

The interpretation of absenteeism in medical education is multifaceted, not reducible to a single cause. Instead, it appears to be a symptom of a complex interplay between institutional pedagogical shortcomings and a discernible shift in student values toward more self-directed learning. On one hand, our findings, consistent with prior literature [1], reveal that perceived deficiencies in teaching quality are a salient contributor to student absenteeism. The prevalence of non-interactive and monotonous teaching styles, coupled with student perceptions regarding excessive content, lack of faculty motivational strategies, poor coordination across courses, and ineffective teaching methods—such as merely dictating notes [12,13,14]—points directly to the need for pedagogical reform and a reevaluation of current teaching practices [12, 15]. Institutions should invest in training faculty with the tools and strategies necessary to foster active learning. Providing faculty with training in student-centered pedagogical approaches can enhance the quality of instruction and increase student engagement [16].

On the other hand, absenteeism can also be interpreted as a reflection of evolving student learning preferences. The availability of recorded lectures and extensive online resources has contributed to a shift in how students choose to learn. Many perceive that academic success is attainable even without regular in-person attendance, opting for self-directed and collaborative learning methodologies that they consider more effective or better suited to their lifestyles. This perspective, in line with Self-Determination Theory (SDT), suggests that when the learning environment does not support autonomy and competence, students may seek alternatives that provide them with greater control over their formative process, manifesting as reduced class attendance. This dichotomy in the causes of absenteeism leads us to explore the inherent tension between mandatory attendance policies and the promotion of student autonomy, a debate of considerable relevance in contemporary medical education.

While many medical institutions implement strict attendance policies [17,18,19], arguing their essentiality for the acquisition of knowledge and the development of non-cognitive skills such as professionalism, communication, and teamwork, rigid enforcement of attendance might be counterproductive if not accompanied by a clear value proposition from the lectures. From the perspective of Self-Determination Theory (SDT), a learning environment perceived as overly controlling or disengaging may undermine intrinsic motivation, leading to disaffection and, ultimately, absenteeism [20]. Students, in their pursuit of satisfying their needs for autonomy and competence, may devalue traditional lectures if they do not perceive significant added value that justifies in-person presence beyond mere content acquisition. Therefore, instead of coercion [21], there is a need to foster a culture of engagement and continuous assessment that encourages active participation, peer-to-peer and faculty-student interaction, and the application of knowledge in real contexts. Restructuring class formats to incorporate interactive elements and practical applications could be key to reconciling the need for presence with student autonomy, making attendance a choice driven by perceived value rather than a mere obligation.

The development of non-cognitive skills, such as professionalism, empathy, and the ability to work in teams, is fundamental for effective and patient-centered healthcare practice. The arguments for and against mandatory attendance often overlook the value gained from being in the classroom itself, focusing primarily on academic performance. Therefore, class attendance and active participation in classroom activities can significantly contribute to the comprehensive training of future medical professionals, beyond the mere acquisition of theoretical knowledge [12].

The analysis of student perspectives reveals a complex interplay of factors contributing to absenteeism within medical education. The perception that academic success is attainable independent of regular attendance, coupled with the accessibility of digital resources, raises pertinent questions regarding the perceived value of in-person instruction [12, 15, 16]. Although we did not conduct statistical tests to compare attendance across academic years, the descriptive data collected during the two assessment points revealed notable differences. Specifically, first-year students exhibited the highest attendance rates, while fifth-year students showed the lowest. These patterns suggest a potential trend of decreasing attendance as students advance through the program, which may reflect evolving attitudes toward lecture-based learning or increased reliance on alternative study methods. Academic factors emerge as significant contributors to student disengagement. The monotony of lectures, perceived deficiencies in teaching quality, and inconvenient scheduling are consistently cited as substantial barriers. Furthermore, personal challenges, including fatigue, examination-related stress, and health concerns, are compounded by logistical obstacles such as transportation issues and inadequate study facilities. Student recommendations underscore a desire for enhanced interactivity, flexibility, and communication. The preference for smaller group sessions and dynamic learning methodologies highlights the need for a paradigm shift in educational delivery. The expressed need for improved faculty communication emphasizes the importance of cultivating supportive and robust student-faculty relationships. Collectively, these findings underscore the necessity for medical education institutions to reassess their teaching strategies and student support systems. It is imperative to cultivate a learning environment that is engaging, flexible, and responsive to student needs. This entails not only the adoption of innovative methodologies but also a concerted effort to address the personal and logistical factors that impact student attendance and well-being.

A significant limitation of this study lies in the fact that most of the opinions collected are from students who were present in class on the day attendance was recorded and the survey was distributed. Consequently, it is highly probable that we missed valuable insights from those students who rarely attend class, who are arguably the most interesting and relevant group in the context of chronic absenteeism. This potential underrepresentation is inferred by observing that, while 71.5% of responding students reported attending class more than 80% of the time, only 16.2% believed their peers attended more than 80% of the time. This discrepancy underscores the possible gap between self-reported attendance and the widespread perception of the problem.

Although conscious efforts were made to mitigate this bias, such as circulating the survey through the student delegation with the aim of capturing impressions from those not present in the classroom on the day of the measurement, the possibility remains that habitually absent students were not reached, and thus, their experiences and reasons for non-attendance remain underrepresented in the findings. The impact of this bias could mean that the causes of absenteeism identified in this study are more representative of students with moderate absenteeism, while the underlying factors for severe or chronic absenteeism might differ substantially (for example, related to more complex personal issues or deeper academic disengagement). Future research should consider specific methodological strategies, such as focused qualitative interviews or more intensive longitudinal tracking, to capture the perspectives of students who frequently miss class, which is critical for obtaining a comprehensive and representative understanding of the issue.