Our study showed significant difference in total questionnaire score between students with excellence degree and their peers with other less academic degrees. There was positive correlation between health, time management, attitude, Use of resources, Comprehension and Exam preparation sections and academic achievement. Attitude of high achiever made the greatest difference in score between groups. Stress failed to be a significant difference factor between gender, school grades except in few aspects which will be discussed later. Gender and school grade played as important factors in changing the attitude of students. Although there wasn't an overall significant difference in stress score between fresh students and older ones, they responded differently to questions discussing medical training, competition in medical school and financial issues. Sleep is important for memory consolidation (helps us to remember) which is necessary for academic performance and better sleep is associated with many cognitive functions, including better learning and memory(Okano et al. 2019). Medical students are at risk for sleep-related problems which were found to be associated with high levels of stress(Alsaggaf et al. 2016). In our study below half of medical student can sleep 7-8 hours on regular bases and regardless of their academic performance, they find it is difficult to sleep before the exam. This situation doesn't differ between grades. when it comes to preparing for exams a study revealed that, students with low GPA sleep more during exams period compared to only 5.52% of students with high GPA (p=0.002)(Shawwa et al. 2015). A study investigated the association between sleep pattern and academic performance, revealed that the average total sleep hours per night was 5.8 ± 2, but students with excellent academic performance had a significantly earlier rise time during the week than students with good or below academic performance(Alsaggaf et al. 2016). Time management is considered a strong factor affecting students GPA. Weak time management skill was reported in 47% of medical students, resulting in weak academic performance(Bickerdike et al. 2016). Our study found that males, in most of the times, when they decided to study, they did start and keep going. Males reported that they had enough time in their week to study while majority of female didn’t and this difference was statistically significant. Social media have a bad effect on study performance(Shawwa et al. 2015). In our study, most of medical students failed control their online time. There is no difference between students with high GPA and low GPA regarding spending time on extracurricular activities and attending medical conferences or other forms of responsibility including spending time performing house chores or their hobbies(Shawwa et al. 2015). In contrast, students in our study reported that medical training controlled their life and left too little time for other activities with a significant difference between younger and older students. It can be explained, despite the extracurricular activities during medical school cannot affect the GPA with proper time management, the huge curriculum and many hours of trainings make them consumed and have no energy for extracurricular activities. Lack of preparation, weaknesses in time management, and deficiency in reading skills have a bad effect on test anxiety and can be reduced by active learning and regular evaluation(Duraku 2017). Test anxiety has a reverse effect on cognitive skills: goal orientation and learning strategies as planning and monitoring which absolutely affects academic performance. The study reported that was no relation between general anxiety and test anxiety(Yusefzadeh, Iranagh and Nabilou 2019). The students who stay in their own comfortable homes have a better academic performance(Okano et al. 2019). On the Same hand, students who visit their families regularly have good academic performance than those who visit their families rarely(Ekwochi et al. 2019). Family education and the presence of physicians in the family have a good effect on medical students' academic performance(ALFAYEZ, STRAND and CARLINE 1990). Family problems, financial responsibility, mode of transportation either public or private, were all not significant and didn't correlate with the performance (p >0.05)(Shawwa et al. 2015). Despite our findings revealed that financial source was a concern for males and females, the difference was also significant regarding your grade at medical school, it is because when you get older you think more about financial issues and independence and as we know in medical schools it takes more time to achieve, so it plays as an extra stress factor. Study Habits such as studying in a quiet place, studying daily, turning off devices such as TV and mobile phones, taking notes, having regular rests and breaks, listening to soft music, studying based on own learning style, and prioritizing the difficult contents, were found to have good and affect academic performance(Jafari, Aghaei and Khatony 2019).Regarding study preference, 79% of excellent grade students prefer to study alone, 62.98% of them in silence, and with no interruptions. On the other hand, lower rank students' study in groups(Shawwa et al. 2015). The number of days students began to study consistently before exams was non-significant in predicting the exam score either close or far tests(Walck-Shannon, Rowell and Frey 2021). Students could review a topic only once before an exam but reviewing it more than once positively affected academic performance, also cheating was not a factor in good academic performance(Shawwa et al. 2015). To achieve a purposeful education, the learning process must be interactive, thus allowing students to relate this knowledge to past experiences and apply it in their daily lives(Cortright et al. 2011). Study aids have an important role in studying because students use them in reviewing and memory aids but the study reported that excellent students who have course text and course notes do not need study aids(Sleight and Mavis 2006). That agreed with our finding that high achiever students reviewed notes shortly after lectures, connected ideas from one lecture to another and summarized texts effectively (not get lost in details).
Table (3): Distribution of studied participants in relation to attitude and academic degree.
Variables
|
Group A
(n=266)
|
Group B
(n=181)
|
Total (n=447)
|
X2
|
p
|
n
|
%
|
n
|
%
|
n
|
%
|
I download and read notes, or read texts before class
|
|
|
|
|
|
|
6.315
|
0.17
|
Never/not often
|
168
|
63.2
|
122
|
67
|
290
|
64.9
|
|
|
sometimes
|
56
|
21.1
|
32
|
18
|
88
|
19.7
|
|
|
Often/always
|
42
|
15.8
|
27
|
15
|
69
|
15.4
|
|
|
I review notes shortly after class.
|
|
|
|
|
|
|
7.729
|
0.10
|
Never/not often
|
131
|
49.2
|
106
|
59
|
237
|
53.0
|
|
|
sometimes
|
66
|
24.8
|
35
|
19
|
101
|
22.6
|
|
|
Often/always
|
69
|
25.9
|
40
|
22
|
109
|
24.4
|
|
|
I make up and answer questions to test myself.
|
|
|
|
|
|
|
8.711
|
0.07
|
Never/not often
|
99
|
37.2
|
78
|
43
|
177
|
39.6
|
|
|
sometimes
|
64
|
24.1
|
37
|
20
|
101
|
22.6
|
|
|
Often/always
|
103
|
38.7
|
66
|
36
|
169
|
37.8
|
|
|
I am able and willing to ask for help when I need it.
|
|
|
|
|
|
|
18.90
|
0.001
|
Never/not often
|
39
|
14.7
|
53
|
29
|
92
|
20.6
|
|
|
sometimes
|
70
|
26.3
|
47
|
26
|
117
|
26.2
|
|
|
Often/always
|
157
|
59.0
|
81
|
45
|
238
|
53.2
|
|
|
I use text, internet, or library resources when needed.
|
|
|
|
|
|
|
17.97
|
0.001
|
Never/not often
|
27
|
10.2
|
42
|
23
|
69
|
15.4
|
|
|
sometimes
|
40
|
15.0
|
26
|
14
|
66
|
14.8
|
|
|
Often/always
|
199
|
74.8
|
113
|
62
|
312
|
69.8
|
|
|
I connect ideas from one lecture to another.
|
|
|
|
|
|
|
15.48
|
0.001
|
Never/not often
|
30
|
11.3
|
40
|
22
|
70
|
15.7
|
|
|
sometimes
|
81
|
30.5
|
65
|
36
|
146
|
32.7
|
|
|
Often/always
|
155
|
58.3
|
76
|
42
|
231
|
51.7
|
|
|
I translate what I’m studying into my own words.
|
|
|
|
|
|
|
3.72
|
0.45
|
Never/not often
|
42
|
15.8
|
40
|
22
|
82
|
18.3
|
|
|
sometimes
|
69
|
25.9
|
44
|
24
|
113
|
25.3
|
|
|
Often/always
|
155
|
58.3
|
97
|
54
|
252
|
56.4
|
|
|
I can summarize texts effectively (not get lost in details).
|
|
|
|
|
|
|
3.01
|
0.56
|
Never/not often
|
78
|
29.3
|
65
|
36
|
143
|
32.0
|
|
|
sometimes
|
79
|
29.7
|
49
|
27
|
128
|
28.6
|
|
|
Often/always
|
109
|
41.0
|
67
|
37
|
176
|
39.4
|
|
|
I am calm enough in an exam that I do my best.
|
|
|
|
|
|
|
14.75
|
0.001
|
Never/not often
|
53
|
19.9
|
47
|
26
|
100
|
22.4
|
|
|
sometimes
|
51
|
19.2
|
55
|
30
|
106
|
23.7
|
|
|
Often/always
|
162
|
60.9
|
79
|
44
|
241
|
53.9
|
|
|
I know what to study for an exam.
|
|
|
|
|
|
|
33.79
|
.001
|
Never/not often
|
49
|
18.4
|
65
|
36
|
114
|
25.5
|
|
|
sometimes
|
62
|
23.3
|
48
|
27
|
110
|
24.6
|
Often/always
|
155
|
58.3
|
68
|
38
|
223
|
49.9
|
27. I answer practice questions to study.
|
|
|
|
|
|
|
30.89
|
.001
|
Never/not often
|
40
|
15.0
|
63
|
35
|
103
|
23.0
|
|
|
sometimes
|
73
|
27.4
|
43
|
24
|
116
|
26.0
|
Often/always
|
153
|
57.5
|
75
|
41
|
228
|
51.0
|
I answer the exam questions I know best, first.
|
|
|
|
|
|
|
7.67
|
0.10
|
Never/not often
|
37
|
13.9
|
42
|
23
|
79
|
17.7
|
|
|
sometimes
|
51
|
19.2
|
32
|
18
|
83
|
18.6
|
|
|
Often/always
|
178
|
66.9
|
107
|
59
|
285
|
63.8
|
|
|
Group A= students with excellence degree; Group B=students with other degree
Interpersonal relations, spiritual growth, and stress management have a positive relation to academic performance. A high level of physical activity has a positive effect on academic performance(Bakouei et al. 2019). Low academic performance is associated with the absence of motivation(Pinyopornpanish et al. 2004). A percentage of 54.7 of the students with high GPA find a solution to difficult topic independently during learning compared to students with low GPA who often try to get help from other students (p=0.012)(Shawwa et al. 2015). Our study reported that students with high academic achievement didn't hesitate to ask for help when they needed but we think it comes after trying to help themselves alone.
The main limitation in our study is the geographical distribution of study including only two universities in upper Egypt. Also this study focused on the students' side with no concern about Education system, teaching style and curriculums which absolutely can affect students' performance. We hope that our study was successfully proved that study habits have a significant effect on academic performance and proved its validity to test different study habits and skills domains. It can be taken as a base for evaluations students after completing their first year in medical school and according to their scores, study skills courses will be provided to improve their academic achievement.