Advances in Medical Education and Practice

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Facility-Related Factors Affecting Academic

Performance of Medical Students in Human
Anatomy

Shibabaw Tedla Tiruneh, Belta Asnakew Abegaz, Abebe Ayalew Bekel,

Yibeltal Wubale Adamu, Mengistu Desalegn Kiros & Dawit Habte Woldeyes

To cite this article: Shibabaw Tedla Tiruneh, Belta Asnakew Abegaz, Abebe Ayalew Bekel,
Yibeltal Wubale Adamu, Mengistu Desalegn Kiros & Dawit Habte Woldeyes (2020) Facility-
Related Factors Affecting Academic Performance of Medical Students in Human Anatomy,
Advances in Medical Education and Practice, , 729-734, DOI: 10.2147/AMEP.S269804

To link to this article: https://doi.org/10.2147/AMEP.S269804

© 2020 Tiruneh et al.

Published online: 13 Nov 2022.

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ORIGINAL RESEARCH

Facility-Related Factors Affecting Academic

Performance of Medical Students in Human
Anatomy
This article was published in the following Dove Press journal:
Advances in Medical Education and Practice

Shibabaw Tedla Tiruneh Introduction: Medical students’ academic performance plays an important role in produ­
Belta Asnakew Abegaz cing qualified graduates who will become great practitioners and workforce for the country’s
Abebe Ayalew Bekel health sector responsible for controlling, diagnosing, and treatment of diseases. The purpose
Yibeltal Wubale Adamu of this study was to identify college facility-related factors affecting medical students’
academic performance in the human anatomy course.
Mengistu Desalegn Kiros
Methods: To achieve the objective of this study, a cross-sectional study design was carried
Dawit Habte Woldeyes
out between January 13 and March 30, 2019. One hundred twenty study participants were
Biomedical Department, College of recruited in the study. Data were collected using self-administered questioners. Binary and
Medicine and Health Sciences, Bahir Dar
University, Bahir Dar, Ethiopia multinomial logistic regression were applied to analyze the data.
Results: A total of 120 participants were included in the study. Of which, 81 (67.5%) were
male while 39 (32.5%) were females. Dormitory crowdedness (AOR 3.16 (95% CI: 0.83–
2.01, p= 0.11), large class size (AOR = 2.36; 95% CI: 1.11–4.64 p = 0.005), inadequate
classroom facilities (AOR = 1.56; 95% CI: 1.51–4.91, p = 0.001), low internet access (AOR
= 1.99; 95% CI: 1.07–3.22, p = 0.015) and inadequate anatomy-teaching model (AOR =
2.63; 95% CI: 1.17–6.12, p =0.003) were significantly associated with low performance of
students in human anatomy course exam. However, college library (AOR = 0.23; 95% CI:
0.1–0.48 p = 0.061) did not show significant association with academic performance (p =
0.61).
Conclusion: Dormitory crowdedness, large class size, inadequate classroom facilities, low
internet access, and inadequate anatomy-teaching models were independent factors, which
affect the performance of medical students in the human anatomy course exam. However,
there was no significant association between the college library and the performance of study
participants in this particular course.
Keywords: academic performance, medical students, facility-related factors

Introduction
Medical student’s academic performance plays an important role in producing the
best quality graduates who will become great practitioners and workforces respon­
sible for the country’s health development.1,2 Academic achievement is one of the
major issues considered by employers in hiring workers specifically for medical
Correspondence: Shibabaw Tedla Tiruneh students.3,4 Medical students have to put the greatest effort into their human
College of Medicine and Health Sciences,
Bahir Dar University, Po. Box: 79, Bahir anatomy course study to obtain good grades and to prepare themselves for future
Dar, Ethiopia opportunity in their career at the same time to fulfill the countries health sector
Tel +251 918 375 554
Email [email protected] demand.5,6 Therefore, Human Anatomy is the language of medicine and the

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Tiruneh et al Dovepress

foundation of medical students in their clinical course collect the socio-demographic character of participants and
performances and clinical practices.7 Investigation of fac­ facility-related factors after clear orientation about the pur­
tors related to the academic performance of medical stu­ pose of the study. The data collection tools were revalidated
dents becomes a topic of growing interest in the higher by two expertise and a pilot study was performed in two
educational circle. Many recent studies were carried out to private colleges before the actual data collection. Data were
explore factors affecting medical students’ academic entered and analyzed using the Statistical Package for
performance.8 Research report showed that students’ per­ Social Sciences 22. Descriptive statistics were used to
formance is affected by many factors. Among these fac­ describe the demographic characteristics of the participants.
tors, facility-related factors such as classroom facilities Bivariable logistic regression was used to identify factors
and environment, internet access, overcrowding, dormitory associated with academic performance. Multivariable logis­
environment, availability of library, and reference books tic regression was used to assess the impact of independent
are identified.9 Classroom environment is a combination of variables on the outcome variables. The odds ratio was used
physical characteristics of the room. These physical facil­ to measure the strength of the association and the p-value
ities of the classroom are one of the stimulating factors ≤0.05 was considered statistically significant. This study
that play a fundamental role in improving the academic was approved by the College of Medicine and Health
performance of students in the school system.10 For exam­ Sciences Research Review committee (No. CMHSRRC-
ple, a study was done on more than 2000 classrooms in 12359/2018). Written informed consent was taken from
California, Washington, and Colorado, students who were each study participant before the administration of ques­
exposed to a larger amount of daylight, optimum tempera­ tionnaires and data collection. Besides these, a supportive
ture, and well-ventilated classroom in their classroom had letter was obtained from the biomedical department.
higher math and reading test scores than students who Personal identifiers were not used. Data were retrieved for
were exposed to less daylight, high temperature, and less only study purposes to ensure confidentiality. The results of
ventilated classroom.11 The Internet is a very useful med­ this study were submitted to the College of Medicine and
ium for quick access to information, especially for stu­ Health Sciences Academic Director Office and the biome­
dents. In particular, social networking sites facilitate dical department. The recommendation was given to them
students in communication, socialization, coordination, to fulfill college facilities important for improving students’
collaboration, and entertainment, but internet usage can achievement.
cause addiction and lead to time-wasting, information
overload, and physical isolation from society.12–14 Result
Determinants of medical students’ academic performance One hundred twenty students participated in this study.
and their teaching-learning process were not investigated Among the participants, 12 (10%) were age 20 years and
well in our school. In addition to this, on random observa­ below while 108 (90%) were above 20 years. Eighty-one
tions, some medical students scored under in anatomy (67.5%) and 39 (32.5%) were male and female partici­
course for the last three successive years in their preclini­ pants, respectively. Forty-two (35%) students were coming
cal course. This condition needs research. Thus, this study from rural areas while 78 (65%) students were from urban.
proposed to identify facility-related factors affecting the Nineteen (15.83%), 28 (23.33%) and 73 (60.8%) students
academic performance of medical students in the human were from families who were unable to read and write,
anatomy course. able to read and write and complete primary school and
above. Among 120 study participants, 48 (48.3%) were
Method and Materials got B and above in their anatomy course while 62 (51.7%)
A cross-sectional study design was carried out from of students scored below “B” (Table 1).
January 13 to March 30, 2019, at the College of Medicine In this study, those students who said there is crowded­
and Health Sciences, Bahir Dar University, Northwest ness in the dormitory (AOR 3.16 (95% CI: 2.01–-0.83)
Ethiopia. All medical students (120) were included in the were scored 3.16 times less grade than those who said no
study. In this study, the outcome variable (letter grade) was crowdedness in the dormitory. Those students who said
scaled as high (≥70%) and low (<70%) based on the stan­ dormitory crowdedness affect their performances (AOR =
dard of the Ethiopian Higher Education Grading system. 2.20; 95% CI: 0.95–4.74) were more likely to have less
Self-administered structured questionnaires were used to score on the human anatomy exam than those who said

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Dovepress Tiruneh et al

Table 1 Analysis of Demographic Characteristics of Study less grade in the anatomy course exam than those who said
Subjects there were enough and quality models in anatomy labora­
Parameters Frequency Percent tory (Table 2).
(%)

Age =< 20 years 12 10 Discussion

> 20 years 108 90 In this study, those students who said there was dormitory
Sex Male 81 67.5
crowdedness were scored 3.16 times less grade than those
Female 39 32.5 who said there was no dormitory crowdedness (p = 0.011).
This study agrees with a study done in Ghana which
Address Rural 42 35
Urban 78 65
described those study participants who said there were
university students dormitory crowdedness (more than 4
Family Unable to read and 19 15.8
students in a single room) were scored 2.10 times less
educational read
status Able to read and 28 23.3
grade than those who said there was no dormitory crowd­
write edness in their campus.15 On the contrary, a study done in
Primary school and 73 60.8 India demonstrated that there was not any significant dif­
above ference in academic performance between participants
Preclinical one student 48 40 who said there were dormitory crowdedness and those
who said there was not any dormitory crowdedness in
Clinical one students 72 60
their campus.16 This deference may be due to a small
Grade Get “B” and above 58 48.5 sample size included in the study or economical disparity
performance Get below “B” 62 51.7
and University standards between the two countries.
Class size is defined as the number of students in
a single classroom. Smaller class sizes increase teacher–
student interaction; make students participate in classroom
that dormitory crowdedness did not affect their grade
activities; foster greater interaction among students and
performances. Large class size (AOR = 2.36; 95% CI:
helping them understand one another and increase their
1.11–4.64) was independent factors that decrease students’
desire to assist one another.17 But study done by Adeyela
grade performance in the human anatomy course.
found out the large class size was not conducive for
Similarly, study participants who said the class contains serious academic work.18 In our university, 100 preclinical
inadequate necessary facilities (AOR = 1.56; 95% CI: students have attended an anatomy course in a single class.
1.51–4.91 were scored less in the human anatomy exam Thus, study participants who said there was a large class
than those participants who said that the class contains the size were about two times more likely to score less in
necessary facilities. The presence of separate and well- anatomy course exam than those who said there was not
furnished libraries for medical students (AOR = 0.23; large class size (p = 0.005). This study was consistent with
95% CI: 0.1, 0.48) were not independent factors that affect research reports noted in the USA which stated that stu­
students’ grade performance in the human anatomy course. dents in smaller classes scored higher on standardized tests
Those students who said that there were not enough anat­ than did those in large classes, smaller classes had fewer
omy references in both quality and quantity (AOR = 1.26; behavioral problems and a teacher felt more productive in
95% CI: 1.21, 4.76) were scored less in the anatomy smaller classes.19 However, a study done in Nigeria
course exam than those who said there were enough anat­ demonstrated no significant relationship between class
omy reference books in both quantity and quality. Study size and students’ learning outcomes.17,20,21 In the present
participants who said there was low internet access for study, participants who said classrooms seat, seat arrange­
searching reference books (AOR = 1.99; 95% CI: 1.07, ment, the color of classroom, light, temperature, ventila­
3.22) were scored less grade than those who said there was tion, acoustics, site and number of the window were not
internet access for searching reference books. In this study, comfortable or inadequate for learning were about one
those students participated in the study who said there time lower odds of scoring in anatomy course exam than
were not enough and quality anatomy model in the labora­ those participants who said the classroom contained the
tory room (AOR = 2.63; 95% CI: 1.17, 6.12) were scored necessary facilities (p = 0.001). This study was in contrast

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Table 2 Analysis of Facility-Related Factors Affecting Academic Performance of Medical Students in Anatomy
Variables Grade COR (95% P value AOR (95% P value
Performance CI) CI)

High Low

Is there any Crowdedness in the dormitory Yes 49 48 3.52(1.2–10.25) 0.021 3.16(0.83–2.01) 0.011
No 18 5 1 1

Is there dormitory crowdedness affect your performance yes 33 44 2.25(1.04–4.83) 0.038 2.20(0.95–4.74) 0.021
No 27 16 1

Was the class size comfortable for teaching learning? Yes 22 35 2.41(1.16–5.05) 0.018 2.36(1.11–4.64) 0.005
No 38 25 1 1

Did the classes have the necessary facilities? Yes 51 3 1 1

No 7 49 2.65(1.20–5.81) 0.015 1.56(1.51–4.91) 0.001

Was there library with anatomy reference books in both Yes 38 27 1 1

quality and quantity? No 20 35 0.41(0.19–0.85) 0.017 0.23(0.1–0.48) 0.061

Did you get internet connection to access books/references? Yes 46 31 1 1

No 16 26 2.41(1.12–5.21) 0.025 1.99(1.07–3.22) 0.015

Were there appropriate models for Anatomy Yes 24 10 1 1

No 38 48 3.03(1.29–7.11) 0.011 2.63(1.17–6.12) 0.003

with findings from a previous study where they found accessible library.23 This may be due to variations in the
classroom environment and physical conditions had an utilization of limited library services between the two
insignificant influence on the academic performance of populations.
students.22 However, a study done in Pakistan demon­ The Internet is an essential part of our society, which
strated that students attended their class in a well- provides easy access to social, political, economical, and
equipped classroom with physical facilities had academic information’s across the world without leaving
a significant positive effect on the academic performance their place of residence. However, there are drawbacks
of students than those who attended their class in an such as impaired academic performance, health problems,
unequipped classroom.10 This indicates that creating personal relationship problems, and social dysfunctions
a conducive school environment for students’ learning is when it is used in a wrong and uncontrolled way.24 In
a must for each country. our university, the problems of internet service are limited
Libraries are essential for generating and seeking access, low seed, frequent disruption, low maintenance,
knowledge, provide place students and faculty members and low coverage. Thus, students have no access to the
to do research and advanced their knowledge; has roles to internet when they need academic work activities. This
collect, process, store, disseminate, and utilize study’s results showed that participants who said there
information.23 In our university, there is one separate was no internet connection to access books and references
medical library for both medical and other health science were about one time more likely to score less grade than
students with limited reference books. In this study, there those who said there was an internet connection to access
was no significant difference between participants who books and references. Similar studies done in Uganda
said there was no well-equipped library with anatomy showed that study participants who said there was internet
reference books and those who said there was a well- connection access without limitation were scored high
equipped library with anatomy reference books (p = grades than those who had no access to the internet.25
0.061). However, research findings showed that those Another study done in Ecuador demonstrated that those
study participants who said there was a well-furnished students who accessed and used internet for academic
library with adequate references were got a higher grade coursework scored higher as compared to students who
than those participants who said there was no easy did not access internet connection.26,27

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Human teaching models are important tools to teach

anatomy course for medical students. This study finding References
demonstrated that those students who participate in the 1. Reddy VB, Gupta A, Singh AK. A study to assess factors affecting
the performance of undergraduate medical students in academic
study who said there was no appropriate teaching model
examination in community medicine. Int J Community Med Public
were scored 2.63 times less grade than those who said Health. 2017;4(4):1066–1070. doi:10.18203/2394-6040.
there were enough and appropriate models (p =0.003). ijcmph20171325
2. Singh SP, Malik S, Singh P. Research paper factors affecting aca­
This study agreed with a study done in the United demic performance of students. Indian J Res. 2016;5:176–178.
Kingdom.28 3. Mushtaq I, Khan SN. Factors Affecting Students Academic
Performance. Global j Management Business Res. 2012;12:17–22.
4. Arora N, Singh N. Factors Affecting the Academic Performance of
College Students. J Educ Tech. 2017;14:47–52.
Limitation of the Study 5. Ghosh SK. Cadaveric dissection as an educational tool for anatomical
Because of budget constraints, the authors did not include sciences in the 21st century. Anat Sci Educ. 2017;10(3):286–299.
more samples from other medical schools. Finally, even doi:10.1002/ase.1649
6. Gorgich EA, Sarbishegi M, Barfroshan S, Abedi A. Medical students
though academic performance is affected by many other knowledge about clinical importance and effective teaching methods
factors, this study focuses only on facility-related factors. of anatomy. Shiraz E Med J. 2017;18:14316.
7. Estai M, Bunt S. Best teaching practices in anatomy education:
A critical review. Ann Anatomy Anatomischer Anzeiger.
2016;208:151–157. doi:10.1016/j.aanat.2016.02.010
Conclusions 8. Al Shawwa L, Abulaban AA, Abulaban AA, et al. Factors potentially
Dormitory crowdedness, large class size, classroom facil­ influencing academic performance among medical students. Adv Med
ities, internet access, and anatomy-teaching models are Educ Pract. 2015;6:65.
9. Hussain I, Suleman Q. Factors Contributing to Students’
independent risk factors for low academic performance Unsatisfactory Academic Achievement in English at Secondary
in the human anatomy course exam. However, there was Level. J Culture Soc Dev. 2017;35:22–30.
10. Suleman Q, Hussain I, Hussain DI. Effects of Classroom Physical
no significant association between the college library with Environment on the Academic Achievement Scores of Secondary
academic performance of preclinical medical students. School Students in Kohat Division, Pakistan. Int J Learn Dev.
2014;4(1):71–82. doi:10.5296/ijld.v4i1.5174
11. Heschong L Day lighting in Schools: an Investigation into the
Acknowledgment Relationship between Day lighting and Human Performance.
Detailed Report 1999.
We would like to say thank you to the College of Medicine 12. Junco R. Student class standing, Facebook Use, and Academic
and Health Sciences, Bahir Dar University. We also gave Performance. J Appl Dev Psychol. 2015;36:18–29. doi:10.1016/j.
appdev.2014.11.001
great gratitude to study participants for their willingness to
13. Ndege W, Teresia M. Social Networks and Students’ Performance in
participate in this study. Secondary Schools: lessons from an Open Learning Centre, Kenya.
J Educ Practice. 2015;6:171–178.
14. Ellore SB, Niranjan S, Brown U. The Influence of Internet Usage on
Author Contributions Academic Performance and Face to-Face Communication. J Psychol
Behavior Sci. 2014;2:163–186.
All authors made substantial contributions to conception 15. Zotorvie JS. Students’ Accommodation and Academic Performance:
and design, acquisition of data, or analysis and interpreta­ the Case of Ho Technical University, Ghana. Eur Sci J. 2017;13
tion of data; took part in drafting the article or revising it (13):290–302. doi:10.19044/esj.2017.v13n13p290
16. Devi V, Ashari S, Dashid S, Adlan M, Musadiq M. Cost, benefit and
critically for important intellectual content; agreed to sub­ risks associated with on-campus and off-campus accommodations of
mit to the current journal; gave final approval of the medical students: a cross-sectional study. Int J Pharmacol Clin Sci.
2015;4(3):58–62. doi:10.5530/ijpcs.4.3.5
version to be published; and agree to be accountable for
17. Owoeye JS, Yara PO. Class size and academic achievement of
all aspects of the work. secondary school in Ekiti State, Nigeria. J Asian Soc Sci.
2011;7:184–189.
18. Adeyela J Problems of teaching science in large classes at the Junior
Funding secondary school level. Implications for learning outcomes.
Unpublished M.Ed thesis University of Ibadan, Ibadan 2000;
This research did not receive any grant from funding
213–224.
agencies in the public, commercial, or not-for-profit 19. Addonizio MF, PhelePhelps JL. Class size and student performance:
sectors. A framework for policy analysis. J Educ Finance. 2000;26:135–156.
20. Willians DD, Cook PF, Quinn B, Jensen RP. University class size: is
smaller better? Res High Educ. 1985;23:307–318.
21. Afolabi F School factors and learner variables as correlates of senior
Disclosure secondary Physics achievement in Ibadan. Unpublished Ph.D thesis,
The authors declare no conflict of interests in this work. University of Ibadan, Ibadan 2002.

submit your manuscript | www.dovepress.com

Advances in Medical Education and Practice 2020:11 733
DovePress
Tiruneh et al Dovepress

22. Raml A, Zain RM. The impact of facilities on students’ academic 26. Torres-Diaz JC, Duart JM, Gomez-Algomez-Alvarado HF, Marin-
achievement. Sci Int. 2018;30:299–311. Gutterez I, Segarra-Faggioni V. Internet use and academic success
23. Wong SHR, Webb TD. Uncovering meaningful correlation between in university students. Comunicar. 2016;24(48):61–70. doi:10.3916/
student academic performance and library material usage. Coll Res C48-2016-06
Libr. 2011;72(4):361–370. doi:10.5860/crl-129 27. Diaz JCT, Montoliu JMD, Becerra MH. Plagiarism, internet and
24. Siraj HH, SalamL A, Hasan NA, Jin TH, Othman MNB. Internet academic success at the university. J New Approach Educ Res.
Usage and Academic Performance: A Study in a Malaysian Public 2018;7(2):98–104. doi:10.7821/naer.2018.7.324
University. Int Med j. 2015;22:83–86. 28. Davis CR, Bates AS, Ellis H, Roberts AM. Human anatomy: let the
25. Obura OC, Magara E Electronic information access and utilization by students tell us how to teach. Anat Sci Educ. 2014;7(4):262–272.
Makerere University in Uganda. Retrieved from: http://creativecom doi:10.1002/ase.1424
mons.org/licenses/by/2-0., 2008.

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