Introduction: Medical student attrition and poor academic performance have implications for both medical schools and the future healthcare workforce. This study aimed to determine the demographic and academic characteristics of first-year medical students with low academic performance across different instructional modalities—traditional face-to-face, online, and HyFlex learning. Methods: This non-concurrent cohort study included first-year medical students enrolled from School Years (SY) 2018–2019 to 2024–2025. Student characteristics analyzed included sex, pre-medicine degree, pre-medicine general weighted average (GWA), National Medical Admission Test (NMAT) score, and academic performance in annual first-year subjects. Low academic performance was defined as failure in at least one annual subject. Students were grouped according to instructional modality: face-to-face (SY 2018–2020), online (SY 2020–2022), and HyFlex (SY 2022–2025). Demographic and academic characteristics were compared between students with and without low academic performance. Results: A total of 2,936 first-year medical students were included. The proportion of students with low academic performance was 19% during the face-to-face period, 17% during the online period, and 27% during the HyFlex period. Across all instructional modalities, students with low academic performance had significantly poorer pre-medicine GWA than students who passed all annual subjects (p<0.05). During the online and HyFlex periods, students with low academic performance also had significantly lower NMAT scores than students who passed all annual subjects (p<0.05), whereas no significant difference in NMAT scores was observed during the face-to-face period. Conclusion Pre-medicine GWA was consistently associated with academic performance across face-to-face, online, and HyFlex instructional modalities. Lower NMAT scores were associated with low academic performance during online and HyFlex learning. Early identification of students with poorer pre-medicine academic performance and lower NMAT scores may facilitate timely academic support.
Students, Medical ; Academic performance ; Education, Distance ;