The global emergence of the coronavirus disease 2019 (COVID-19) pandemic has precipitated profound transformations within the landscape of higher education on a worldwide scale. In response to the exigencies posed by the pandemic, educational institutions have been compelled to expeditiously reconfigure their operational frameworks, pedagogical methodologies and evaluative paradigms. Consequently, academic establishments, including the Faculty of Health Sciences at the University of the Witwatersrand, have expeditiously embraced the integration of online instructional modalities and the augmentation of digital infrastructural capacities to sustain educational continuity amid the prevailing challenges.

This study was conducted at the University of the Witwatersrand after it was noted that the academic performance of students enrolled in the 2nd-year course of Physiology and Medical Biochemistry (PHSL 2004A) at Wits University School of Physiology exhibited a decrease in performance in 2021. The decrease was noted among students enrolled in medical (MBBCh) and Bachelor of Health Science (BHSc) degree programmes offered by the Faculty of Health Sciences. In previous years, the pass rates for the MBBCh programme ranged from 82% to 98%, and for the BHSc programme, they ranged from 65% to 95%. In 2021, the pass rates were 77% for the MBBCh programme and 53% for the BHSc programme. In view of the drop in student performance in the PHSL 2004A course in the 2020 cohort, we analysed the decline in student performance by examining data based on admission categories, programme, race and residence status while acknowledging the influence of asynchronous teaching methods implemented in response to COVID-19 restrictions and the possible contribution of some factors that are known to influence students’ performance and progression in tertiary education.

Prospective students applying for the above programmes must take the National Benchmark Test (NBT), which accounts for 50% of the composite index used to determine eligibility. The remaining 50% is obtained from the combined results achieved in specific subjects of the National Senior Certificate, which is required for admission into the programme. Afterward, the composite index is used to organise applicants into four unique categories. The first category allocates 40% of available positions for the top-performing students, while the secondary category reserves 60% of allocations for high-performing candidates from rural areas, quintiles 1–2 and black or coloured students.

The National Benchmark Test 2020 report highlighted the need for the higher education sector to offer substantial support in quantitative literacy (QL) and mathematics (MAT), as a large majority of potential students achieved scores within the Basic and Intermediate benchmark ranges (CETAP 2020). This cohort was admitted during a time when the Faculty of Health Sciences used an admission policy that included the requirement for students to write NBT in addition to the National Senior Certificate (Merwe et al. 2015). The core domains assessed in the NBT for selection in health sciences programmes are Mathematics, Academic and Quantitative Literacy (Mabizela & George 2020). The critical subjects compulsory in the NSC for admission are Mathematics, English, Physical Sciences or Life Sciences.

This study employed a quantitative approach, incorporating both parametric and non-parametric statistical analyses to explore factors influencing academic performance in the PHSL2004A course.

The study aimed to investigate various factors influencing academic performance and progression outcomes among medical (MBBCh) and health science (BHSc) students in the context of a specific physiology course (PHSL2004A). Through a comprehensive analysis encompassing independent sample t-tests, chi-square tests and ANOVA, the study explored the impact of demographic variables such as living arrangements, race and admission categories on students’ academic achievements and progression outcomes. The results of these analyses provided valuable insights into the complex interplay between individual characteristics and educational environments, shedding light on potential disparities and areas for targeted interventions within medical and health science education. In this discussion, we delve into the implications of these findings, addressing the significance of each factor in shaping student outcomes and proposing avenues for future research and educational practices aimed at enhancing academic success and equity within the medical and health science disciplines.

We observed that MBBCh programme students performed better with higher mean scores compared to their BHSc counterparts. The chi-square test of association revealed no statistically significant difference in the academic performance of PHSL 2004 students in 2021 based on their accommodation type, whether on-campus residences or off-campus private accommodations. However, existing research suggests that students residing in private accommodations often achieve better academic outcomes compared to those living in university residences, highlighting ongoing debates on the influence of accommodation on academic performance (Gichere, Adem & Adenya 2019; Mabizela & Bruce 2022; Mbandlwa 2022).

Meaningful academic performance has been shown to be dependent on a good housing environment that offers comfort, convenience, satisfaction and overall life fulfilment (Ghani & Suleiman 2016). A non-conducive student accommodation environment has been shown to increase the risk of developing health problems, stress and depression that negatively impact academic performance (Ghani & Suleiman 2016). Hence, the provision of an on-campus student accommodation that positively contributes to the enhancement of the overall curriculum environment is one of the priority developmental areas in higher education institutions (Adesoji & Jiboye 2010). The lack of association in the performance of students in the PHSL 2004 course suggests that both off-campus and on-campus student accommodation offered the same housing environment and perhaps amenities such that there was neither a disadvantage nor an advantage for students to be in either of the types of accommodation. However, although we did not find a statistically significant association in the performance of the off-campus and on-campus students in the 2021 PHSL 2004A course, 72% of the off-campus students compared to 65% of on-campus students passed the course. The higher percentage pass rate by off-campus accommodated students, although not statistically significant, corroborates the assertion by Mbandlwa (2022) that off-campus accommodation provides higher means in academic performance. When just considering the nominal difference in percentage of pass rate, our findings suggest that although on-campus accommodation provides for proximity to educational amenities, this may not necessarily advantage on-campus accommodated students, which makes one question the rationale of investing in on-campus accommodation, particularly with current advances in access to information, even via smartphones. However, a thorough evaluation of the socio-economic and support status that surround the off-campus accommodated students needs to be dissected before drawing definitive conclusions, as these may be drivers of better performance, especially in historically advantaged sections of society.

Findings from the current study show that 91% of white students passed the PHSL 2004A course in 2021 compared to 61% for the combined black, coloured and Indian students (Figure 1). Despite advancements in school transformation and increased access to education for historically disadvantaged communities, the lingering effects of apartheid, particularly the enduring impact of the discriminatory Bantu Education policies, persist, underscored by the deliberate dismantling of educational infrastructure that once served as the foundation for the political elite (Wilson 2011). In these communities, racial and ethnic inequality remains as one of the most significant social issues. The difference in pass per cent by race does not reflect any difference in intellectual capacity between the races but is a reflection of the effect of differences between ‘starting out’ from an ‘advantaged and privileged’ position compared to from a ‘disadvantaged and unprivileged’ platform. While we unreservedly subscribe to and agree with the fact that intellectual capacity is similar across human societies, we are also alive to and cognisant of the existence of an achievement gap between black and white students (Carnoy & García 2017); that, in our considered view, gives historically advantaged students a privileged foundation in academics, which is not a consequence of superior intellectual capacity but one of better access to resources. Further to the effect of resource-induced achievement gap between white people and black people, white–black teacher to student mismatch has also been observed to affect academic performance (Egalite et al. 2015).

In their study on determinants of academic performance in medical students, Ekwochi et al. (2019) report that mode of admission into medical school had the strongest correlation with good academic performance, making it a key predictor of good academic performance. Our study findings show that admission category affected both BHSc and MBBCh students’ performance in the PHSL 2004A course in 2021. Overall, students admitted in the Top 40 category had higher mean scores compared to their counterparts admitted in the Top rural category. On a programme basis, BHSc students admitted in the Top 40 category performed better than their counterparts admitted in the Top BC category, and MBBCh students admitted in the Top 40 category performed better compared to their counterparts admitted in theTop rural and Top BC categories, but there was no difference in performance for students admitted in the Top rural, quintile and Top BC categories. Our results are in tandem with the observation by Ekwochi et al. (2019). Admission category-dependent differences in student performance require medical schools to craft and implement special support programmes that target assisting students whose admission categories are and or have been associated with lower academic performance. While the aim of enrolling students on the basis of different admission categories could be to spread, open and improve access to medical science education to broader society, medical faculties must invest in targeted support schemes in order to increase and improve academic performance, especially of students from historically disadvantaged communities whose admission categories may be associated with lower academic performance.

The decreased pass rates (performance) in the PHSL 2004A course in 2021 by BHSc and MBBCh programme students occurred in a cohort that enrolled for 1st-year university education in 2020 during the global COVID-19 pandemic. During this period, governments imposed lockdowns in order to minimise human contact and contain the spread of the novel coronavirus, the cause of COVID-19 (Bonaccorsi et al. 2020). During the COVID-19 pandemic years 2020 to 2022, Wits University, like other higher education institutions, migrated from the traditional didactic face-to-face content delivery in a physical class to using the online platform to facilitate learning. This online mode of delivery tended to be more of an asynchronous online learning format where students listened to voice-over PowerPoint presentations and or viewed instructional material largely at the time of their choice. There was very little, if any, online synchronous engagement, which would have allowed students to participate in live online synchronous learning and/or engagement sessions. The heavy dependency on asynchronous online learning deprived students in the two programmes of both in-person and/or live online synchronous engagement. Previous research has shown that outcomes of online learning are largely mixed. In a study, Hurlbut (2018) reported that students who learnt in physical class settings performed better when compared to counterparts exposed to online content delivery. Furthermore, Sintema (2020) reported that students’ academic performance was significantly impacted by their presence and or absence from physical classes. Physical classes allow for in-person individual activities that are crucial to the students’ comprehension of the subject matter (Şen 2013) and that translate to better performance on assessment.

The pass rates of MBBCh and BHSc students in the PHSL 2004A course during the period 2013 to 2020 ranged from 82% to 98% and 65% to 95%, respectively. In 2021, the pass rates dropped to 77% and 53% for the MBBCh and BHSc programmes, respectively. This drop in student performance occurred in a period when knowledge construction by students was mediated largely through an online asynchronous mode. Our findings seem to confirm the observations and assertions by Hurlbut (2018) and Sintema (2020), who argued that students exposed to physical classes tend to perform better than those exposed to online learning. The authors are of the view that virtual online asynchronous content delivery may have deprived students of opportunities for in-person individual activities, which have been demonstrated to buttress students’ comprehension of subject matter content offered by and in physical classes (Şen 2013). Our findings suggest that the 2020 cohort of students experienced a significant loss in learning opportunities, which could be one of the reasons for the drop in performance in the PHSL 2004A course in 2021 compared to previous cohorts that enrolled at the university and studied the course during pre-COVID-19 pandemic years. In their study on student academic achievement in the non-lecture physiology topics, Varachotisate et al. (2023) reported summative scores that were 4.80% ± 0.92% higher in the pre-COVID-19 year than in the COVID-19 year, and the student cohort opined that compared to the traditional face-to-face on-site and in-class learning, online learning reduced peer-to-peer and learner-educator interaction, albeit the students preferred the latter. It is also our contention that virtual online asynchronous content delivery and learning took away the benefits of peer-to-peer and peer-to-educator interactions, resulting in the drop in the pass rate in the PHSL 2004A course in 2021. In addition to the possible shock to students caused by the sudden change from the traditional lecture theatre approach to teaching and learning to online learning, members of the academy may have lacked the requisite competencies to package subject matter content in a user-friendly manner that facilitated students’ self-directed learning.

The discernible disparity in academic performance between MBBCh and BHSc students in the PHSL 2004A course during the academic year 2021, despite a decrease in pass rates compared to pre-COVID benchmarks, raises several questions. One important factor to consider is that the admission requirements for the MBBCh programme are typically more rigorous than those for BHSc counterparts, despite the shared curriculum in the first 2 years of study. This admission standards discrepancy raises important questions about the fairness of academic assessments within the common educational framework. Also, the current configuration of the PHSL 2004A curriculum raises questions about its suitability for BHSc, which is a general degree, and MBBCh, which is a professional degree. The students enrolled in these programmes have different educational goals. As a result, it is important to consider whether the curriculum is calibrated in a way that is fair and equitable for both programmes.

Our study provides valuable insights into the impact of programme affiliation, race and admission categories on academic performance and progression outcomes among medical (MBBCh) and health science (BHSc) students in the PHSL2004A course. The performance of MBBCh students consistently surpassed that of their BHSc counterparts, but the influence of living arrangements on progression outcomes was not found to be significant. Unfortunately, the shift to online learning as a result of the COVID-19 pandemic may have influenced student performance. Targeted support programmes and improvements in virtual learning experiences are crucial for addressing disparities and promoting equity. Through the implementation of these measures, we can strive to create a more level playing field and improve academic achievement in medical and health science education.