Factors influencing the late submission of assignments in a medical university environment: a qualitative case study

Abstract

The late submission of assignments by medical students is a chronic problem. Students' characteristics and past academic performances are useful indicators for predicting delays during medical school. However, medical students' perspectives on factors that lead to delays in assignment submission remain unexplored. To address this issue, this study examines the factors that influence the late submission of assignments in a medical university setting from the perspective of medical students. This exploratory qualitative case study recruited 20 undergraduate medical students who had submitted their assignments late at a private Japanese medical university. Data were collected through face-to-face, semi-structured interviews and analyzed using thematic analysis from a constructivist paradigm. A qualitative analysis revealed the following three themes regarding the factors influencing the late submission of assignments: (1) factors related to the medical university curriculum, including its structure, course offerings, and academic requirements, (2) factors related to the instructions from and authority of faculty, and (3) situational factors that exacerbate delays in student assignment submissions. Medical students felt that the nature of the assignments, which were assigned with no apparent regard for student schedules and offered a limited evaluative metric, was often irrational. The students implicitly accepted this situation while being aware of the infeasible submission deadlines. Medical students may have an internal sense of the perceived irrationality of faculty-imposed assignments and the authority behind them, and may strategically neglect some in favor of efficient course completion. Faculty members should ensure their assignments are consistent with course contents.

Introduction

In higher education, assignments such as reports before and after classes play an important role in formative and summative assessment. However, a certain number of students tend to procrastinate in submitting their assignments, which has raised concern among faculty, and research has been conducted to identify effective solutions [1–3]. For medical school faculty, students' late submission of assignments is a chronic problem that continues to cause concern. While no prior studies have been found that indicate the general rate of assignment submission delays in medical schools, 80%–95% of university students procrastinate when completing assignments [1]. Although the risk factors for delays and other academic difficulties vary [4], students' backgrounds and past academic performances have been found to be useful indicators for predicting future grades and delays during medical school [5–8]. However, identifying at-risk medical students is challenging owing to the involvement of various cognitive and noncognitive factors [9,10]. Approximately 10% of students entering medical school will face academic difficulties at some point during their studies, and providing remedial programs to support these students can enhance their learning approaches [11].

Meanwhile, submitting assignments on time is also a matter of professionalism. Unprofessional behaviour in medical school, including irresponsibility required in physician duties and diminished capacity for self-improvement, may predict future issues with professional misconduct later in one's career [12]. In fact, medical students who struggle with professionalism in medical school are more likely to face disciplinary action as physicians for acts such as severe irresponsibility [13]. Because of these concerns, medical school faculty often attempt to address this issue through various approaches, including remediation. However, some medical students avoid seeking support from their faculty [8,14,15], and the usefulness of frequent faculty mentoring and the need for support have been discussed [16–18].

Why do a certain number of medical students fail to submit assignments on time? Faculty understand the educational significance of using submitted assignments as assessments [19]. The educational impact of assessments on learners is greater than that of specific teaching and learning methods, and learning behavior is influenced by assessments and evaluations [20,21]. Furthermore, remedial interventions linked to formative assessment are useful for improving medical students' grades [22]. Having an understanding of the evaluation process for the assignments they submit is important for students' abilities to reflect on their learning methods and consider future strategies [23,24]. Providing medical students with genuine, appropriate evaluations from their teachers also increases their receptivity to feedback [25], and it has been suggested that collaborative work between medical students and teachers can increase student motivation [26]. While assignments offer various learning benefits, procrastination in their submission may hinder these effects. Previous studies on delayed assignment submission from a faculty perspective have indicated the possibility of differences between students and faculty regarding assignment recognition, as well as the possibility that faculty are unable to adequately communicate assignments' pedagogical significance to students [27,28]. Additionally, research on reflection-based assignments that involve multiple tasks across several grade levels and explore trends in university assignment submission delays reveals that project assignments requiring students to document their long-term learning experiences are particularly challenging for students, often leading to more frequent delays compared with written assignments or presentations [1]. Prior research suggests that regardless of course format or assignment type, most students tend to maximize the time available before submitting when assignment submission flexibility is offered [29].

However, previous research has neglected investigating the perspectives of medical students about reasons for delays in submitting assignments. There are likely multiple factors behind students' failure to submit assignments by the deadlines set by faculty, but these have not been fully explored. This study explores medical students' thoughts and experiences about what caused delays in turning in assignments, their thoughts about faculty and their requirements, and the suggestions medical students have made.

Methods

Study design

The authors followed the Standards for Reporting Qualitative Research recommendations [30] and adopted an exploratory qualitative case study methodology within a constructivist paradigm [31], which enables holistic study of multiple constructed realities. A case study constitutes an empirical investigation of a current phenomenon in a real-world setting [32]. The strength of this approach lies in its consideration of various perspectives of a phenomenon, allowing for in-depth investigation [33,34]. This approach provided the authors with detailed information to interpret the perspectives of the medical students.

Setting

This study was conducted at Kansai Medical University, a six-year medical university in Japan with a capacity of 130 students per year. At the time of the study, the university had a total of 760 students. All medical universities in Japan offer six-year programs, and formal clinical clerkships are usually conducted during the fourth, fifth, and sixth years of study [35]. This medical university offers a six-year program in which the preclinical curriculum is taught primarily through face-to-face instruction, with additional use of online resources. In preclinical education, a curriculum that integrates various specialties in a cross-disciplinary manner is employed alongside didactic instruction and active learning approaches. The clinical clerkship follows the model core curriculum in Japan and is conducted face-to-face, within and outside university hospitals. During the clinical clerkship, students complete two- to four-week rotations while repeating this cycle. While the exact duration varies by university, students typically complete an average of 72 weeks of clinical clerkship. On average, faculty members at this university give clinical assignments several times a week. The assignments are primarily 300–500-word written assignments focused on self-reflection based on class contents and responses to specific clinical cases. This assignment format is the most common type given across all years and multiple courses at this university, although other types of assignments exist, including presentations and multiple-choice questions on clinical reasoning. This assignment type was selected as the case study for this study because the rate of late submissions for medical university assignments is high compared with that for other assignments. Although the assignments vary in nature, each one takes approximately 1–2 hours to complete. Assignments are due one week after the end of the class, and 80% of students typically adhere to these deadlines. Although guidelines may vary slightly by course, late submissions are generally accepted up to one week after the deadline. Submitted assignments are graded, but significant points are usually deducted. Additionally, repeated late submissions may result in a warning from the university following the evaluation of professionalism. Multiple warnings may result in deductions from the professionalism evaluation and disciplinary action, such as a formal reprimand.

Participants

Medical students who submitted late clinical assignments five or more times during the year were recruited for this study. The university's online data management system was used to identify delays in submitting assignments. To avoid the influence of MH's own position as a teacher, this only included delays in submitting assignments MH did not assign. All 45 medical students at the university (grades 1–6) who met these criteria in 2023 were invited by email. Participation was voluntary. Twenty medical students (11 men, 9 women) agreed to participate. The average age of the participants was 22.4 (with a range of 18–26).

Ethics

This study was approved by the Institutional Review Board of Kansai Medical University (2021043). The participants were informed of the study's scope and nature, and they provided written consent prior to participation.

Data collection

Semi-structured interviews were conducted to understand the perspectives of medical students who had submitted assignments late several times [36]. The first author (MH) conducted face-to-face interviews between April 2023 and December 2024. In reference to prior research findings on assignment submission delays, open-ended questions were used to obtain detailed perspectives on the students' past experiences and how these contributed to their subsequent lives as medical students. Based on a constructivist paradigm, the interview questions balanced the goal of capturing unexpected elements by following the participants' lead, with the aim of generating relevant data about the phenomenon under study. This approach also enabled participants and interviewers to collaborate in exploring ideas and developing interpretations. The authors designed these questions to explore the factors related to delays that students consider, as well as their suggestions for addressing them. The main questions were as follows:

• 1.What was the main reason for the delay in submitting the assignment(s)?
• 2.What was the reason for you not being able to submit the assignment on time while many of your peers submitted it on time?
• 3.What do you expect from teachers when it comes to submitting assignments?

In addition, MH confirmed that there was no need to change these questions during the interview analysis. Interviews lasted 30–60 minutes, were conducted in Japanese, and were audio-recorded. The recorded data were transcribed verbatim immediately after each interview.

Data analysis

The interview data were analyzed using thematic analysis, which involves generative coding and theorizing to identify similar concepts in the data set [37,38]. Data analysis followed an inductive approach in which emergent conceptual categories and descriptive themes were determined using the qualitative data analysis program NVivo 12 (QSR International, Australia). MH and KN conducted all steps of the analysis individually, including the reading and rereading of the transcripts until the researchers found the themes and categorized the data positioned within a constructivist paradigm. To ensure diverse perspectives were captured, MH and KN independently performed the initial coding for a subset of the data. During the initial coding process, a codebook was developed iteratively to standardize the coding scheme and promote consistency. Each unit was assigned a descriptive code that preserved its semantic meaning, and the codebook was updated to reflect emerging patterns. Then, MH and KN collaboratively compared the initial coding results to identify broader patterns of meaning and generate preliminary themes. For each disagreement, they discussed and reviewed the data until reaching consensus. Finally, MH applied these themes to code the remaining transcribed data and grouped the smaller units into more abstract categories.

MH and KN are currently faculty members at Kansai Medical University and are involved in the education of medical students. Given that researcher reflexivity is essential for reinforcing trustworthiness, MH maintained a reflexive diary throughout the process and regularly reflected on his position and assumptions during data collection and analysis [39]. The interpretation of the results of the analysis was carefully reviewed to minimize arbitrary interpretations.

Results

Qualitative analysis revealed the following three themes regarding the factors that influence the late submission of assignments by medical students at a medical university: the medical university curriculum, including its structure, course offerings, and academic requirements, the instructions from and authority of faculty, and the situational factors that exacerbate delays in student assignment submissions. The sections provide a detailed description of the findings, along with representative verbatim quotes from participants.

Factors related to the medical university curriculum, including its structure, course offerings, and academic requirements

Because the curriculum becomes busier as the year progresses, some students noted that the longer they have been enrolled, the more likely it is they will become slack off in submitting their assignments on time. Others believed that as their education progressed, they would learn more efficient ways to complete their assignments and practice ‘strategic’ laziness to overcome delays:

‘We have many hours of lectures a day, and our schedules are packed throughout the week, so we feel lazy when we have to do assignments …. Over the course of the year, we have learned how to cut corners.’

The students were always under pressure to meet the deadlines of their many assignments, and they prioritized their work based on the degree to which each assignment contributed to the final grade. This suggests that assignments with formative assessments may contribute to delays in completion. Conversely, they also suggested that they were more motivated to work on assignments directly related to their future careers. However, they added that assignments unrelated to their future careers might cause delays:

‘There's so much content in the medical school curriculum that I feel like I can't survive in medical school if I don't have a good head for it …. If it's an assignment related to my career as a doctor, I might be a little more motivated.’

Specifically, they thought the lack of real-world clinical scenarios in first- and second-year medical students' assignments might cause delays in submission. They believed that making the assignments given in the first and second years of medical school based more on real-world clinical scenarios could bolster their motivation for future clinical training. At the same time, they strongly communicated their need to know clear expectations and grading criteria in advance so that they can submit assignments on time:

‘If the assignment is something vague like “What kind of doctor do you want to be?” then the students will only be able to write superficial content, so I want the teachers to show the medical students specifically what they are looking for and what kind of evaluation criteria they are going to use.’

In addition, when an assignment was due following clinical rotations, there was often no clear alternative if the student had not participated in a rotation, and there was concern that students’ poor health or disabilities were not considered when setting deadlines:

‘I feel that if teachers could discuss the due date and alternatives with each other, it would motivate students to complete their assignments on time.’

Factors related to the instructions from and authority of faculty

Medical students tended to strategize by estimating the firmness of an assignment's deadline, accounting not only for the instructions of the faculty member making the assignment, but also the atmosphere and mood of the classroom created by that faculty member. After the faculty member explained the significance of the assignment, the students estimated how feasible and burdensome the assignment would be for their classmates. Then, they developed strategies and made estimates for completing the assignment. If faculty members emphasized the submission of assignments by the given deadline, students may have difficulty communicating with faculty members because of their strict preconceptions, which could make them more resistant to the class itself:

‘I feel that the atmosphere of the class affects my perception of the assignment's due date …. I want to enjoy the class, but if I have to do the assignment first, I can't concentrate on the class itself.’

The students were strongly aware that the prior instructions were important for submitting assignments on time, especially assignments related to their clinical education. Conversely, they were equally aware of the difficulties in the timely submission of assignments given during clinical training, as there was often a lack of preparatory training and reference materials:

‘We understand that the summary of the patient's history during clinical training is very important in any department, but if there are no detailed lectures or careful feedback on the submissions before training, it feels like we are groping in the dark.’

Furthermore, when students perceived that the faculty who gave the assignment held a high position or had a high level of authority, they were more likely to focus on their relationship with that faculty than on the quality of the assignment itself, especially in a clinical setting. Students believed that building relationships with their faculty would lead to hints that would help them find the answers to their assignments:

‘To meet the deadlines of the challenging assignments that arise in clinical clerkship, I will work to develop positive relationships with clinical physicians. These relationships will provide me with valuable insights to help me find answers.’

Situational factors that exacerbate delays in student assignment submissions

Medical students believed that the unique environment of a medical university contributed to delayed assignment submission. This environment included limited evaluative perspectives and an outcome-oriented focus. Medical students also believed that the mismatch between university outcomes and frequent assignments contributed to delayed submission. They felt frustrated by the nature of many assignments given during the busy medical school curriculum with a limited evaluative perspective. However, they noted the conflict caused by their implicit acceptance of the situation while being aware of the unrealistic deadlines. Medical students felt that the frequent assignments given by the faculty were incompatible with the overall outcome-oriented environment of medical university, which also includes assignments and exams that are used as comprehensive assessments. Some medical students perceived the many assignments as a rite of passage. In addition, there was concern that this process could lead to uncertainty when medical students considered the contents of the assignments:

‘I feel like there's a little bit of a disconnect between what the medical school faculty wants in the assignments and how the medical school operates …. If I can't really keep up with the content that's required, I get lost on how to research it, and I end up in a situation where I have to turn it in late.’

The students believed that educational practices involving high cognitive load were associated with delayed assignments. The students suggested that limiting the number of post-lecture assignments to a moderate level, and ensuring that they are closely related to the lecture, may reduce the overall cognitive load on students when completing the assignments. In addition, they hoped that the results of completing assignments would be reflected in their clinical training and that their future importance for that training would be made clear:

‘I was able to see the importance of the assignments I was given after I started clinical training. If the assignments had been linked to the significance of the training and my career image when I was given them, I might have been able to approach them with a little more motivation.’

Discussion

The analysis of the interview data in this study revealed that the reason the medical students were unable to submit their assignments within the set deadlines was not only due to the nature of the assignments themselves, but also due to the specific classes that formed the basis of the assignments and the tight schedule of the university as a whole. Despite the educational significance of the interventions intended by faculty members, the medical students perceived irrationality in both the assignments and the authority behind them, even if they superficially complied. Some even strategically chose not to complete certain assignments to manage their overall workload more efficiently. While these findings may be difficult for faculty to accept, this study provides important implications for reconsidering assignment deadlines and their contents when planning for future classes and curricula. The specificity of the insights and the clarification of the evaluation criteria identified by the findings of this study aligned with some of the best practices in medical education recommended by researchers in the field [40,41]. However, the most novel aspect is that these points were addressed from the perspective of the medical students who struggle with submitting assignments.

Previous studies have shown that it is important for medical students to understand the evaluation process of their assignments to develop strategies for future learning [23,24]. Based on the results, faculty members should review the assignments they give their students to ensure that they are consistent with the course contents. Faculty members should also ensure that their assignments are tailored to the students' educational level and that the evaluation criteria are clearly defined in advance, which may encourage medical students to turn in work on time. Previous studies on delayed assignment submission have also highlighted the possibility of differences in assignment perception between students and faculty regarding assignment recognition [27,28]. Unexpected events in students' personal lives and an insufficient awareness of deadlines may also be related to delays in submissions [4], although these factors were not mentioned in the interviews. This may be because, during the interviews, the authors tended to place somewhat strong expectations on the participants regarding the importance and prioritization of submissions to faculty members. Though faculty members may believe assignments have clear educational benefits, they may need to honestly reassess the necessity of certain assignments and consider alternative methods, taking into account the perspectives of their students. Furthermore, medical students who have been late should be invited to share the reasons for delays so that the faculty members can determine whether the deadlines they set were realistic. Another useful approach is to review feedback on the assignments after a course has concluded to check that they fairly reflect students' efforts.

Reviewing the contents of assignments may also require a reconsideration of the specific course topics that formed the foundations for assignments and a more general review of the course itself. The results indicated that the medical students tended to procrastinate on submitting their assignments as they progressed through their academic years. However, based on the students' experiences with procrastinating on submitting their assignments, the results suggest that students sometimes fall into poor patterns continuing to submit assignments late as they had done before. Therefore, through these experiences, they developed effective shortcut strategies for completing future academic assignments. Faculty members may find it helpful to review the place of assignments in a curriculum and ensure that factors such as assignment frequency, grading scales, and due dates are appropriate. It is also important not to overemphasize the submission of assignments, but instead create an atmosphere in the class itself that motivates medical students to submit assignments. As mutual trust and understanding are formed in the classroom, medical students are more likely to seek help from the faculty [18], and faculty members are better able to anticipate problems with timely submission and facilitate students' personal and professional growth [42].

The innermost thoughts of the medical students who submitted assignments late clearly revealed the dilemmas they faced in submitting their assignments and the authoritative academic resources of the medical university. Furthermore, the results suggest that placing too much emphasis on motivating students to complete assignments by a certain deadline may increase their resistance to the course itself. The authors believe that this provides an important opportunity for reflection on the relationship between students and faculty members at a medical university. Both students and faculty must strike the right balance when it comes to emphasizing assignments. Faculty members must seek student feedback about assignment contents and consider contents that encourage and motivate self-reflection, such as discussions about students' future professional self-image [43]. In addition, students who consistently make late submissions can be asked, through enhanced mentoring, whether they require individual attention or alternatives. As it has been found that students with learning disabilities who are provided with alternatives can significantly improve their assessment performance [44], it is possible that students encountering other difficulties could be equally helped by flexible arrangements. Meanwhile, it may be beneficial for students to share strategies for managing deadlines and creating an environment in which they can support each other.

This study had some limitations. It was conducted at only one medical university in only one country; therefore, given the importance of each institution's context, it is crucial to focus on students' unique experiences and perspectives influencing the late submission of the assignments. Furthermore, the small sample size of this study makes it difficult to rule out the possibility that students who agreed to participate had more critical views about the assignment with unclear content and evaluation criteria and restricted submission deadline than those who declined participation. Further research at other institutions is required to verify the transferability of these findings. Moreover, this study was not longitudinal. This study found that students understood the importance of the assignments given before their clinical clerkship. This suggests that the long-term value of assignments given by faculty members should also be evaluated. Follow-up interviews would provide more data on the development of the students' perspectives over time and provide more insight into how they utilised their individual experiences during their education. Future research should invite all medical students to verify the results of this study and determine whether students who consistently turn in assignments on time have similar perceptions. Finally, although this study adopted a thematic analysis approach based on its constructivist stance, other methodological and analytical approaches may reveal distinct perspectives on assignment delays among medical students.

Author contributions

Mikio Hayashi, MD, MHPE, PhD, FACP is an associate professor at the Centre for Health Professions Education, Kansai Medical University. He was the principal investigator of this study, conducted the interviews, and authored the manuscript. Rintaro Imafuku is an associate professor at the Nursing Research Promotion Centre, Nagoya City University. He checked the results and critically revised the manuscript. Katsumi Nishiya, MD, PhD is a professor at the Centre for Health Professions Education, Kansai Medical University. He contributed to the design of this study and analysed the data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Funding

This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability statement

The datasets generated and/or analysed during the current study are available from the corresponding author upon reasonable request.