Undergraduate medical education is facing many new challenges in India. Upon graduation, medical students are expected to have developed enough competency in medical knowledge and clinical skills. In spite of the best teachers applied to the medical students, performance of students as well as doctors in the community is perceived to have largely declined [1]. Globally, students with top academic performance and high intellectual capacity usually opt to study medicine. However, once they get enrolled in medical schools, their academic performance varies widely [2]. Study habits is one important factor which influences the academic performance of students [3-8].

Some habits are considered to be more desirable than others from the point of view of academic achievement [9, 10]. In general, students who achieved success had previously found the best study method for themselves [11]. Aim of education is to help students become effective learners [11]. Process of learning itself must be learned [12]. Learning strategies are behaviors or thoughts that facilitate knowledge, experiences, attitudes, beliefs, and values [13]. Whereas the learning approaches have been given importance in higher education, they have not received enough attention in medical programs [11].

Many students are spending a lot of time using low-efficacy learning techniques [14]. Lack of study skills puts students at a disadvantage and they suffer tremendously at various stages along their student journey [15]. Study skills support is an important factor to consider in helping students achieve success and withstand challenges they face in academic context [16]. Students from all backgrounds need support for smooth progression through the academic semesters [17].

Since academic performance is a highly prized parameter for academic excellence, focused efforts are required in understanding the effective learning strategies that would help in enhancing it. Dissemination of effective learning strategies will in turn benefit average and low performers, while in the long term, this will help in building their self-confidence [18]. It has been shown that possessing a scheduled plan, profound study along with concentration can improve learning in medical students [19]. Study skills among students can be improved further by better time management and test preparation.

5, More than half of the time: 4, About half of the time: 3, Less than half of the time: 2, Almost never: 1, students were expected to circle the number that best describes their behaviour for that particular study skill. The cut off-scores for the skill domains suggesting change for better grades were: Text Book reading: 30; Notes taking: 20; Memory: 30; Test Preparation: 40; Concentration: 35; Time Management: 20 Institutional ethics committee approval was obtained. Informed consent was obtained from the participants. Questionnaires were distributed after clear explanation of the questions. The responses were collected within a span of 2 weeks. Confidentiality was maintained throughout the study. Results were analysed statistically and p value for statistical significance was analysed for various study habits among high, average and low achievers. Quantitative data was entered into Microsoft Excel and analysed using IBM SPSS 21.0. Key analytic outputs are the total and domain wise score – Overall and across gender and achievement categories. Mean and standard deviation or median and interquartile range were used to summarize the score based on the distribution. The difference in scores across achievement categories was assessed using Kruskal Wallis test. p value of <0.05 was considered as indicative of statistical significance.

Total final year students were 140. Rejected invalid responses were 8. Responses were considered invalid if some of the questions were not responded or same number was encircled for all the questions. Non-Participants were 14. Total number of participants were 118 students. Of the 118 students included in the study, high, average and low achievers were 22/118 (18.64%), 75/118 (63.55%) and 21/118 (17.79%) respectively (Figure 1).

Study skills are considered to be important in judging students’ overall potential and attainment levels (Nuthana & Yenagi, 2009). Understandably, to achieve academic excellence, students need to possess essential study skills which include time-management, organization, note taking, reading and critical thinking. Some studies have asserted that student success depends on the study skills they adopt to achieve the expected outcomes (Maribeth & Jill, 2002; Meneghetti, et al., 2007). Psychologists find study skills to be the most contributing factor in students' performance at the university level (Gholiazdeh, 2001) [15].

The teacher of the undergraduate medical student has an important role to play in the development of these skills [22]. Study strategies that are effective in high school may not be as effective in college [23]. At-risk medical students entering medical school plan to increase their number of study hours in the first year of medical school. However, given the busy schedules required of a modern medical student, these expectations may not be congruent with a realistic study schedule. Students must learn to master complex subject material in an efficient and long-lasting manner [24].

Thus, to enhance the quality of education, there is a need to improve the study habits and attitudes of the students. This could be done through provision of developmental programs that will help students build efficient and effective study habits and positive attitudes towards learning, in an early stage of their studies [25].

From the results of the study, the following conclusions can be drawn. Though the students are talented, they need refinement of their study skills.

The present study had many similarities to many previously published studies on this topic. In the study by S. Madhavi et al [20], the main problems among students were time management, concentration, note taking and test preparation. The study done by Chitra Nagaraj et al [26], Note taking skills were significantly associated with good performance of medical students. Memorizing notes and failure to organize main ideas and details were associated with bad performance.

The present study results were in accordance with study by Abbasali Nourian et al [27], which observed that marked problems were in the areas of time management, concentration, reading speed, note taking, study habits and comprehension.

In the study by Hafiz Naweed Ahmad et al [28], poor academic performance is associated with poor time management approach to study, excessive use of social networking and poor study habits.

The present study had dissimilarities with the study done by Anuradha Sujai Joshi et al [18] using focused group discussions and in depth interviews, in which significant themes that influenced high academic achievements comprised of hard work in the form of regularity in studies, meticulous preparation of notes, constructive use of time, active utilization of e-learning, regular visit to clinical wards, and incorporating individual learning styles, strategic and deep learning approaches while studying and small group learning.

The present study results were also in contrast with the study of Shanmugananda P et al [29], which concluded that high achievers have a diligent study pattern, they not only study regularly, but were also involved in group discussions and approach their teachers when in doubt.

Limitations of the study were as follows: Students were categorised as high, average and low achievers based on the marks of internal assessment of one subject only. Categorising the students according to internal assessment marks alone can be erroneous. Internal assessment was theoretical only and clinics were not included. Sample size was limited to one batch of students only. It could have been better if other batches were also involved. In spite of clear explanation and instructions, random marking of responses cannot be ruled out. Focused Group Discussions and In-Depth Interviews could have been more effective in reflecting the true picture.