Futoko is a Japanese term that has been variously translated as absenteeism, truancy, school phobia or school refusal. It is quite a common phenomenon among medical students and has become a source of worry to both medical faculty and staff. Is it a reflection of the medical school system rather than an issue with medical students? What really are the underlying causes of “futoko” in medical school?

Stress-induced causes are quite common, particularly during clinical postings. Medical school is demanding and more often than not, it’s strenuous activities leave the average medical student physically, emotionally and mentally strained at the end of the day. Neurosurgery for example is one clinical posting where medical students experience little or no sleep and long hours of physical exhaustion. Except in cases of public holidays and weekends, breaks are not frequent and even when given, are quite brief. In order to ‘de-stress’, medical students look for days to be absent from one school activity or the other.

Another reason could be a desire to study. A medical student who has been attending ward rounds, clinics e.t.c without having an appreciable time for personal study could decide to miss a day or two to bridge that knowledge gap. Medical students are overloaded with a tremendous amount of information within a limited time period and reading is quite difficult at the end of a strenuous day. An inability to handle all the overload of information at once, coupled with a desire to succeed during the examination period usually leads to being absent from school activities.

Unfriendly lecturers could be a reason for medical students’ “futoko”. Attending a clinic activity or ward round with a strict and intolerant consultant could be a nightmare, which might only be avoided by being absent, despite a keen desire to learn. Apart from the exacting questions that are usually asked, the remarks made by the consultant could be belittling. Medical students might therefore prefer to use that time for something else.

Traveling for a quiz competition, attending a Model United Nations conference, volunteering at a community outreach or going for an entrepreneurial internship are few extracurricular activities that medical students participate in. Some of these activities, though very important in developing passion, leadership and making impact, often clash with normal school work and could be a reason for being absent.

Lastly, apathy and a general lack of interest in Medicine could instigate “futoko” in medical students. A number of factors that could cause this include false perception of medical school before enrolling, conflicting interests, change in life circumstance e.g death of a loved one, engaging in drug or substance abuse or lack of personal motivation. Once lack of interest sets in, a reluctant attendance will inevitably set in.

In conclusion, absenteeism, truancy or even phobia in medical school are not idiopathic. Mental stress, a reading objective, biting lecturers, engagement in extracurricular activities and a lack of interest are few underlying causes among others. Is “futoko” a fault of the school system or a problem with medical students? Should it be allowed to be part of medical school training? Looking at both the advantages and disadvantages would help provide answers to questioning minds.