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a) Summer campb) Working part time0271118153382333024125813c) Travelling(Upper half Group vs Lower half Group）(More than 4 months vs 3 months in advances）(Participating Group vs Not participating Group)Summer vacation events(a + b + c)Practice examination †P<0.05, ‡P<0.01Science electives for university entrance examinations(Biology Group vs Physics Group）Grades in the third yearTime of starting preparationSummer campSummer vacation eventsPractice examination †P<0.05, ‡ P<0.01No. of Poor CBT scores17(10.0%)10(11.2%)11(10.0%)16(10.7%)4(5.1%)23(12.7%)15(11.1%)12(9.7%)7(5.3%)486.5±73.3†513.3±104.1489.9±76.7500.0±88.7507.5±78.2490.6±87.3485.3±78.3†507.1±92.4519.3±90.2471.3±73.9‡20(15.8%)‡regression coefficientodds ratio0.010.960.390.280.260.76136Table 8　Multivariate analysis to identify risk factors associated with poor CBT scoresTable 7　Ways to spend the summer vacationWithout COVID-19No. of students IRT score1708911014978181135124132127YesNoYesNoYesNo≥10 days< 10 daysYesNo（<10 days vs ≥10 days）（Taken vs Not taken）rations for regular tests and CBT, while attending face-to-face lectures and exercises and engaging in extracurricular activities, such as club activities and part-time jobs. During the summer vacation, they participated in the summer camp for the East Japan Sports Meeting of Medical Students (“Toitai”), and then needed to concentrate on their prepara-tion for CBT. Thus, they spent a productive summer, but with no margin of time. In contrast, the with COVID-19 group experienced a switch of face-to face lectures and exercises to home learning, mainly online, and their extracurricular activities, such as club activities and part-time jobs, were restricted. Accordingly, the time they spent at home overwhelmingly increased. Not being allowed With COVID-19No. of students IRT score　　－534.4±80.8534.2±78.8534.5±82.6527.9±71.7535.4±82.3522.3±89.5535.9±79.7538.3±77.7†456.3±102.3†95%confidence interval1.020.49 - 2.057.022.43 - 29.72.191.09 - 4.681.750.76 - 4.141.670.71 - 3.174.582.24 - 9.52No. of Poor CBT scores16(5.9%)7(5.9%)9(5.9%)1(2.6%)15(6.4%)4(13.3%)12(5.0%)11(4.3%)5(38.5%)‡P-value0.95＜0.01‡0.03†0.190.20＜0.01‡DiscussionClearly insufficient study and a superficial under-standing lead to failures in CBT, and clearly insuf-ficient study results from a late start of prepara-tion. When running out of time for preparation, students begin to simply resolve practice questions, rather than studying, which results in superficial knowledge without a deep understanding as a vicious circle. Students with poorer performance need to start their preparation earlier4, 5).The clear difference between the without and with COVID-19 groups in this study comes from the difference between online and home learning. The without COVID-19 group started their prepa-