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to go out, they had no choice but to devote this time to study. With the Toitai also cancelled and no summer camp, they were able to use most of the summer vacation to prepare for CBT. Allocating much time to study at home, they may have achieved improved CBT scores7). When the educa-tion curriculum and extracurricular activities are gradually resumed in the future, students will not have as much time to prepare for CBT as they did this time, but the important thing is to make a study schedule, and stick to it with a sense of urgency.Moreover, medical students nowadays not only have more time to study, but they are also likely to be more proficient in study methods using online systems. With regard to the acquisition of knowl-edge, face-to-face lectures in classrooms are not necessarily required, and the results of the present study may have demonstrated that online lectures and self-learning using online systems suffice for students to acquire knowledge to the level they can pass CBT8). There is no doubt that this pandemic has been a turning point to reform medical educa-tion. Specifically, online education, which had not been widely adopted up until it, has been rapidly disseminated throughout Japan. In the early stages of the COVID-19 pandemic, online lectures were an alternative to face-to-face lectures, but now they are recognized as one of the most important educa-tional tools. The introduction of online lectures, especially on-demand lectures, has greatly changed medical students’ learning styles, and such lectures are likely to continue to be favored by students. In the future, it is necessary to review face-to-face lectures in classrooms, while expanding educational approaches using online systems9). In such an unprecedented and uncertain situation, medical students’ efforts to pass CBT and achieve better scores than before the pandemic are commendable. In the without COVID-19 group, the rate of having a poor CBT score was higher among males, indicating that some male students prioritize their extracurricular activities such as club activities, rather than study, and do not sufficiently study10). In addition, many questions in CBT are based on biology, and students who choose physics are disadvantaged to some extent compared to those who choose biology in their entrance examinations. We previously reported a higher rate of choosing physics among male students, which is one of the reasons5). However, during the COVID-19 pandemic, even male students who had been prioritizing their extracurricular activities had enough time to study, and in the physics groups, an increased number of students started to prepare for CBT early. There-fore, neither the sex nor science elective caused differences.CBT examines basic knowledge of basic medi-cine, clinical medicine, and social medicine. As these areas are extensively learned, it is natural that students’ performance up to the third year affects their CBT scores, and it is obvious that regular effort is more important than last-minute study. Although it is difficult to prepare for CBT in parallel with study for the regular curriculum and regular tests, it is important for students to plan their study, focusing on CBT, from the beginning of the fourth year, and start preparing for it at least 4 months in advance. Realizing one’s poor performance, but preparing late for an examination that your promo-tion depends on indicates a lack of urgency and the necessity of reviewing your attitude toward the examination in the future.As the CBT is conducted immediately after the summer vacation in our university, how to spend this period is the important point. In the without COVID-19 group, the IRT scores of students who participated in the summer camp were significantly lower than the scores of those who did not, suggesting that students do not study during the camp even if they bring their own study tools. The IRT scores of students who spent more than 10 days for events other than study, such as the summer camp, were also lower, but this may be attributed in large part to the performance of those who had participated in the summer camp. In any case, students had better give priority to prepara-tion for CBT during the summer vacation in their fourth year.Most students prepare for CBT using the work-books published by a publisher specializing in medicine, which have recently been shifted from paper-based to online. Additionally, purchasers of the workbook, who have registered with an online membership system, are allowed to take a practice examination for free as a special benefit. Our university does not force students to take a prac-tice examination, but based on data showing that the performance of students taking practice exam-137