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3) Althwanay A, Ahsan F, Oliveri F, et al: Medical educa-inations is better than that of students not taking them, it has recently begun to recommend that students take them4). Accordingly, most of the with COVID-19 group had taken practice examinations. The better performance of these students may have resulted from leeway for preparation and the ability to objectively assess their own achievement level and overcome their weak points, acquired by taking practice examinations4). The without COVID- 19 group’s reason for not taking any practice exam-ination may have been because they did not have enough time to take it, or they studied using paper-based questions collections handed down from senior students. The with COVID-19 group’s reason for not taking it is unclear, but it is possible that mental instability made it difficult for them to concentrate on study11).The multivariate analysis of the risk of students having poor CBT scores showed that students with poor performance during the third year, starting preparation for CBT late, and not taking any prac-tice examination are more likely to have poor CBT results. Based on this, students with poorer perfor-mance need to start preparing for CBT earlier. As previously mentioned, the with COVID-19 group’s reason for not taking any practice examination is unclear, but this will not be the cause of poor CBT results anymore in the future, as taking such prac-tice examinations will be standard. As a limitation of this study, the results were obtained only by analyzing a single facility. Addi-tionally, students’ performance was compared between without and with the COVID-19 pandemic, the latter of which is an unprecedented and special situation. Some students had their days and nights reversed due to not commuting to school, which resulted in an unhealthy circadian rhythm, while others’ mental health became unstable due to living alone and not being able to return home or go back to their countries. Therefore, the possibility of these students having been unable to show their true potential should be taken into account11). It is inter-esting to know whether students’ CBT performance will return to the previous level “after COVID-19”, when the situation is settled, and extracurricular activities are resumed. We will continue to follow up on this. We should also examine some problems caused by the suspension of extracurricular activi-ties due to the COVID-19 pandemic, as such activ-138ities, including club activities, are important in student life. Helping students restore and maintain their motivation that has decreased due to the loss of goals is a top priority. Supplementary approaches for the development of communication skills in interpersonal relationships and the acquisition of a regular life and common sense behaviors during their remaining days at university are also required. We will continue to monitor this generation, whose student lives were affected by the COVID-19 pandemic, to clarify its influences on their motiva-tion and personality development in the future.Due to the COVID-19 pandemic, students spent more time on online home study, and this may have consequently improved their CBT scores. Such learning performance is desirable for medical students, but they have lost the opportunity to gain valuable experiences that they could have acquired through extracurricular activities, such as club activ-ities. In this respect, we cannot simply be pleased by the improvement in students’ CBT scores.Not applicableThe authors received no financial support for the research. This manuscript was drafted by YT, TS, and TO. The questionnaire was compiled by MW and MS. Data entry was done by MN and AE, and data interpretation and statistical analysis were done by HW. YT and YN contributed significantly to the writing of this manuscript. All authors read and approved the final manuscript.The Authors declares that there are no conflicts of interest. 1) Common Achievement Tests Organization. Common achievement tests before clinical exercise. 19th edition. 2021. www.cato.umin.jp/ 2) Akers A, Blough C, Iyer MS: COVID-19 implications on clinical clerkships and the residency application process for medical students. Cureus, 2020; 12: e7800. doi:10.7759/cureus.7800.AcknowledgmentsFundingAuthor contributionsConflicts of interest statementReferences