Historically, attendance has been a marker of academic performance, but the current medical education literature has had mixed results. In addition, attendance is dropping in the preclinical curricula, whereas, at the same time, the focus on United States Medical Licensing Examination Step 1 performance is increasing. This present study is a mixed-method approach correlating student attendance and access to the formal curriculum in a second-year pathophysiology course to performance on Step 1. Additionally, survey and focus group data evaluated the usage and importance of both the formal curriculum and third-party resources. Out of 112 eligible students, 77 participated in the study. There was no correlation between attendance or access to the learning materials and Step 1 performance. There was a strong correlation between the performance on the final examination and that of Step 1 (r = 0.813; P < 0.001) and a moderate correlation between formative quiz (r = 0.321; P = 0.005) and individual readiness assessment test performance (r = 0.351; P = 0.002) and Step 1 performance. Survey and focus group data show that students place high importance on faculty-developed materials that they can use on their own, but not attendance. The third-party resources are highly used as an adjunct to the formal curriculum and to focus on Step 1 study. Attendance and access to the formal curriculum do not predict Step 1 performance, whereas performance on high- and low-stakes internal assessments do. Further study on how the lack of social interaction gained from attendance affects development of other competencies and the learning climate are warranted.