Since the availability of lecture recordings, there have been limited studies of any associations between face-to-face lecture attendance and academic outcomes. The aims of the study, in an introductory pathophysiology course, where lecture recordings were available, were 1) to quantify lecture attendance and any associations between academic outcomes and lecture attendance, and 2) to determine why students do or do not attend lectures. Data were analyzed for the whole cohort before separating the nursing ([approximately]60%) and nonnursing students. Of 288 enrolled students, 205 consented to sign the attendance register, and 139 to undertake the online survey. Lecture attendance was higher (41%) before the midsemester exam than afterwards (24%), P < 0.001, due to higher attendance by the nursing than nonnursing students. Students who attended [greater than or equal to]50% of lectures consistently got higher academic outcomes than those that attended <50%, e.g., examinations, 11 percent points higher. Pearson's or Spearman's correlation coefficients for students from both the sign-in and survey showed that there were positive associations between lecture attendance and academic outcomes, which were mainly weak for nursing students (P [less than or equal to] 0.05), with no association for nonnursing students. From the survey, most students who attended lectures did so because they considered they learned more by attending lectures, whereas not liking the lecture time was the most common reason for not attending lectures. In conclusion, even though students have access to lecture recordings, lecture attendance is still a determinant of academic outcomes for some students of pathophysiology.