As far as attendance is concerned: It was "highly encouraged" with some bonus points, freebee test questions, and quizzes during second year CIL's. The hands on stuff like OMM and clinical skills is just plain required. There would be no other way for them to grade you because it's basically participation points. Then there is the pure fluff course called Community Doctoring. It's a known waste of time and back in the day you could miss a certain percentage of the lectures and get away with it. However, I remember missing just one such lecture on a day that nearly everyone else also decided it was a good idea to go ski or whatever. All of a sudden I had to write a 3 page paper on some random topic to "make up" for the day that I missed even though I had not missed any other days of that course. Basically, you can miss stuff, but be prepared to jump some extra hoops that someone in power creates to make themselves feel very good... about forcing future physicians to jump more hoops? I'm still confused about why administration gets off on making busy work, but they have you over a $200,000 barrel so you basically just do what you're told until you get that diploma.