<p>Medical students are often given the option to disengage from passive learning sessions such as attending a lecture or watching pre-recorded educational content. This decision is based on the lower retention rate of material delivered by passive educational methods. The goal of this study was to track the engagement of high- and low-performing students during the pre-clinical curriculum and determine if student engagement was associated with academic performance in either group. Participation in an optional weekly formative TopHat quiz was used as a proxy to measure the behavioral dimension of student engagement. Two thousand seventy-three pairs of participation data were collected from three cohorts of medical students. Nonparametric Spearman correlation analyses were performed to determine if there was a correlation between mean percent engagement and exam performance for each organ system course, and Welch’s <i>t</i> tests were performed to determine if there was a statistically significant difference in exam performance by high or low-performing students. Both high- and low-performing students disengaged from the quiz over time, although low-performing students disengaged at a higher rate. Participation was often associated with higher academic performance, although this effect was largely driven by disengagement of low-performing students. High-performing students received some benefits from participation. These data suggest that strategies to increase participation may not positively impact low-performing students as well as they impact high-performing students.</p>