First year medical students' approaches to study and their outcomes in a gross anatomy course.

Three approaches to study have been described in phenomenographic educational research: deep, strategic, and surface. Deep approaches to learning have been correlated with meaningful learning and academic success, whereas surface approaches produce an externalization of learning and poor outcomes. Students adopting a strategic approach adopt either a deep or surface approach in response to perceived examination demands. Despite being well known in Europe and Australia, this research paradigm has been applied sporadically in the United States. In this study, the approaches to study of a group of first year American medical students were collected using the Approaches and Study Skills Inventory for Students instrument at the beginning and end of their first year to find how consistent these approaches remained over time. At both times, the majority of participants adopted deep approaches, followed by strategic and then surface approaches. The percentage of participants using a surface approach grew during the first year but never exceeded 10%. The mean anatomy grades of students adopting each approach were then compared to find how each approach correlated with success in the course. Mean grades of students using a strategic approach were significantly higher than average at both times. Students who maintained a strategic approach throughout the first year had significantly higher mean grades than average while students who changed to a surface approach had significantly worse mean anatomy grades. Problem-based students had significantly higher scores on several deep submeasures than lecture-based peers and female students demonstrated greater fear of failure than male peers at both times.