MEDICAL EDUCATION First Year Medical Students’ Approaches to Study and Their Outcomes in a Gross Anatomy Course PETER J. WARD * Department of Biomedical Science, West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia Three approaches to study have been described in phenomenographic educa- tional 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 corre- lated 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. Clin. Anat. 24:120–127, 2011. V V C 2010 Wiley-Liss, Inc. Key words: education; phenomenography; medical anatomy; medical education; anatomy education; ASSIST; approaches to study; study approaches INTRODUCTION Students’ approaches to study can affect their per- formance on exams and later recall of class material. However, because of the wide array of variables in a classroom environment, it is difficult to find simple cause and effect relationships between study and edu- cational outcomes. To generate a model of student learning that was drawn directly from actual classroom experience, the phenomenographic method of qualita- tive research was created by Marton and Sa ¨ljo ¨ (1976a,b) to describe how students arrived at different levels of understanding within the context of a course. Interviews with the students showed that their approaches to study fell into two major categories: deep or surface. Students using a deep approach worked to internalize the coursework and make it *Correspondence to: Peter J. Ward, West Virginia School of Osteo- pathic Medicine, 400 North Lee Street, Lewisburg, WV 24901, USA. E-mail: pward@osteo.wvsom.edu Received 27 April 2010; Revised 25 August 2010; Accepted 31 August 2010 Published online 12 October 2010 in Wiley Online Library (wileyonlinelibrary.com) DOI 10.1002/ca.21071 V V C 2010 Wiley-Liss, Inc. Clinical Anatomy 24:120–127 (2011)