Medical students' approaches to learning over a full degree programme

Students take three approaches to learning and studying: deep, surface and strategic, influenced by the learning environment. Following the General Medical Council's report "Tomorrow's Doctors," a deep approach was cultivated in Years 1 and 2 of a university undergraduate medical programme by introducing explicit written learning objectives constructed according to Biggs' SOLO taxonomy, problem-based learning and constructively aligned in-course assignments and examinations. The effect of these changes was measured with the Approaches to Study Skills Inventory for Students (ASSIST). Scores were highest for a deep approach and lowest for a surface approach and showed relatively little change during the degree programme, apart from a slight fall in the scores for a surface approach, particularly for students undertaking an intercalated science degree. Possible explanations include: students' approaches may be established prior to university entry; deep scores were already high at the beginning of the programme and may be difficult to increase further; the changes in learning environment may not be strong enough to alter approaches which students perceive as having been successful.