Study smarter, sleep better: learning approaches as predictors of sleep quality among medical students

Sleep is vital for effective learning, yet medical students frequently sacrifice rest during examination periods. This sleep loss, often attributed to last-minute cramming, undermines cognitive processes critical for academic success, including attention, memory encoding, and consolidation. Despite these concerns, the relationship between students' learning approaches and their sleep quality remains unclear. Thus, this study aimed to examine whether different learning approaches predict subjective sleep quality among medical students in the lead-up to their examinations.

This cross-sectional study surveyed 224 medical students (Medical University of Vienna) during their end-of-term examination period (June-September 2023). Participants reported their learning approach preferences and subjective sleep quality by completing online versions of the ASSIST and PSQI questionnaires, respectively.

Medical students scored highest for a deep approach, followed by a strategic and, last, a surface approach. Notably, a strategic approach significantly predicted better sleep quality, whereas a surface approach was strongly associated with poorer sleep outcomes, including longer sleep latency and higher PSQI scores. Somewhat unexpectedly, a deep approach also significantly predicted poorer sleep quality. Exploratory cluster analysis provided further nuance: students reporting high deep and strategic scores and low surface tendencies reported better sleep quality, whereas deep-oriented students without strong strategic engagement did not. Further analyses revealed that particularly the high scores on time management items were associated with better sleep quality, whereas high scores on fear of failure items were strongly linked to poorer sleep quality.

These findings shed light on the association between students' preferred learning approaches and their sleep quality during high-pressure examination periods. Educational interventions should promote strategic learning behaviors, such as effective time management, whereas offering guidance on managing examination-related anxiety and dysregulated study behaviors that impair sleep. Emphasizing the role of sleep in cognitive functioning may support students in maintaining balanced study-sleep routines.