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Background  No consensus exists on whether medical students develop towards more deep (DA) or surface learning approaches (SA) during medical training and how this impacts learning outcomes. We investigated whether subgroups with different trajectories of learning approaches in a medical students’ population show different long-term learning outcomes.    Methods  Person-oriented growth curve analyses on a prospective cohort of 269 medical students (M age =21years, 59 % females) traced subgroups according to their longitudinal DA/SA profile across academic years 1, 2, 3 and 5. Post-hoc analyses tested differences in academic performance between subgroups throughout the 6-year curriculum until the national high-stakes licensing exam certifying the undergraduate medical training.    Results  Two longitudinal trajectories emerged:  surface-oriented  ( n  = 157; 58 %), with higher and increasing levels of SA and lower and decreasing levels of DA; and  deep-oriented  ( n  = 112; 42 %), with lower and stable levels of SA and higher but slightly decreasing levels of DA. Post hoc analyses showed that from the beginning of clinical training,  deep-oriented  students diverged towards better learning outcomes in comparison with  surface-oriented  students.    Conclusions  Medical students follow different trajectories of learning approaches during a 6-year medical curriculum.  Deep-oriented  students are likely to achieve better clinical learning outcomes than  surface-oriented  students.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12909-021-02809-2.

Trajectories of learning approaches during a full medical curriculum: impact on clinical learning outcomes