The results prompted a revised model of how learning approaches relate to performance. The model incorporates students' initial scores on learning approaches as an element that influences students' perceptions of the educational context. In turn these perceptions have an impact on students' selections of learning approaches that are associated with performance.

Students perceived that learning during longitudinal ambulatory clerkships had greater impact on skill enhancement than on attainment of knowledge-related objectives. Sources of variation in student opinion, perceptions of learning as a function of career preference, and correlation of students' perceptions of learning to demonstrable changes in their competence require further investigation.

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