INTRODUCTIONStudents' motivation, educational strategies, types of assessment and different learning approaches are factors that are considered fundamental to medical education. They have an important influence on the teaching-learning process. 1-3 Biggs 4 defined learning approaches as the combination of motivation and strategy that students use in the learning process, which can be "surface" or "deep".The deep approach comprises the capacity to correlate new and previous knowledge, study comprehensively in order to obtain the "entire picture" and search for meaning and implications for the acquired knowledge. 5 Its strategy is based on personal commitment to the learning process and its motivation is intrinsic, in the search for self-fulfillment. 4 This contrasts with the surface approach, which is the tendency to choose the quickest way to accomplish the task, in which students study the material in a linear manner, do not ask in-depth questions, do not show proper interest in the subject and rely on memory instead of comprehension. 5 Students with surface approaches tend to achieve the minimum necessary to avoid failure at school. 6Previous studies have pointed out that the same students can have varying approaches, depending on the subject that they are studying, levels of apprehension and work overload. 7,8 Understanding these learning approaches could have important repercussions on students' academic life. Mattick et al. 9 showed that students with a deep approach tend to be more organized, monitor their studies better and exert a greater effort to learn, such that their performance in tests is better. The same results were found by McManus et al., 10 who found that students with a deep approach had better outcomes in final exams. I MD. Physician and Research Collaborator in the ABSTRACT BACKGROUND: Different approaches to learning can exert considerable influence on the teaching-learning process in medical education. This study aimed to investigate the association of surface and deep learning with study patterns, preferred type of assessment, practices of cheating and quality of sleep among medical students. DESIGN AND SETTING: Cross-sectional study on medical students enrolled in all six years of a medical school in Juiz de Fora, Brazil. METHODS: Questionnaires were applied to evaluate learning approaches (R-SPQ-2F), study patterns, sources and choices, and quality of sleep. Students' learning approaches (deep or surface) were assessed in relation to their study patterns, study resources, quality of sleep and whether they cheated in tests. RESULTS: Among the 710 students included, 43% frequently studied on the night before an exam, 65% had used psychostimulants to study and more than 46% had cheated in an exam. Regarding quality of sleep, most students (53.4%) reported that their quality of sleep was poor, such that 45.3% slept for fewer than five hours before an exam. Those who studied just prior to an exam, used class summaries, preferred multiple-choice questions and cheated during the test had a mor...