Purpose
Effective learning strategies enhance long-term learning and academic performance and are therefore crucial for lifelong learning. However, literature shows inconsistencies in reported effectiveness of individual strategies. This study explores which learning strategies first-year (bio)medical students use, whether usage differs across different undergraduate programs, and if any overarching combinations are present.

Methods
First-year undergraduate Medical (Med, n=187), Clinical Technology (CT, n=28), and Biomedical Sciences (BS, n=40) students at our institution in 2023 reported their usage of cognitive learning strategies from a list of twelve most commonly used strategies, both effective and ineffective. Learning strategy combinations were analyzed specifically among Med students (due to sample sizes), using principal component analysis (PCA) with varimax rotation.

Results
In all three programs, students widely used Practice Testing and Summarization and infrequently used Peer Learning. Although the overall ranking of learning strategy usage was similar across the programs, BS students used slightly more deep-learning strategies, and CT students used fewer surface-learning strategies. Specifically in Med students, PCA identified five coherent combinations of learning strategies:

1. Deep learning’ clustering deep-learning strategies (Self-Explanation, Elaborative Interrogation) with Imagery;
2. Surface learning’ combining two surface-learning strategies (Rereading, Highlighting) with Summarization;
3. Creative learning’ pairing Summarization with visual and associative learning strategies (Imagery, Mnemonics);
4. Distributed repetition’ integrating Distributed Practice and Practice Testing, excluding Mass Practice; and
5. Interleaved repetition’ linking Interleaved Practice, Practice Testing, and Peer Learning.

Conclusions
The usage of learning strategies is similar across the three undergraduate programs, but appears to be a mix of both effective and ineffective strategies. However, the PCA revealed five combinations of strategies, which might explain the inconsistencies in the literature on effectiveness of individual strategies. These insights could inform the development of targeted learning-to-learn interventions in bio(medical) education and may guide further research into the effectiveness of learning strategy combinations.