Purpose
Workplace-based assessments have been emphasized as important measures for medical trainees’ clinical performance. Few studies have been conducted to examine the associations between the approaches to learning medicine and clinical performance. The objectives were:

1. to examine the association between medical trainees’ approaches to learning medicine and their clinical skills; and
2. to examine the association between medical trainees’ approaches to learning medicine, and their clinical reasoning and decision-making.

Methods
We used the Approaches to Learning Medicine (ALM) questionnaire, a modification of the Revised Learning Process Questionnaire, to measure the medical trainees’ approaches to learning medicine. We measured clinical skills using Mini-Clinical Evaluation Exercise (Mini-CEX), and clinical reasoning and decision-making using Case-based Discussion (CbD). Cronbach’s alpha was conducted to examine the internal consistency reliability. Pearson’s correlation coefficient and Spearman’s Rank correlation coefficient were used to measure the correlation coefficient between the independent variables and a dependent variable. Stepwise multivariate linear regression with backward elimination was then employed to examine the associations between the approaches to learning medicine and clinical performance.

Results
A medical trainee’s overall academic performance (r=0.27, p=0.05), and the deep motive of "Intrinsic Interests" (r=0.09, p=0.04) were associated with clinical skills. In comparison, the deep motive of "Intrinsic Interests" (r=0.11, p=0.05) was associated with clinical reasoning and decision-making.

Conclusions
This study showed that a medical trainee’s approaches to learning medicine predicted his/her clinical skills, clinical reasoning, and clinical decision-making ability. Medical trainees as medical learners, for better clinical performance, should promote intrinsic interests in being a capable physician, to regard each clinical assessment as one of the series of qualifications, and to avoid fearing failure by using the strategies such as preparing early, making good time arrangement, and so on.