This qualitative study investigated processes used by undergraduate students over a course sequence in anatomy and physiology (A&P). Longitudinal data for each participant include weekly written reflections and interviews at the beginning, middle, and end of the two-semester sequence. The themes that emerged describe three variations of approach to learning the course content. In some cases, the focus was on completing tasks and actions without connecting those to a specific outcome. In other cases, the focus was on outcomes without specific references to what steps might lead to that outcome. A third approach explicitly linked tasks and actions to one or more of nine different outcomes, including both personal and course expectations. Two other themes emerged as salient in combination with the three approaches: self-identified shortcomings with their study approaches and affective responses to the course and content. Affective responses included both positive affect such as enjoyment or excitement and negative affect such as frustration or dislike. Understanding the approaches that students take to learning, combined with their affect and shortcomings in those approaches, can inform instructor decisions about course activities and resources that support specific learning outcomes. It also provides a foundational knowledge base for the development of context-specific instruments for quantifying student learning processes in A&P.