Having performed research using approaches to learning and studying inventories and become familiar with the concepts they purport to measure, the authors were concerned that existing inventories might not capture the full range of "intentions" and "motivations" for learning that exist within populations of medical students. We used semi-structured interviews to explore the approaches to learning of undergraduate medical students at two time points: in the academic setting (year 2) and subsequently in the clinical setting (year 3). A thematic index was created using a framework analysis approach with the data derived from the academic setting and subsequently applied to and developed by the data derived from the clinical setting. Some themes and sub-themes emerging from the analysis fitted well with the deep, surface and strategic approaches described previously in higher education. Others did not. In particular, the importance of the vocational and social aspects of learning was striking in this sample of students, in both academic and clinical settings, and these would be missed by the majority of existing inventories. This study confirms that existing conceptions of approaches to learning within the higher education literature do not account for the full range of intentions and motivations that exist within medical student populations.