OBJECTIVE This paper reports an investigation of the approaches to study and learning of nursing and midwifery students at a school of nursing and midwifery in Iran. BACKGROUND Current knowledge suggests that students approach their studies in surface, deep or strategic manners. Students' approaches to study have an important impact on their academic success. Awareness of their approaches to study and factors that affect their choices is important for curriculum planners as well as nurse and midwife educators. METHODS A cross-sectional design was used with a convenience sample of nursing and midwifery students in all 3 years of study at one university in Iran. The validated Persian translation of Entwistle and Ramsden's Approaches and Study Skills Inventory was administered in a classroom context in 2003. RESULTS Sixty-four per cent (95% CI; 57-72%) of nursing and 63% (95%; CI 50-75%) of midwifery students adopted a deep approach. The use of a surface approach was negatively correlated to the stage of study for midwifery but not nursing students. There was also a statistically significant positive correlation between level of interest in the field of study and use of strategic approach for both nursing and midwifery students. Grade point average for the nursing students adopting the strategic approach was statistically significantly higher than for those adopting deep or surface approach. The grade point average for midwifery students adopting strategic approach was statistically significantly higher than that for those adopting deep approach, but not different from the grade point average of those adopting surface approach. CONCLUSIONS Our findings suggest that adoption of strategic or deep approaches to learning was associated with better educational outcome, as indicated by higher grade point averages. Moreover, the findings emphasize the impact of students' interest in their field on their academic success. Therefore, the adoption of factors which foster deep or strategic approaches and activities which increase students' interest should lead to improved academic outcomes.