The purpose of this study was to explore the use of an online curriculum system by first year medical students and its relationship to academic performance. The course test performance and online use of course based materials and resources were monitored for 114 first year medical students on a continuous basis from August 15, 2003, to May 31, 2004. Repeated measures of analysis of variance and multiple regression were used to assess differences in use online and test performance. All of the first year medical students showed dramatic fluctuations in online use of curriculum materials dictated by the seven regularly scheduled course examinations. The relationship between online study patterns and examination performance, however, was found not to be statistically significant. In conclusion, the patterns of online use of curriculum materials by first year medical students is not consistent, but varies dramatically as a function of the assessment process.