Objective: Few studies describe changes in students' class preparation, note-taking, and examination preparation over the course of professional school. This study aims to describe the use of these learning and study strategies by pharmacy students and to analyze changes during enrollment. Methods: We performed a prospective, observational cohort study of students at a single US pharmacy school between 2016-2019. Students completed an online survey on learning and study strategies at the beginning of each school year. Quantitative results were analyzed by level in pharmacy school during which the survey was completed as the primary predictor. Open-ended responses were thematically analyzed using an inductive approach. Results: We observed significant changes in strategies, including an increased use of audiovisual materials for course preparation, preference for electronic over manual notetaking, increasing use of lecture capture viewing, and increased use of peer materials in studying. Changes were generally largest between the first (P1) and second (P2) survey years, representing adjustments in student behaviors during P1 year. In some cases, changes from P1 to P2 survey years were followed by a gradual return towards P1 survey levels. Three themes described students' comments: Students' preferences shaped their learning strategies, experiences guided changes in learning strategies, and description of additional strategies beyond those included in the survey items. Conclusions: Significant changes in pharmacy student study strategies occur over the course of enrollment. This may represent an opportunity to promote use of more effective approaches for long-term learning.