This article reports on a qualitative evaluation of student use of a computer-assisted learning (CAL) program and associated learning outcomes. Learning outcomes were classified by analysis of examination scripts using the Structure of Observed Learning Outcomes (SOLO) taxonomy, and individuals were interviewed to uncover aspects of their learning processes while using the CAL program. All students were aware of the “design for learning” features of the CAL program, although not all students were able to take advantage of these because of their own note-taking practices. Verbatim or excessive note-taking was associated with surface learning outcomes, while summarizing or personal note-taking and engagement with the program was associated with deep learning outcomes. Other factors affecting learning outcomes included students' perceptions of the role of the program, social elements of the learning environment, and a lack of distinction between major and minor issues in the content.