New instructional technologies are increasingly used in today's quickly changing learning environment. The classical lecture format is often supplanted by recordings of lectures that can be streamed by students at a time of their choosing. The published literature presents varying conclusions regarding how students accept this alternative learning experience and how it impacts their learning and academic success. A multi‐year study of the first‐year (M1) histology component at the University of Michigan Medical School revealed that students strongly prefer the use of electronic learning resources (Holaday et al., Med. Sci. Educ., 23: 607–19, 2013). In addition, performance on M1 histology examinations is positively correlated with attendance at live lectures and is negatively correlated with the use of video recordings of the same lecture (Selvig et al., Anat. Sci. Educ., 8: 1–11; 2015). Two recent classes of University of Michigan M1 students (n=304; 90.2% participation rate) were surveyed in greater depth regarding their lecture attendance and lecture video usage. This analysis was aimed to identify factors that modulate the relationship between learning outcomes and the use of live lectures versus lecture videos. Students’ resource choices and usage patterns were analyzed and correlated with examination results in histology, anatomy, biochemistry, and physiology. We identified several usage behaviors that were negatively correlated with histology examination results. Students who attended live lectures while engaging in non‐lecture activities (e.g., social media, reading emails, Internet browsing) performed poorly on histology examinations compared to attendees who did not engage in these activities. Similarly, students who watch lecture videos and report being interrupted, feeling sleepy, or engaging in non‐lecture activities score lower on histology assessments than their non‐distracted counterparts. Similar correlations and patterns between subject test scores and lecture attendance versus lecture video usage were also observed for gross anatomy and biochemistry, but not for physiology. Students, who reported always attending live lectures, had the highest average subject test scores for all four subjects. These results indicate that the effectiveness of either learning modality (e.g., a live lecture or lecture video) is modulated by a number of factors, including the didactic context in which the lecture is offered and how it is used by learners.