Background: Little is known about the impacts of class attendance and learning preferences on academic performance in dermatology. Objectives: This study was designed to examine the effects of medical student class attendance and learning preferences on students' academic performance in an introductory dermatology course. Methods: A total of 101 second-year medical students enrolled in a required introductory dermatology course were surveyed regarding their learning preferences. Records of class attendance and scores on the final examination were reviewed. Results: The most frequently cited reason for attending classes was social expectation (96%), whereas the least cited was learning well in a classroom-type setting (65%). The top reasons cited by students for not attending classes were availability of lectures online (35%), preference for individual study outside the classroom setting (26%), and the inconvenience of traveling to class (24%). Multivariate analysis found no statistically significant relationship between class attendance and performance on the final examination (estimate -0.074, standard error 0.12; P = 0.54) after adjusting for sex, age, Medical College Admission Test (MCAT) score, having children at home, and reason for attending class. Those who prefer to learn by watching online videos scored significantly higher on the final examination (prefer online videos: 87 ± 5.5; neutral: 86 ± 5.9; do not prefer online videos: 82 ± 2.6 [P = 0.049]). Conclusions: Class attendance was not associated with improved academic performance in a dermatology course. Those who preferred to learn by watching online videos demonstrated a higher level of performance than those who did not prefer to learn this way.