I've successfully used a screen reader (Jaws and NVDA), MS Word, and a pair of lightweight headphones throughout my undergrad and grad degrees. I found that typing my own notes (rather than having a note taker do it) vastly improved my understanding and recall of the material. Plus, you can immediately figure out if you need additional information/description of something, so you can schedule a meeting with the professor or TA as soon as the lecture ends.

Record your classes, if they'll let you. Then don't take any notes during class! Turn on the recorder, and hands off. Concentrate on participating in class; some classes have a portion of the mark that depends on in-class participation. And even the ones that don't, when it comes time that you need to ask for an extension from the professor, if they see you've been active and involved in the class, you're much more likely to get what you need from them. The day after class, listen to the recording, and take notes at that point. You'll still have memories of the class, so you'll have a much better idea what was important, and should go in your notes. Plus, listening to the class a second time is a useful way to study. When exam time comes, you'll find that you remember the start of term material pretty well, and don't need to cram as hard.

I think it would depend on what the class is, and how much notes you need to take. I know people who use both VoiceOver with a bluetooth keyboard and a JAWS laptop, but most students I work with prefer to use human note takers so they can focus on listening to the professor, and review the notes later.

When I was in college, I used a notebook PC with MSWord. Now that Word is much more accessible in IOS, I would use my iPhone, Word for IOS, and a Bluetooth keyboard. Using this option, you could probably record your classes at the same time. The iPhone mic is pretty darn good for general purpose recording.