Background: Current broadcasting technology enables distance learning but the impact of such on medical student participation is unknown.  Here we evaluate student participation amongst second year medical school students comparing offsite vs onsite/in-person lectures at the University of Toronto Faculty of Medicine St. George (STG) and Mississauga Academy of Medicine (MAM) campuses.

Methods: Questions asked per offsite vs onsite lecture was compared as a measure of student participation at each campus and analyzed for course type (Concepts, Patients and Communities 3, CPC-3, and Life Cycle, LC), and lecture category (Lecture only, ISAL only, and Lecture and ISAL). Unpaired, t-tests were used to determine statistical significance (p-value <0.05).

Results: A total of 102 lectures (86 at STG, 16 at MAM) yielded 239 questions by STG students (213 onsite, 26 offsite) and 46 questions by MAM students (22 onsite, 24 offsite). When comparing onsite to offsite lectures, STG students asked 1.13 and 0.85 more questions per lecture and 0.83 fewer questions per lecture for Lecture only, Lecture and ISAL, and ISAL only categories, respectively (p-values of 0.09, 0.19, and 0.61, respectively). When comparing onsite to offsite lectures, MAM students asked 1.08, 1.10, and 1.25 more questions per lecture for these same categories (p-values of <0.0001, <0.0001, and 0.01, respectively).

Conclusions: Students are statistically likely to ask more questions when the lecturer is physically present than through distance learning. Future observational studies are needed to identify reasons for these differences and the corresponding impact on student learning and performance. The overall goal is to maximize learner participation.