Who benefits more from online vs. face-to-face learning?
The evidence shows that the answer depends heavily on the type of student. A 2023 study of anatomy students found that face-to-face learning boosted undergraduate exam scores by an average of 8.3% compared to online, but it actually lowered postgraduate scores by 8.1% [1]. This suggests that more experienced, self-directed learners may thrive online, while less experienced students benefit from the structure of a physical classroom.
Another study of nursing students found that those who took an obstetrics course online reported a more positive attitude toward learning and less avoidance of studying than their face-to-face peers [5]. The online group scored higher on a measure of active learning methods (77 vs. 67 out of a possible score), indicating that online formats can actually increase engagement for some learners.
When does face-to-face instruction outperform online?
For hands-on, skill-based subjects, face-to-face teaching still has a clear edge. A 2025 study of neurosurgery students found that those who learned in person scored significantly higher on clinical practice skills—like taking a medical history, performing a physical exam, and making a diagnosis—than those who learned online [6]. Students in the face-to-face group also reported better learning motivation, clinical thinking, and communication skills.
Similarly, a study of small-group collaborative learning in medical school found that students lost important opportunities for collaboration and social connection when they moved online [8]. The virtual setting made it harder to build a sense of community and to learn from peers outside their immediate group. This aligns with findings from a vestibular support group study, where online participants engaged more frequently (36% daily vs. less frequent in-person attendance) but still reported similar psychosocial benefits—suggesting that the depth of interaction may differ even when outcomes are comparable [2].
The real key: course design, not just delivery mode
The most important finding from the research is that how a course is designed matters far more than whether it is online or in person. A large analysis of 133 blended learning courses (where classroom time was cut in half and replaced with online work) found that overall, student achievement was equivalent to traditional classes [3]. However, there was huge variation between courses—some online courses performed much better, others much worse. The difference came down to design factors like clear course structure, activating learning tasks, frequent interaction with instructors, and timely feedback.
A 2025 study on mindfulness interventions found that both online and face-to-face groups reduced anxiety, stress, and depression, with the online group actually showing slightly better results on some measures [4]. This suggests that for certain types of content—especially those that rely on self-reflection and practice—online delivery can be just as effective, if not more so. The key is that the online version was synchronous (live) and carefully designed to mirror the in-person experience.
Finally, a long-term study spanning three years found that regardless of format, students who reached a certain threshold of knowledge accumulation experienced an 'epiphany' moment of sudden comprehension [7]. This breakthrough happened in both online and face-to-face settings, suggesting that the essence of learning—deep understanding—can occur in either mode. The study also highlighted the importance of engaging teachers, noting that interesting instructors were a key factor in effective learning, regardless of format.
Sources used in this answer
The effect of face-to-face versus online learning on student performance in anatomy: an observational study using a causal inference approach
Face-to-face learning improved undergraduate anatomy exam scores by 8.3% but lowered postgraduate scores by 8.1% compared to online learning, suggesting different modes suit different students.
Utilization of Face-to-Face Vestibular Support Groups: A Comparison to Online Group Participation.
Online support group participants were younger (mean age 50 vs. 57) and engaged more frequently (36% daily) than face-to-face participants, but both groups reported similar psychosocial benefits and goal achievement.
Learning effectiveness of a flexible learning study programme in a blended learning design: why are some courses more effective than others?
Across 133 blended learning courses, overall student achievement was equivalent to traditional classes (effect size near zero), but effectiveness varied widely based on course design quality, especially interaction and feedback.
Comparison of face-to-face and synchronous online mindfulness-based interventions: a quasi-experimental study.
Both online and face-to-face mindfulness interventions reduced anxiety, stress, and depression, with the online group showing higher efficacy on some measures; online was a viable alternative.
The effect of online and face-to-face active learning methods on learning attitudes
Nursing students in an online obstetrics course scored higher on active learning methods (77 vs. 67) and had lower learning avoidance than face-to-face students, indicating a more positive attitude toward learning online.
Comparison of face-to-face teaching and online teaching in neurosurgery education for medical students.
Face-to-face neurosurgery students scored significantly higher on clinical practice skills (history, exam, diagnosis) and reported better learning motivation and communication skills than online students.
Online vs. face-to-face: a long-term study on the effectiveness and essence of learning
A three-year study found that students who reached a knowledge threshold experienced an 'epiphany' moment of understanding in both online and face-to-face settings, with engaging teachers being a key factor.
Beyond Collaborative Learning: a Comparison of Small Groups in Face-to-Face and Online Settings
Medical students in online small-group learning lost collaboration opportunities and social connections compared to in-person groups, with less positive peer evaluations in the virtual setting.