Is there a difference between distance and in-person learning during the COVID-19 pandemic in decentralized settings?

Objectives: This study aimed to explore differences in the effects of online and in-person decentralized learning programs on students' satisfaction, attitudes toward community healthcare, and career intentions. Methods: This cross-sectional study used questionnaires administered before and after Kobe University's rural decentralized learning program (conducted in-person in 2018 and 2019 and online in 2020). Of the 208 medical students who participated in any of these three, 198 were included in this study. Questionnaires had ten items regarding program satisfaction, students' attitudes toward community healthcare, and career intention. Difference-in-differences analysis using linear regression was performed for the online and in-person programs' pre-post score differences. Results: Both programs showed improved scores for most outcomes. However, the difference-in-differences analysis indicated significant differences in the enjoyment of the program (F-(5,F-390) = 18.58, p< 0.01, R-2 =0.17) and recognition of whether local physicians looked happy (F-(5,F-390) = 12.82, p< 0.01, R-2 = 0.16). The online program showed inferiority in the enjoyment of the program (beta = -0.89, t((390)) = -1.99, p = (0.05) and recognition of whether local physicians looked happy (beta = -0.67, t((390)) = -2.32, p = 0.02). Conclusions: The components of Kobe University's rural decentralized learning program could not be adequately replaced online. Further research should determine which components can be effectively replaced online and what results can be achieved when online programs consciously constructed to include such elements are compared to in-person programs.