Comparing online and onsite communication training: effects of social presence, performance, and acceptance in a randomized field trial

Effective doctor-patient communication is crucial for patient health outcomes, emotional well-being, and overall satisfaction. In undergraduate medical education, such skills are often taught through simulated patient (SP) interactions. With the acceleration of digital learning and teaching (DLT) during the COVID-19 pandemic, new flexible opportunities have emerged. However, questions remain about the quality of the communication experience, particularly the perceived social presence in online settings. A randomized between-subjects trial was conducted with 140 fourth-year medical students attending a mandatory communication course at the University of Bern, Switzerland. All participants completed identical preparatory learning materials before being randomly assigned to either online or face-to-face communication training with SPs. Both groups engaged in motivational-interviewing scenarios. Students’ and SPs perceptions of social presence were measured using the newly developed SoPr-scale . Communication performance was assessed by trained raters using the Behaviour Change Counselling Index (BECCI) for MI and the Berlin Global Rating (BGR) scale for general communication quality. SPs and students also rated their acceptance of the training modality. Both students and SPs in face-to-face condition reported significantly higher social presence compared with the online condition. Communication performance, however, did not differ significantly between groups. Notably, 99% of students and all SPs preferred face-to-face interactions. Although online training produced communication performance equivalent to face-to-face training, perceived social presence and preference strongly favored in-person delivery. These findings underscore the persistent challenge of fostering interpersonal connection in DLT environments despite technological progress. While online communication training can achieve comparable performance outcomes, enhancing social presence remains essential for (e.g.) sustaining engagement and satisfaction in medical DLT environments. Blended learning designs combining online preparation with onsite practice, and targeted efforts to enhance social presence, are recommended to optimize engagement and learning effectiveness. • Online and face-to-face training showed equivalent communication performance • Social presence was significantly higher in face-to-face encounters • Online training is a valid, flexible, and resource-efficient alternative • Enhancing social presence is key to improving digital communication learning