How do students learn in a large-enrollment hybrid forensic medicine course?

Background Large-enrollment hybrid courses can expand access to highly demanded courses, but simultaneously teaching in-person and online students may create challenges for engagement, interaction, and equitable participation. This study examined how students learned in a large-enrollment hybrid forensic medicine course by analyzing relationships among learning experiences, perceived learning, assignment performance, and attendance patterns, together with students’ perceptions of course delivery. Methods Participants were 194 undergraduates enrolled in a general education forensic medicine course offered at University A during the second semester of 2025. Class satisfaction, hybrid satisfaction, student engagement, and perceived learning were assessed using self-report scales. Assignment performance was assessed using a rubric-based argumentative essay on the legalization of physician-assisted dying. Attendance records from Weeks 1–11 and open-ended responses were also analyzed. Quantitative analyses included descriptive statistics, correlation analyses, and hierarchical multiple regression with HC3 robust standard errors; open-ended responses were examined thematically. Results Class satisfaction was positively associated with perceived learning, hybrid satisfaction, and student engagement, whereas assignment performance was not significantly associated with any self-reported learning-experience measure. After adjustment for year of study, academic discipline, and prior hybrid-course experience, hybrid satisfaction and student engagement significantly predicted perceived learning. Perceived learning and hybrid satisfaction significantly predicted class satisfaction, whereas student engagement and assignment performance did not. Five qualitative themes were identified: expanded access and flexibility, reduced concentration and interaction online, technological and physical constraints, concerns about attendance-policy clarity and fairness, and interaction challenges associated with large enrollment. Conclusions Perceived learning was not significantly associated with assignment performance in this sample. Evaluation of large-enrollment hybrid courses should therefore consider student-reported learning alongside assessed performance. Formative feedback, structured interaction for online students, transparent attendance policies, and reliable technological and instructional support may strengthen learning in large-enrollment hybrid settings.