Introduction Given Japan’s cultural emphasis on group harmony, hierarchical relationships, and indirect communication, the study explores to what degree online Problem-Based Learning (PBL), which requires active participation and self-directed learning, is suitable for Japanese medical students. This is particularly important in fields such as child and adolescent psychiatry, where effective communication and collaborative problem-solving are essential.

Method This study analyses data from medical students at Nagoya University who participated in a Child and Adolescent Psychiatry (CPA) PBL program. In 2019, the program was conducted in-person, while in 2021, another group of students participated in the program online. Both groups completed a 15-item questionnaire. Statistical analyses (regression, factor analysis, clustering) were performed to assess factors influencing satisfaction and engagement with PBL.

Result In-person PBL group reported lower satisfaction (p = 0.002), and younger students and females showed higher satisfaction (p=0.025 and p=0.053, respectively) with PBL. Factor analysis showed two dimensions: Perceived Learning Efficacy and CPA-Specific Appropriateness, with significant group differences (p < 0.001). Cluster analysis identified two groups: Cluster 1 (69% in-person, dissatisfied) and Cluster 2 (57% online, satisfied), with key factors being understanding and enjoyment.

Discussion Online PBL improved student satisfaction, particularly for topics requiring engagement and reflection. These findings suggest that online PBL offers flexibility and accessibility, but challenges related to English language and communication skills remain. Tailoring PBL to specific cultural and demographic contexts, along with fostering international collaboration, could enhance learning outcomes and engagement.

The authors have declared that no competing interests exist.

The author(s) received no specific funding for this work.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was approved by representatives of the ethical committee at Nagoya University (Approval Code: 2021-0482).

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The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.