Evidence is steadily mounting on the prominence of online and technology-enabled learning in higher education. The present study intended to investigate whether virtual, interactive, real-time, instructor-led (VIRI) online learning has the potential to yield comparable student performance and engagement results to that of a traditional face-to-face (F2F) course. This is of great significance since the study delves into the possibilities of synchronous online learning in environments where resources are scarce and provide valuable insights into how technology can contribute to improving medical education and accessibility to educational resources in Iran and other comparable educational contexts. The participants were 18–30-year-old male (n = 16) and female (n = 24) students of nursing (n = 20) and operating room (n = 20) who enrolled in synchronous online and face-to-face courses as the requisite for the fulfilment of a bachelor’s degree. T-tests and descriptive statistics were the study employed T-tests and descriptive statistics to assess variations in both student performance and engagement results. The results revealed that a synchronous course conducted through VIRI classroom technology yields equivalent student performance outcomes to a traditional face-to-face (F2F) learning environment. The findings further showed that while the students did not appear to differ in terms of the levels of expected interest in the course and paying attention in class for the F2F and VIRI courses, they perceived themselves as displaying a different behaviour in the two courses in terms of attending class, participating in class, academic workload and instructor interactions. In fact, the post-semester findings showed that despite the students’ earlier expectations, they displayed different behaviour on all six student engagement factors. The findings of this study could have direct implications for the creation, development, and delivery of synchronous online courses in higher education, including medical ones.