The study compared the effectiveness of online and offline communication skills (CST) courses in 435 second-year postgraduate medical students, divided into an online group (2022) and an offline group (2023). Both groups completed 28 hours of CST, which included seven communication scenarios including role playing and Balint groups. Empathy was measured by the Jefferson Scale of Empathy (JSE) and patient orientation by the PPOS scale. Results showed that both groups achieved significant increases in PPOS scores, with the online group also experiencing significant improvements in JSE scores. No significant differences were found between the online and offline groups, indicating that online CST is not less effective than traditional offline training. Subgroup analyzes showed that men and surgical students tended to be more patient-oriented after training. The study supports the integration of online courses into medical education to increase accessibility and tailor modules to specific needs, while recommending further research to track long-term skill retention[1].