BACKGROUND: In the field of medical education, students faced significant challenges during the COVID-19 pandemic. Abrupt alterations were made in the form of preventative precautions. Virtual classes replaced onsite classes, clinical placements were canceled, and social distance interventions prevented face-to-face practical sessions. The present study aimed to assess students' performance and satisfaction before and after the transition of a psychiatry course from onsite to entirely online during the COVID-19 pandemic. METHODS: A retrospective, non-clinical, and non-interventional comparative educational research study included all students registered in the psychiatric course for the academic year 2020 (pre-pandemic/onsite) and 2021 (during the pandemic/online).To assess students' satisfaction, we utilized the National Commission for Academic Accreditation and Assessment (NCAAA) students' satisfaction survey used by the academic quality unit at KSU, College of Medicine.Satisfaction was assessed in six domains: course organization, learning resources, faculty experiences, clinical teaching, practical sessions, and overall satisfaction. The reliability of the questionnaire was measured using Cronbach's alpha test.To assess their performance, students' grades from both periods were obtained from the exam center. RESULTS: A total of 193 medical students enrolled in the study; 80 received onsite learning and assessment, while another 113 received full online learning and assessment. The students' mean indicators of course satisfaction for the online courses exceeded their corresponding indicators significantly compared to the onsite courses. These indicators included students' satisfaction in terms of course organization, p < 0.001; medical learning resources, p < 0.050; faculty experience, p < 0.050; and overall course, p < 0.050. There were no significant differences regarding satisfaction in both practical sessions, p > 0.050, and clinical teaching, p > 0.050. The students' performance mean was significantly higher in the online (M = 91.76) compared to the onsite courses (M = 88.58) (p < 0.001), and the Cohen's D statistic showed there was a medium level of enhancement in students' overall grades (Cohen's d = 0.41). CONCLUSION: Students perceived the switch to online delivery methods very favorably. Students' satisfaction significantly improved regarding the themes of course organization, faculty experience, learning resources, and overall course satisfaction, while a similar level of adequate student satisfaction was maintained in terms of clinical teaching and practical sessions during the transition of the course to e-learning. In addition, the online course was associated with a trend toward higher students' grades. However, the assessment of the achievement of course learning outcomes and the maintenance of this positive impact warrants further investigation.