BackgroundSustained remote learning environments, like those experienced in late 2020 due to the COVID-19 pandemic, share characteristics with online courses but were not intentionally designed to delivered virtually. The purpose of this study was to investigate the impact of Community of Inquiry, a widely used online learning environment framework, and self-efficacy on perceived student attitudes within sustained remote learning environments.MethodsAn interinstitutional team of health professions education researchers collected survey data from 205 students representing a wide range of health professions in five U.S. institutions. Latent mediation models under structural equation modeling framework were used to examine whether student self-efficacy mediates the relationship between Community of Inquiry presence and student’s favorability of sustained remote learning delivered in the prolonged stages of the COVID-19 pandemic.ResultsHigher levels of teaching presence and social presence in the remote learning environment were associated with higher levels of remote learning self-efficacy which, in turn, predicts variance in positive attitudes toward remote learning. When mediated by self-efficacy, significant variance in student’s favorability of sustained remote learning was explained by teaching presence (61%), social presence (64%), and cognitive presence (88%) and self-efficacy. Significant direct and indirect effects for teaching and social presence, and only direct effects for cognitive presence were observed.ConclusionsThis study establishes the Community of Inquiry and its three presence types as a relevant and stable framework for investigating sustained remote health professions teaching and learning environments, not only carefully designed online learning environments. Faculty may focus course design strategies which enhance presence and increase student self-efficacy for the sustained remote learning environment.