Introduction <p>Livestreaming lectures during the pre-clerkship curriculum might facilitate student engagement. However, little is known about how livestreaming impacts student patterns of engagement, whether it is utilized by students when available, and how this technology is perceived by faculty.</p> Methods <p>We surveyed pre-clerkship students and faculty and compared attitudes regarding classroom engagement (January 2022). We then conducted a pilot of livestreaming large-group lectures and assessed the impact on student patterns of engagement (February 2022). After livestreaming was longitudinally integrated into the pre-clerkship curriculum, we collected multiyear follow-up data to determine if the technology continued to be utilized by students (January 2023 – March 2025).</p> Results <p>In a pre-intervention survey, a significantly higher percentage of students compared to faculty somewhat or strongly agreed that livestreaming provided equivalent education compared to in-person attendance (61.0% of students vs 19.0% of faculty, <i>p</i> &lt; 0.01). During the livestream pilot, the mean (SD) in-person attendance at optional large-group lectures decreased for both 1^st and 2^nd year modules with the introduction of livestreaming [65.9 (9.7) students vs 50.8 (14.0) students (<i>p</i> = 0.02) for the 1^st year module; 13.4 (9.3) students vs 5.0 (1.9) (<i>p</i> = 0.03) for the 2^nd year module]. In multiyear follow-up, 32.5% of students self-reported use of livestreaming half the time or greater during pre-clerkship modules.</p> Discussion <p>Students and faculty hold distinct views on classroom engagement. Livestreaming attendance-optional large-group lectures during the pre-clerkship curriculum changes patterns of engagement including a decrease in in-person attendance. When longitudinally integrated into the pre-clerkship curriculum, livestreaming is consistently utilized, albeit by a minority of students.</p>