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This study evaluates the effects of three key simulation methods\u2014Standardized Patients (SP), High-Fidelity Simulators (HFS), and Virtual Reality (VR)\u2014on medical students\u2019 engagement and clinical performance confidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study involved 43 fifth-year medical students from the Ajou University School of Medicine during a respiratory clinical rotation. The students participated in SP-, HFS-, and VR-based simulation education. After each simulation module, their engagement (interest, flow, relevance) and clinical confidence (history taking, physical examination, interacting and communicating with patients, clinical reasoning) were assessed using self-report surveys. A Multivariate Analysis of Variance was conducted to analyze differences in engagement and confidence across the simulation modules.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The simulation methods had little significant effect on students\u2019 learning engagement or its sub-factors. However, there were significant differences in clinical performance confidence depending on the simulation module. Confidence in history taking, physical examination, and interacting and communicating with patients were significantly higher when using SP compared to HFS and VR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides practical guidance for designing and developing clinical training curricula by directly comparing the effects of various simulation-based education methods. The results suggest that SP-based simulation education is particularly effective in enhancing medical students\u2019 confidence in clinical settings. While VR and HFS offer advantages in immersion and realism, the experience of interacting with actual patients remain crucial for boosting clinical performance confidence. These findings offer crucial insights for optimizing medical education and improving clinical competencies of medical students.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12909-026-08634-9","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T06:36:15Z","timestamp":1769150175000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluating medical students\u2019 engagement and confidence across three simulation-based education methods: standardized patient, high fidelity simulator, and virtual reality"],"prefix":"10.1186","volume":"26","author":[{"given":"Jihye","family":"Yu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukyung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janghoon","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun Jung","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"8634_CR1","doi-asserted-by":"publisher","unstructured":"Motola I, Devine LA, Chung HS, Sullivan JE, Issenberg SB. 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The study was approved by the Institutional Review Board (IRB) of Ajou University Hospital (Ethics consent No. AJOUIRB-DB-2024-392). The requirement for informed consent was waived by the Ajou University Hospital Institutional Review Board, as this was a retrospective study analyzing student engagement and clinical performance confidence based on simulation-based educational methods implemented in the respiratory medicine clerkship as part of the regular curriculum of Ajou University School of Medicine. The study utilized data collected after completion of the educational program and included the entire cohort of participating students. The IRB determined that the impact on the safety, rights, and welfare of the students was minimal, thereby justifying the waiver of informed consent. All methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"283"}}