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Simulation-based learning (SBL) is widely used in professional training because it recreates realistic situations and calls for active decision-making. In research, however, simulation is often delivered alongside additional supports, such as preparatory materials and feedback, and comparison conditions can differ in important ways (for example, learning time, content exposure, or assessment methods). This can make it harder to isolate what simulation itself contributes. In our study, we therefore used a tightly controlled design to focus on one core element: a live, interactive encounter with a “patient”.

We recruited 88 adults and excluded individuals with academic training or work experience in medicine or psychology, so participants could not rely on prior knowledge. The task emphasized identifying the symptoms displayed by the “patient” and the sequence in which they appeared. For one case, participants learned through a live encounter with a trained actor (a standardized patient): they asked guided questions and engaged in brief, scripted interactions to observe how symptoms unfolded over time. For the other case, participants learned the same information through a structured on-screen text narrated by an unfamiliar voice. Importantly, informational content and exposure time were matched across the two learning formats.

One month later, we assessed long-term learning in two formats. In the written format, participants answered on-screen questions about which symptoms appeared and in what order. In the video format, they watched short clips of an actor displaying the symptoms and answered comparable questions. For each response, we measured accuracy, response time, and confidence in their answer.

Overall, the simulation condition led to better performance: participants answered more accurately and faster than after text-based learning, and they were more likely to report being fully certain about their answers. Learning order mattered as well: starting with the text-based version enhances subsequent performance in the simulation condition, whereas starting with simulation did not provide the same benefit for later text learning. Finally, individual differences played a role: participants who reported stronger mental imagery ability were generally more accurate, particularly in the written format.

These findings raise the possibility that simulation-based learning protocols may benefit from a brief initial textual/theoretical primer (or structured pre-brief) that helps learners build an initial mental framework before the embodied, interactive encounter. This kind of “theory-first” step may scaffold attention and encoding during simulation —potentially making the subsequent SBL experience more efficient and more durable.