Prior text-based learning enhances the benefits of simulation-based learning on confidence and long-term recall

Simulation-based learning (SBL) has been mostly studied in medical and STEM settings, where its specific role in learning is difficult to isolate. We ran a randomized, counterbalanced mixed design (N = 88) in which naïve adults learned two fictitious clinical cases via a live standardized-patient simulation or a structured text format; content and exposure time were matched. One month later, video- and text-based evaluations assessed accuracy, reaction time, and confidence. SBL yielded faster responses and higher accuracy than text. An order effect emerged: learning text first boosted subsequent SBL accuracy, while the opposite order did not. Individual imagery ability predicted better accuracy overall and more strongly in the text condition. Participants were more likely to report absolute confidence after SBL, with confidence more closely aligned to accuracy. These findings suggest that both SBL and text support durable learning, but their effects depend on instructional order and imagery ability, and SBL additionally enhances confidence-accuracy calibration.