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This article was migrated. The article was marked as recommended. Introduction: Despite the increasing popularity of high-fidelity simulation (SIM), few studies compare the effectiveness of SIM with established small-group modalities such as problem-based learning (PBL) for factual learning among pre-clinical medical undergraduates. Methods:162 second-year medical students were randomized to two groups. The first group encountered teaching points related to the management of hypertensive emergency during a traditional PBL session, while the second group covered the same teaching points through SIM. Both groups then completed a post-test. The students were subsequently crossed-over to the opposite modality and assessed on teaching points related to the management of chronic obstructive pulmonary disease exacerbations. Results: A total of 162 students participated in the study. For the hypertension case, the average proportion of correct questions for the SIM intervention was 83% compared to 70% for the PBL intervention (OR = 3.1, 95% CI [1.3, 7.2], p=0.009). For the COPD case, the average proportion of correct questions for the SIM intervention was 73% compared to 51% for the PBL intervention (OR = 2.6, 95% CI [1.8, 3.8], p < 0.001). Conclusion:Students scored significantly higher with SIM in both cases, indicating that SIM may be superior to PBL for factual learning among students with limited clinical exposure.