Aim: to determine whether asynchronous virtual simulation with automatic feedback enhances learning about clinical decision-making in stroke compared with synchronous simulation with instructor-guided feedback in 4th-year medical students. We hypothesize that instructor-guided feedback drives better learning than automatic feedback. Methodology: a quantitative randomized controlled parallel study was designed using the CONSORT extension to simulation studies. Twenty 4th year undergraduate medical students were divided into two groups. One group performed virtual simulations with instructor-guided feedback, and the other worked autonomously with automatic feedback. We administered a knowledge score test survey before and after applying the intervention bundle and a usefulness perception survey. Two-way repeated measures analysis of variance (ANOVA) was used to compare changes in performance. Results: the results of the two-way ANOVA on the performance level showed no significant changes between groups and between the first and third scenarios (p=0,428). Analysis of the simple main effect showed no significant difference between groups in the post-test (p =0,086) and no significant difference after the third scenario in the Synchronous (p = 0,001) and Asynchronous (p = 0,009) groups. The most remarkable improvement was the International Normalized Ratio that contraindicates thrombolysis (70 % improvement), followed by the first-line drug for hypertension and the platelet value that contraindicates thrombolysis (25 % improvement for both). Conclusion: we did not identify differences in student stroke knowledge gained via virtual simulation with automated v/s instructor-guided feedback. The students learned specific elements linked to the safety of administering thrombolytics in patients with stroke. © Autor(es); 2023.