Simulation is widely used in medical education, but controversy continues as to whether high-fidelity simulation is a more effective pedagogical modality than less intensive (and less expensive) types of simulation. In this controlled study, medical residents who underwent signout and teamwork training using high-fidelity simulation were no more effective at conducting high-quality signouts than residents who used an online virtual patient simulation. However, faculty felt that the high-fidelity simulator offered more opportunities for realistic feedback.