Clinical skills acquisition is a cornerstone of medical education, traditionally imparted through bedside teaching (BT). However, the increasing complexity of medical practice and the imperative for patient safety have catalyzed the integration of simulation-based training (SBT) into medical curricula. This randomized controlled trial (RCT) aimed to compare the efficacy of SBT versus traditional BT in enhancing clinical skills among medical students. A total of 120 2nd -year medical students were randomly assigned to either the SBT group (n = 60) or the BT group (n = 60) at Al Aleem Medical College. The SBT group engaged in high-fidelity simulations encompassing scenarios such as myocardial infarction and reactive airways disease, facilitated by experienced clinical educators. The BT group participated in conventional bedside teaching sessions in hospital wards under faculty supervision. Clinical skills were assessed using Objective Structured Clinical Examinations (OSCEs) at baseline, post intervention (week 8), and at a three-month follow-up. Post-intervention analysis revealed that the SBT group exhibited a significant improvement in OSCE scores, with a mean increase from 62.5 ± 8.3 to 81.3 ± 7.9 (p < 0.001). In contrast, the BT group demonstrated a modest enhancement, with scores rising from 61.8 ± 8.1 to 71.1 ± 8.5 (p = 0.002). The between-group difference was statistically significant (p < 0.001). Additionally, self-reported confidence levels in clinical skills escalated by 35% in the SBT group, compared to an 18% increase in the BT group (p = 0.002). At the three-month follow-up, the SBT group maintained higher OSCE scores, although the intergroup disparity slightly diminished. These findings underscore that SBT is more effective than traditional BT in augmenting clinical skills and confidence among medical students. The structured and immersive nature of SBT offers a safe environment for repetitive practice and immediate feedback, thereby enhancing learning outcomes. Integrating SBT alongside traditional BT could optimize medical education by balancing theoretical knowledge with practical proficiency. Future research should explore the long-term retention of skills acquired through SBT and its impact on patient care outcomes.