BackgroundSimulation-based interventions for nursing students addressing challenging communication situations involving geriatric patients and end-of-life care are limited. PurposeThis study evaluated the effects of technology-based interactive communication simulations on nursing students' communication knowledge, self-efficacy, skills, compassion, and program satisfaction. MethodA randomized controlled repeated-measures design was used with third- and fourth-year nursing students enrolled in five nursing colleges located in five regions in Korea as participants. Participants were randomly assigned to either a technology-based interactive communication simulation or an attention control group. Changes in communication knowledge, self-efficacy, skills, compassion, and program satisfaction were assessed using three self-reported measures and communication skills were measured by the raters. Statistical analyses included descriptive analyses, chi-square tests, t-tests, and a generalized estimating equation model. ResultsEighty students participated in one of the two programs, and 77 in the four-week follow-up test. The intervention group indicated significant improvements in communication knowledge, self-efficacy, skills, and compassion, as well as higher program satisfaction compared with the attention control group. Communication skills as assessed by raters also showed significant change at all assessment time points. ConclusionThe technology-based interactive communication simulation program is effective in improving communication skills among nursing students managing geriatric patients and end-of-life care.