Aim: This study aimed to evaluate the effects of the psychoacoustic learning method and high-fidelity simulation on the cardiac auscultation competence of nursing students. Background: Cardiac auscultation is a crucial skill for nursing students, yet many struggle to develop proficiency. Simulation-based training has emerged as a potential solution, but the effectiveness of different simulation modalities remains unclear. Design: A randomized controlled experimental study. Method: A total of 52 s-year nursing students were randomly assigned to one of three groups: psychoacoustic learning (n = 18), high-fidelity simulation (n = 17) and control (n = 17). Cardiac auscultation competence was assessed through a success test administered at three-time points: pre-test, post-test and follow-up (four weeks later). Learning satisfaction and self-confidence in learning were measured post-intervention. Results: The psychoacoustic learning group significantly improved cardiac auscultation scores from pre-test to post-test and follow-up (p < 0.05). The high-fidelity simulation group improved from pre- to post-test (p < 0.05) but not at follow-up. The control group showed no significant changes. No significant between-group differences in auscultation scores (p > 0.05), but high-fidelity simulation had higher learning satisfaction (p = 0.013) and total scale scores (p = 0.017) than psychoacoustic learning. Group-time interaction was not significant (p = 0.547). Conclusions: Psychoacoustic learning boosts short- and medium-term cardiac auscultation skills, while high-fidelity simulation enhances short-term performance and learning satisfaction. Combining psychoacoustic methods with simulation or traditional teaching may improve sustainable learning outcomes, balancing effectiveness, accessibility and cost.