INTRODUCTION: Disaster triage is a crucial competency for paramedics. Traditional training methods, such as lectures and tabletop exercises (TTx), may not provide immersive and high-pressure experience necessary for optimal skill development. Virtual reality (VR) is innovative, allowing trainees to engage in realistic triage simulations in a controlled, interactive environment. OBJECTIVE: The study aimed to compare the effectiveness of VR-based triage training and traditional methods by assessing knowledge, learner motivation, and practical skills through pre-and post-tests, the ARCS model, and live simulations. METHODS: This method-oriented, randomized study was conducted over a 2-week intervention among 83 paramedic students and compared traditional lecture-based (n = 41) with VR-based (n = 42) training for MCI triage education among paramedic students at the Faculty of Medicine, Ramathibodi Hospital, Mahidol University. Both groups attended lectures. Knowledge was assessed through validated pre- and post-tests in four domains: memory, comprehension, application and analysis. Learner motivation was evaluated using the ARCS model (Attention, Relevance, Confidence, Satisfaction), and practical skills were measured during live simulations, assessing time use and a validated accuracy score that included triage steps, proper sequencing, and the correctness of triage judgment. RESULTS: Both groups demonstrated significant improvements in post-test knowledge scores. The VR group scored higher across all ARCS model dimensions: attention (4.78 vs. 4.17, p <
0.001), relevance (4.79 vs. 4.37, p <
0.001), confidence (4.74 vs. 4.24, p <
0.001), and satisfaction (4.71 vs. 4.34, p <
0.001). In the practical triage assessment, the VR group achieved higher accuracy in SORT triage (14.39 vs. 12.09, p = 0.001) than the traditional group. CONCLUSION: Both training methods effectively improved disaster triage knowledge and skills. However, the VR-based method significantly enhanced learner motivation and SORT triage accuracy, suggesting that VR may be a valuable alternative to traditional TTx in disaster triage training. CLINICAL TRIAL NUMBER: TCTR20241105003. Registration Site: Thai Clinical Trials Registry. URL: https://www.thaiclinicaltrials.org/show/TCTR20241105003 .