Patient-centered communication is an essential skill in nursing, particularly in the care of elderly patients. However, Generation Z nursing students, who primarily communicate through digital platforms, face unique challenges in adapting to traditional face-to-face communication with older adults. As a result, there is a need for teaching methods that align with this generation's learning style to enhance their communication skills. This study aimed to compare the effectiveness of two teaching methods-standardized patient simulation and role-play-on nursing students' acquisition of patient-centered communication competence in elderly care. Methods: A controlled cluster-randomized trial was conducted with 124 nursing students, divided into eight teaching groups. Students participated in either a standardized patient simulation or a role-play workshop, each consisting of a 1.5-hour online module and a 1.5-hour face-to-face session. The three components of patient-centered communication competence-knowledge, skills, and self-efficacy-were assessed using simulated scenarios at pre-test, post-test, and six-week follow-up. Between-group and withingroup differences were measured based on the number of students who achieved competence. Results: Both interventions significantly improved students' knowledge, skills, and self-efficacy in patient-centered communication between pre-and post-tests, with improvements maintained at follow-up. No significant differences were found between the two methods. Conclusions: Both standardized patient simulation and role-play are effective in enhancing patient-centered communication competence in elderly care. However, neither method was found to be superior in teaching knowledge, skills, or self-efficacy.