Innovative use of standardized patients (SPs) in a telemedicine environment can improve learning outcomes and clinical competencies. This randomized, cross-over study examined the relationship of technology-based strategies and the improvement of knowledge outcomes and competencies. Results showed that the innovative use of SPs and telemedicine, compared to a traditional distance learning teaching methodology, significantly improved learning outcomes. In addition, there was a significant increase in performance motivation and an interesting decrease in student satisfaction that may be linked to the pressure of performance-based learning. This article addresses knowledge improvement only.