Background: In medical education, students still lack sufficient practice time to develop emergency medical competencies and clinical decision-making skills [3]. Aspects of patient safety and economic constraints in the emergency department complicate targeted competency-based teaching.Objective: Can the necessary competencies for clinical decision-making in emergency medicine be conveyed to medical students through the use of virtual reality (VR) embedded in a blended learning concept?Materials and methods: In a blended learning concept consisting of mandatory online preparation and a peer-led VR simulation (learning module) set in a virtual emergency department, students were trained in the initial care of an emergency patient. This was followed by a real-simulated structured handover and subsequent structured feedback session as part of post-training reflection. Evaluation of the learning module was conducted through a questionnaire addressing aspects of simulation-reality and immersion, subjective competency expansion, and preparation for the event. Additionally, subjective competency assessment was measured before and after the event using a survey.Results and conclusion: As part of a curriculum elective, our concept was used by 40% (n = 120) of fourth-year medical students at the Hannover Medical School in the 2022/23 academic year. The developed concept enables fourth-year medical students to acquire competency-based emergency management skills for high-risk situations. Using VR, students can practice realistic emergency scenarios in a safe and controlled environment without jeopardizing patient safety.