As the role of pharmacists expands toward patient-centered care, pharmacy education emphasizes competency-based learning through practice, with simulation-based learning increasingly used. However, evidence on the effectiveness of simulation remains limited. This study aimed to develop and evaluate a scenario-based computer simulation for pharmacy practice education. The study had two phases. In phase 1, simulation components, including a scenario, rubric, and performance checklist, were developed and validated through a Delphi process with 16 hospital pharmacists. In phase 2, a randomized controlled trial compared educational outcomes of simulation and lectures. Among 68 students, 26 who completed the study were randomly assigned to intervention (n=13) and control (n=13) groups. Learning outcomes were measured by a pharmacotherapy knowledge test, the Student Satisfaction and Self-Confidence in Learning scale, and flow. No statistically significant between-group differences were found in pharmacotherapy knowledge, confidence, satisfaction, or flow. The control group showed a greater increase in learning confidence (p=0.05). Grade point average and change in confidence correlated positively with satisfaction and flow (p<0.05). The simulation did not show superior effectiveness to lectures but may serve as a structured approach to support pharmacy practice learning. Further research is needed to optimize simulation design and assess its effectiveness in larger samples.