Background <p>This study aims to assess the effectiveness of model-assisted simulation training in teaching midwifery students the cardinal movements of the fetal head during the second stage of labor, as well as comparing students’ practical skills, satisfaction with learning, and self-confidence levels.</p> Methods <p>This study was carried out as a prospective, randomized controlled experimental study with a pre-test/post-test design, and it involves a total of 65 students from the Department of Midwifery at Karabük University. The training group received simulation-based, model-assisted hands-on training using a pelvis–fetal head model, whereas the control group received theoretical instruction accompanied by a video presentation. Data collection was conducted employing the Learner’s Guide and the Student Satisfaction and Self-Confidence in Learning Scale.</p> Results <p>In the training group, significant increases were found between pre- and post-test mean scores for the total scale and all subscales of the Student Satisfaction and Self-Confidence in Learning Scale (<i>p</i> &lt; 0.001). In the control group, a significant improvement was noted only in the “self-confidence” subscale and total scale scores (<i>p</i> = 0.001). In the post-test comparison, the training group demonstrated significantly higher mean scores for both the total scale and all subscales. In the evaluation of the Learner’s Guide, the training group showed significantly higher performance in critical cardinal movements (engagement, descent, flexion, internal rotation, extension, external rotation, expulsion) (<i>p</i> &lt; 0.05).</p> Conclusion <p>Simulation-based training supported with a fetal head-pelvis model is an effective method for improving midwifery students’ practical skills, satisfaction with learning, and self-confidence. Future educational programs and policymakers should consider adopting such evidence-based simulation practices to improve training outcomes and ultimately enhance patient care quality.</p> Trial Registration <p>Clinicaltrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT06755216">NCT06755216</a>.</p>