Students’ Satisfaction and Learning Outcomes with Virtual and Light Microscopy in Undergraduate Pathology: A Randomised Cross-Over Trial Virtual microscopy (VM) has emerged as a valuable adjunct to light microscopy (LM) in medical education, enabling remote access to high-quality histopathological images. While many studies report improved satisfaction and comparable better learning outcomes with VM, effectiveness in student performance was not properly studied. This study evaluated students’ satisfaction and effectiveness of VM compared to LM in undergraduate pathology teaching of a Malaysia private institution. A randomised cross-over trial was conducted among Year 1 and Year 2 medical students. Pre- and post tests consisting of 10 one-best-answer (OBA) questions, mapped to the histopathology slides used in pathology practical sessions, were used to analyse effectiveness of VM and LM. After crossover swapping the groups, students completed pre-validated 5-point Likert scale questionnaires to assess the satisfaction on both methods. A majority (≥65%) expressed satisfaction with both LM and VM; however, VM scored higher for ease of use, time efficiency, and image quality. Group (B) with VM followed by LM had higher mean pre-test scores (6.85 ± 1.80) than Group A with LM followed by VM (5.92 ± 2.29), suggesting possible baseline differences. Post-test scores improved significantly in both groups (p < 0.001). Although Group B’s post test mean was higher (9.13 ± 1.19) than Group A’s (8.61 ± 1.63), this may reflect initial group performance rather than VM superiority alone. Although the reliability statistics of tests could not be analysed, this study concluded that VM is a reliable adjunct tool to replace traditional LM in teaching learning. However, differences in baseline performance between groups highlight the need for cautious interpretation when comparing modalities. Integration of VM into e-learning platforms may enhance blended pathology education.