Background: Nowadays simulation is taking an important place in training and education of healthcare professionals, moreover simulation allows for assessment and evaluation of the students'` performance. Aim: The aim of the study was to evaluate the effect of clinical versus simulation teaching among pediatric nursing students regarding competency level to care of preterm infants. Design: A quasi-experimental design .Sample: A purposive sample which included 95 students, which divided randomly into two groups (the study and control). Setting: the study was conducted at Faculty of Nursing, Palestine University and governmental Hospitals in Gaza strip. Tools: A pre/post designed questionnaire and observation checklist Results: The study revealed that, there were statistically significant differences between simulation group which had higher competency level with P value < 0.001 regarding to care of premature infants compared with the clinical group. Conclusion: Study students who have simulation had a better competency level with care of the premature infants. Recommendations: The study recommended that; create simulation training program as a strategy in nursing clinical training especially care of premature infants.