imulation-based learning is a well-established learning activity in health professions education. [1][2][3][4][5] Simulation has been used in physical therapist (PT) education to provide students with opportunities to advance psychomotor skills, engage in clinical decision making, apply feedback from mentors, and navigate patient interactions in a low-risk setting to prepare for patient care as entry-level clinicians. 4,5 Health care simulation consists of using high-fidelity simulation, 1,6-8 standardized patients (SPs), 2,4,9-13 volunteer patients (VPs), 11 and peer role-playing. 2,13 These models of simulation have demonstrated an increase in PT students' confidence in clinical skills and decision-making abilities. 1,8 High-fidelity simulation, which consists of the use of a computerized manikin, has been shown to be an effective teaching tool among health care professions. 6 In addition, research supports the use of SPs, individuals trained to depict medical conditions, to teach clinical skills in health care education. 2,4,[9][10][11][12][13] Because of the high costs of high-fidelity simulation and SPs, VPs and peer role-playing are often used to improve student performance. Dalwood et al 2 demonstrated that although peer-role-playing lacked the realism of using a SP, PT students demonstrated increased confidence,