Purpose: To inform physical therapy educators on how to confront the challenge of teaching entry-level doctoral physical therapy students the complex art of therapeutic alliance in the acute care setting of physical therapy. Methods/Description: Sixty-seven second year DPT students were given a 10-question survey to determine knowledge of and perceived importance of therapeutic alliance in physical therapy at the beginning of the 12 week acute care course. The theory of therapeutic alliance and supporting research was presented through lecture. During weekly 3 hour labs, the importance of therapeutic alliance was emphasized pertaining to the clinical skills practiced that day. Lab simulation learning was facilitated by a variety of learning pedagogies. Students participated in simulation scenarios followed by self-assessment, verbal peer feedback, clinical reasoning debriefing, verbal faculty feedback, and written feedback from standardized patients using the validated CARE measure form. The simulation effectiveness tool was filled out by each student to determine their perception of the effectiveness of learning through simulation. At the completion of the class, students completed a written reflection of their course experience pertaining to the perception and value of therapeutic alliance in acute care physical therapy. In addition, students completed the identical preliminary survey for knowledge comparison before and after therapeutic alliance education. Results/Outcomes: Pre- and post- survey results regarding knowledge of therapeutic alliance are presented on bar graphs and pie charts. Statistics from the CARE measure forms completed by standardized patients are introduced. There was strong agreement, from the simulation effectiveness tool (SET-M), that students experienced increased confidence in communicating with patients. The following themes emerged from the student written reflections; simulation significantly improved learning, high benefit from peer and faculty feedback and debriefing, and marked increase in knowledge and importance of physical therapy therapeutic alliance in the acute care setting. Conclusions/Relevance to the conference theme: Research supports the importance of therapeutic alliance between clinician and patient with improved outcomes, decreased pain, and increased adherence. Our research, using a simulation-based learning approach along with other pedagogies, embraced the challenge of teaching entry-level students the complex art of therapeutic alliance in an acute care class. The results support the included methodologies as an effective approach of teaching doctoral physical therapy students therapeutic alliance.