Purpose/Hypothesis: The purpose of this study was to evaluate the change in physical therapy student self-efficacy for acute care clinical practice before and after a low-fidelity simulation activity in a mock acute care environment in the classroom, as measured by scores on the Acute Care Confidence Survey (ACCS). This study also explored the student experience during low-fidelity simulation. Number of Subjects: Sixty first-year Doctor of Physical Therapy students completed both the pre- and post-simulation survey (71% response rate). Twenty-two students participated in focus groups immediately following the low-fidelity simulation experience. Materials and Methods: This study used a mixed methods research methodology and was conducted using a sequential explanatory research design in which the qualitative data was used to further explain the quantitative results. A repeated measures design was used by asking participants to complete the ACCS before and after a low-fidelity simulation activity. Focus groups were conducted to delve deeper into the student experience. Results: Scores on the ACCS obtained after the simulation experience were significantly higher than scores on the ACCS obtained before the simulation for both the total scale and all four subscales: manual, judgement, mobility, and instruction. Four primary themes related to participating in low-fidelity simulation emerged: (1) perceived psychological fidelity; (2) promotes clinical reasoning; (3) provides opportunities for reflection; and (4) increases self-efficacy for future clinical practice. This led to the development of a conceptual framework of the development of self-efficacy through low-fidelity simulation. Conclusions: Low-fidelity simulation improves physical therapy student self-efficacy for acute care clinical practice. In order for this to occur, the simulation must be structured to include opportunities for participation as the physical therapist and observation of peers in that role. Self-efficacy develops over the course of the simulated experience via self-reflection and observational learning in an environment that facilitates clinical reasoning with a high degree of psychological fidelity. Clinical Relevance: This research represents the first study on the impact of low-fidelity simulation in physical therapy education. Low-fidelity simulation can provide an avenue to incorporate simulation-based education into physical therapy programs that cannot afford high-fidelity simulation. The more programs use simulation to teach hospital-based physical therapy, the more students could decide to seek employment in acute care settings, decreasing the overall job vacancy rates.