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High fidelity human simulation (HFHS) is a pedagogical tool implemented in physical therapy curricula to prepare students for acute care clinical experiences. While evidence in nursing and medical education supports implementing HFHS in preparation for clinical practice, there is limited literature related to efficacy of HFHS in physical therapy education. The purpose of this study was to compare selfefficacy between physical therapist (PT) students who did and did not participate in HFHS training prior to acute care clinical experiences.In this randomized, exploratory study, using a mixed quantitativequalitative methodology, 16 PT students were randomly assigned to either the control or the experimental groups. The experimental group participated in 6 HFHS experiences prior to an acute care clinical experience. Self-efficacy was measured using the Acute Care Confidence Survey (ACCS) on 3 occasions: baseline, after HFHS training, and midterm of the clinical experience. A focus group was conducted with the experimental group upon completion of the clinical experience to examine the students’ perceived value of HFHS training. Baseline demographics were compared using the Mann-Whitney test for continuous data and the chi-square test for categorical data. Self-efficacy scores on the ACCS were analyzed using Friedman's analysis of variance (ANOVA) and the Mann-Whitney test. Qualitative methods were utilized in analysis of the focus group.Significant difference between groups was found on self-efficacy scores following HFHS and on total change in self-efficacy from baseline to midterm of the clinical experience. Focus group qualitative analysis revealed 4 themes: (1) Simulation provided a safe, nonjudgmental, and productive learning environment; (2) students gained confidence in preparation for acute care clinical experience in initial interaction with clinical instructor, patient, and interprofessional team communication, and knowledge of the clinical setting; (3) simulation fostered clinical reasoning skills; and (4) simulation facilitated skills in multitasking in a complex setting. Themes were triangulated and supported by quantitative self-efficacy scores.HFHS in physical therapy education leads to increased self-efficacy for acute care clinical practice. Academic programs may consider the curricular integration of HFHS experiences when preparing PT students for acute care clinical experiences. While further research is warranted, this study indicates students may be better prepared for acute care clinical practice when given exposure in the academic setting through HFHS, allowing them to enter clinical practice in the acquisition stage of learning.