High-fidelity simulation, with the potential to enhance cognitive, associative, and autonomous skills, can help students develop clinical reasoning. This study examined third-year students' (N = 300) perceptions about the implementation of high-fidelity simulation into an existing clinical course. Data were collected using an evaluation form completed by students after the simulation. Students perceived high-fidelity simulation as enjoyable, with an appropriate degree of challenge yet possessing congruency with concepts studied in the course. Students' transient feelings of confusion were interpreted as a natural component of the problem solving process as they analyzed, clustered, and interpreted cues to respond to rapid changes in the simulated patient's clinical condition. Debriefing was viewed as an important component and assisted in clarifying students' knowledge and rationale for practice. Further research is required on the relationship between the degree of confusion and its impact on learning and whether high-fidelity simulation increases the ability to reason in the clinical setting.