The model described above was developed to guide nursing faculty design high fidelity clinical simulations. It was employed as part of an extensive, multi-site study (Jeffries & Rizzolo, 2006). The study was carried out in four phases, with model and instru-ment development included in the initial phase. Eight project directors (with the assistance of nursing fac-ulty) utilized the framework to design, implement and evaluate a simulation experience at their site during the second phase. The results from this phase of the study are not included in the report, so little is known about how the model was actually used to design and imple-ment the simulations. During the third phase, 395 stu-dents were randomly assigned to one of three condi-tions – paper/pencil case study, simulation with a mod-erate fidelity simulator, and simulation with high fidel-ity. There were no significant differences in knowledge based on posttest score comparisons. However, learn-ers using the high fidelity simulation scored higher than those in the other groups on satisfaction and self-confidence measures. Additionally, student perceptions of the incorporation of active learning, feedback and diverse learning styles were significantly increased with high fidelity simulation.