Student participants also completed two surveys. The first was a 12-item questionnaire designed to measure satisfaction with the simulation activity and self-confidence in learning. The second was a 20-item questionnaire to measure their perception of the pres-ence and importance of design features in the simula-tion. Both of these instruments were developed by Jeffries (2005). To further explore student perceptions, participants were asked to list activities that supported or hindered their learning during the simulation.