The profession of Occupational Therapy (OT) has traditionally included in-class learning paired with authentic clinical experiences in community settings. Currently, academic OT programs are considering the use of simulation experiences for level I fieldwork as a possible addition to or alternative for traditional clinical experiences. Due to the changing healthcare market, there are significant shortages of traditional level I sites across the country. Therefore, there is a need to explore alternative ways for students to gain clinical skills. There is a minimal body of research for scenario based learning in the form of simulation within occupational therapy. This study is designed to examine the experience of Level I occupational therapy students participating in a combined clinical and simulation experience. It was hypothesized that this simulation experience would build the student's critical thinking skills, as well as or better than, a traditional level I fieldwork experience. This study was a mixed methods experimental design using the Health Sciences Reasoning Test (HSRT) portion of the California Critical Skills Test (CCST) for pre- and posttesting. Qualitative data were collected based on students' answers to questions triangulating their expectations for performance, experience within the simulation, and comparison of the simulation to traditional clinical level I experience. Data indicate that, while there is no significant difference in critical thinking skills for students participating in the combined experience as compared to traditional level I experience, the simulation experience added value to the students' learning and changed their perceptions of their own skills. This has significant implications for occupational therapy education programs. Three models of fieldwork education incorporating simulation were proposed: a combined model, an integrated model, and a clinical site model. Future research should explore the effects of these models, looking at how they could be applied to all areas of occupational therapy education.