From a theoretical perspective, simulation experiences enable experiential learning through interactive behavioral experiences that have varying levels of realism with respect to patient factors. Research on issues related to human patient simulators focuses on costs of and access to HPS and training, limited training of instructors and operators, and continued restriction toward realism (Issenberg & Scalese, 2008; Jeffries, 2012) . However, simulation experiences require cognitive skills such as critical thinking, decision making, and reflection on the part of students (Jeffries, 2012; Nehring, Ellis, & Lashley, 2001), which may be problematic in some