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Teachers’ pedagogical content knowledge and confidence in teaching mathematics is central to their teaching quality and thus, student performance. Concerns about preservice teachers’ lack of strong pedagogical content knowledge confidence and for teaching mathematics have been expressed in the literature. This study examined the characteristics of pedagogical content knowledge and confidence in teaching elapsed time among a group of elementary preservice teachers developed in a reformed method course. Drawing on survey and video presentation data from the participants, it found that they were strong in their confidence and knowledge of instructional tools for teaching elapsed time but were weak in their use of these tools and strategies. Its implications for mathematics teacher preparation and future research are then discussed.