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The purpose of this study was to determine the effect of first clinical placement setting and pre-existing schemas of patient care on Doctor of Physical Therapy student perceptions of the importance of simulation-based learning experiences in their cardiovascular and pulmonary course. Using a mixed method analysis of archival data, research was conducted on student perceptions and pre-existing schemas with clinical placement settings. Through purposive cluster sampling in a convergent parallel method across seven DPT programs over four academic trimesters, course planning survey results were collected. From archival survey results, research questions were answered. Findings from the study will aid DPT faculty in design of simulation-based learning aligning with clinical practice preparing DPT students for immediate primary cardiovascular and pulmonary practice.