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Numerical simulation-based environment gains more and more attention in engineering, medical education, and management. A considerable body of research has focused on how to practice complex skills in numerical simulation-based environment. However, previous work has generally overlooked how knowledge is constructed. So this study tries to examine knowledge construction behaviors in a course named “medical imaging science” in a medical university. Data was collected during a semester including 1680 posts. Lag sequential analysis is used to identify patterns of knowledge construction and to explore differences between high- and low-achieving groups. Results showed that the numerical simulation environment can promote students’ knowledge construction processes. The high-achieving groups attained a deeper level of knowledge construction through the negotiation of meaning than the low-achieving.