The purpose of this pilot study was to explore student perceptions and outcomes surrounding the use of a labor and delivery simulation as a midterm exam in a maternal-newborn lecture course. An exploratory case study design was used to gain a holistic view of the simulation experience. Data from focus groups, written debriefings, simulation scoring rubrics, student course evaluations, and other course exams were analyzed using Stake's case study method. Qualitative analysis revealed four themes: confidence, fairness, reliability, and team effort. Students were able to accurately grade the performance of their group as a whole and complete a group self-debriefing, but quantitative analysis showed that the group scores were significantly higher than other individual course grades. The findings suggested that the group simulation was an authentic assessment of teamwork, but not individual performance. Future research is needed to determine what role simulation and collaborative testing should play in pre-licensure education.