Occupational therapy programs can use a variety of delivery modes for Level I fieldwork. All experiences aim to contribute to the clinical and professional preparation for Level II fieldwork. This study compared the Level II fieldwork outcomes for two cohorts of students, one that participated in simulation-based Level I fieldwork and one that completed community and clinic-based Level I fieldwork. The student outcomes on the American Occupational Therapy Association AOTA Fieldwork Performance Evaluation (FWPE) for the Occupational Therapy Student were used for comparative data. The results indicated no statistically significant difference in the two cohorts' midterm score ratings. Statistically significant differences with higher performance for the cohort that participated in simulation-based Level I fieldwork were noted in the areas of safety and use of occupation-based interventions. The results of this study support the effective use of high-fidelity simulation in preparing students for success on Level II fieldwork.