||High-fidelity patient simulation (HFPS) is a common curricular component of nurse anesthesia programs. HFPS has been shown to promote student learning of knowledge and skills in both introductory and complex scenarios without any risk to a patient. Use of simulation as a teaching strategy can be limited by the shortage of available nurse anesthesia faculty, which has the potential to limit the effective implementation of HFPS in a curriculum. Thus, the investigation of teaching strategies to facilitate the effective use of HFPS in the education of nurse anesthetists is warranted. Peer-instruction is a student-to-student teaching strategy that can maximize faculty resources and has been found to augment learning, enhance communication, develop collaborative relationships and skills, improve independence and self-confidence, and decrease student anxiety in the classroom, lab, and clinical settings. The use of peer-instruction in the high-fidelity patient simulator has not been investigated. The purpose of this pilot study was to determine if there was a difference in learning outcomes between first-year nurse anesthesia students who received peer-instruction versus those who received faculty-instruction in the high-fidelity patient simulator. Perceptions of peer-learners and peer-instructors about the benefits, limitations and overall level of satisfaction of a peer-instruction teaching model used in the high-fidelity patient simulator were also examined. The pilot study was a posttest-only true experimental design using a convenience sample of a cohort of first-year nurse anesthesia students (n = 22) randomly assigned to either a control or intervention group. On the first instruction day, the control group received faculty-instruction and on a second instruction day, the intervention group received peer-instruction in the high-fidelity patient simulator to review two introductory anesthesia scenarios. On a subsequent instruction day, each first-year student was evaluated by two certified registered nurse anesthetists (CRNA) raters who were blind to student group assignment and trained on the use of a 25-item skill checklist, Morgan et al.'s 2001 Rapid Sequence Induction Skill Checklist (MRSISC), during an introductory scenario in the HFPS. First-year students' scores were averaged between raters, ranked and compared for statistical significance using the Mann-Whitney U. The non-parametric statistic was used for data analysis due to small sample size and the inability to meet the random distribution assumption required for a t -test. No statistically significant difference in learning outcomes was found between groups, U = 56.5; p = 0.792. The faculty-instruction group (control group) had an average rank of 11.14 and the peer-instruction group (intervention group) had an average rank of 11.86. The perceptions of first- and second-year nurse anesthesia students regarding the use of a peer-instruction model in the high-fidelity patient simulator were assessed by a student satisfaction and course evaluation survey. Peer-learner and peer-instructor versions of the survey were administered to first- and second-year nurse anesthesia students, respectively, at the end of the 10-week introduction to anesthesia course that utilized a peer-instruction model in the high-fidelity patient simulator. Feedback from first-year and second-year nurse anesthesia students was mostly positive regarding peer-instruction in the HFPS and was consistent with previous cohorts of students, as well as literature describing other applications of peer-based educational strategies.