Introduction:
Clinical simulation has become a key strategy in physiotherapy training providing a safe environment for practical learning. This study explores students' perceptions after participating in clinical simulation sessions identifying benefits and areas for improvement in the subject of Musculoskeletal System Pathology in the Degree in Physiotherapy at University of Valencia.

Methodology:
A qualitative study was conducted based on analyzing 256 open-ended responses from physiotherapy students after completing six clinical simulation sessions, three in-person and three online. A thematic content analysis was used to identify patterns and emerging categories in the responses.

Results:
The responses were grouped into five main categories.
Learning benefits: 75 responses. Students highlighted that simulation helped them improve skills knowledge and confidence in their clinical practice: "It has allowed me to improve my decision-making security with patients", "Thanks to the simulation I have learned to better handle emergency situations".
Realism and clinical preparation: 54 responses. The value of facing realistic scenarios as preparation for professional practice was emphasized: "The simulation was the closest thing to a real consultation I have experienced at university", "I faced real clinical situations and learned how to act under pressure".
Self-assessment and reflection: 40 responses. Participants valued the possibility of seeing themselves on video and analyzing their performance to identify areas for improvement: "Seeing myself on video made me realize that I spoke too quickly and did not give the patient time to respond", "I was able to identify errors in my body language and correct them for future practices".
Difficulties and improvements: 5 responses. Challenges such as session duration anxiety and associated stress were mentioned: "The sessions were sometimes too long and ended up being exhausting", "I felt a lot of anxiety before starting although it later helped me gain confidence".
Teamwork and feedback: 3 responses. Some students highlighted the importance of collaborative learning and structured feedback: "Working in pairs helped me feel more secure during the simulation", "Group feedback after each session was key to learning from mistakes and improving".

Conclusions:
The findings confirm that clinical simulation is an effective tool in the training of physiotherapists strengthening their skills and confidence. However, it is necessary to optimize aspects such as time management and the integration of strategies to reduce anxiety. These results can serve as a basis for improving future simulation experiences in physiotherapy. By addressing the identified challenges, such as session length and student anxiety, educators can enhance the overall effectiveness of clinical simulation. Incorporating structured feedback and promoting teamwork can further enrich the learning experience. Additionally, the flexibility of recorded simulations can complement live sessions providing students with opportunities to review and reinforce their learning at their own pace. Ultimately, a hybrid approach that combines the strengths of both live and recorded simulations may offer the most comprehensive and effective training for physiotherapy students.

Keywords: Clinical Simulation, Student’s perceptions, Learning methodology, Physiotherapy.