Purpose Simulation provides learners with opportunities to apply classroom knowledge in authentic clinical contexts while allowing mistakes to become learning opportunities without real-world consequences. This study examined student perceptions of simulation across three medical student cohorts exposed to increasing levels of curricular simulation integration. Methods A 21-item survey utilizing a 5-point Likert scale was administered to three cohorts: M1 students participating in required neuroscience simulations, M2 students participating in required cardiovascular and gastrointestinal/nutrition simulations, and M4 students participating in required multisystem simulations in a Transition to Residency course. Survey items explored seven domains: physician identity formation, patient ownership/accountability, team leadership, comfort/confidence, medical decision making, motivation for self-directed learning, and purpose/meaning in medicine. Results M1 students reported the highest levels of agreement for motivation for further training/self-directed learning (96.8%) and reminder of meaning in medicine (96.0%), while physician identity formation was similarly high across cohorts (M1 94.7%, M2 94.0%, M4 95.4%). Agreement among M2 students was lower for motivation for further training/self-directed learning (83.3%). M4 students demonstrated the highest levels of agreement in patient ownership/accountability (97.5%), team leadership (97.3%), comfort/confidence (97.7%), and medical decision-making (95.7%). Conclusions Collectively, these findings support a developmental model in which simulation acts as a longitudinal educational intervention that contributes to growth across multiple dimensions of becoming a physician. By providing a safe environment for development and repeated opportunities to learn from mistakes, simulation in the preclinical and clinical curriculum supports holistic learner development and prepares students for future clinical responsibilities.