Teachers and students struggle with the complexities surrounding the evolution of species and the process of natural selection. This article examines how science teacher candidates (STCs) engage in a clinical simulation that foregrounds two common challenges associated with natural selection--students' understanding of "survival of the fittest" and the variation of species over time. We outline the medical education pedagogy of clinical simulations and its recent diffusion to teacher education. Then, we outline the study that situates each STC in a one-to-one interaction with a standardized student who is struggling to accurately interpret natural selection concepts. In simulation with the standardized student, each STC is challenged to recognize content misconceptions and respond with appropriate instructional strategies and accurate explanations. Findings and implications center on the STCs' instructional practices in the simulation and the use of clinical learning environments to foster science teacher learning.