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Using a Mixed Methods approach, this study investigated changes in levels of self-efficacy among elementary preservice teachers following a semester course on teaching elementary students’ mathematics. Participants in this study included 347 preservice elementary teachers at a mid-size regional university who had just completed an elementary mathematics methods course. The data were collected from several semester groups. The instruments used were the Mathematics Teaching Efficacy Beliefs Instrument, interview data, and observation data collected during the clinical experience. The focus of this study was to compare the changes in teacher self-efficacy following a methods course that emphasized hands-on mathematics instruction with manipulatives by means of the 5E instructional format. The results of the paired-samples t-test indicated that there was a significant difference in the preservice elementary teachers’ self-efficacy for teaching mathematics after engaging in the elementary methods course. Preservice teachers reported that their understanding of various instructional practices changed significantly from a “tell, show, and do” model to an approach utilizing interactive and engaging activities. They also reported that their attitude toward mathematics had improved significantly and that there had been a direct impact on their confidence for teaching mathematics as a result of the structure of the elementary math methods course.